Assisted Living Facility

A residence for individuals whose condition precludes independent living, but does not require the level of care available in a Nursing Home. Such facilities typically provide general supervision, meals, housekeeping services, medical monitoring, and planned social, recreational, and spiritual activities for people who are still independent and ambulatory, but do not provide full-time medical care. Specifically, for the purposes of this Policy, Assisted Living Facility means:

• an institution that is licensed by the appropriate licensing agency (if licensing is required) to primarily engage in providing ongoing care and services to a minimum of 10 inpatients in one location and operates under state licensing laws and any other applicable laws; or
• any other institution that meets all of the following tests:

     • provides 24-hour a day care, custodial services and personal care assistance to support needs resulting from a disability;
     • has an employee on duty at all times who is awake, trained and ready to provide care;
     • provides 3 meals a day, including special dietary requirements;
     • operates under applicable state licensing laws and any other applicable laws;
     • has formal arrangements for the services of a physician or nurse to furnish medical care in the event of an emergency;
     • is authorized to administer medication to patients on the order of a physician; and
     • is not, other than incidentally, a home for the mentally retarded, the mentally ill, the blind or the deaf, a hotel or home for alcoholics or drug abusers; or

• a similar institution approved by the insurer.

NB: These requirements are typically met by assisted living facilities that are either free-standing facilities or part of a life care community. These requirements are generally not met by individual residences, boarding homes or independent living units.