Who can't be admitted to assisted living in Alabama?
Under rule 420-5-4-.06(11), an Alabama ALF may not admit anyone who needs skilled nursing, has a wound beyond basic first aid, cannot make safety decisions or direct their own care, has dangerous behaviors, cannot manage medications even with assistance, needs hospice, needs restricted exits or has an acute contagious lung disease.
- Receives or requires skilled nursing care
- Has a wound needing care beyond basic first aid
- Lacks the ability to make decisions about personal safety
- Cannot direct his or her own care
- Has behaviors that may be dangerous to self or others
- Cannot safely self-manage medications or self-administer them with assistance
- Is receiving or needs hospice services
- Cannot safely live there unless exits are restricted
- Has an acute infectious pulmonary disease such as influenza or active tuberculosis
These are not facility policies that a friendly director can waive; they are licensing conditions ADPH cites on inspections. If a hospital case manager suggests assisted living for someone with an open pressure wound or a feeding tube, expect the facility to say no.
What is Alabama's 90-day rule for assisted living residents?
An Alabama ALF may not keep a resident whose medical or skilled nursing needs are expected to last more than 90 days, unless the resident performs that care personally or is physically limited but cognitively able to direct staff, who then provide the physical help under a written facility policy.
The 90-day rule is why short-term needs, such as a few weeks of wound care after surgery delivered by a home health agency, are usually fine, while a permanent daily skilled need is not. Skilled services must come from licensed or certified outside agencies, never from the ALF's own aides. When a hospital discharge plan includes ongoing skilled care, ask the ALF in writing whether it can accept the return.
Can someone on hospice stay in Alabama assisted living?
Yes, with conditions: a current ALF resident diagnosed with a terminal illness other than dementia may receive care from a licensed and certified hospice and stay beyond 90 days, as long as the facility can still meet the resident's needs.
New residents who already need hospice cannot be admitted, and dementia is excluded from the exception. If the facility becomes unable to meet the needs, it must promptly arrange a safe transfer under its prearranged discharge plan, and it remains responsible for making sure needed care is delivered in the meantime.
When must an Alabama assisted living resident move out?
An Alabama ALF must transfer a resident whose behaviors infringe on others' rights or safety, whose needs exceed what the license allows, who develops an acute contagious lung disease, or who can only stay safely behind restricted exits; it also may not readmit someone returning from a hospital who now needs more care than it can lawfully give.
That last point catches families off guard. A parent who goes from assisted living to the hospital, then to a nursing home for rehab, may not be able to return if the rehab stay ends with new skilled needs. Our guide to when a facility asks a resident to leave covers the practical steps, including the ombudsman's role.
At a glance
| Alabama ALFs can accept | Alabama ALFs cannot accept | |
|---|---|---|
| Medications | Residents who self-manage or need reminders and opened packages | Residents who need a nurse to give every dose and cannot recognize their packets |
| Wounds | Minor wounds needing basic first aid | Wounds needing ongoing skilled care |
| Cognition | Residents who can direct their own care | Residents who need secured exits (SCALF instead) |
| End of life | Current residents who later need hospice (not for dementia) | New residents already needing hospice |
Sources: Ala. Admin. Code chapters 420-5-4, 420-5-10 and 420-5-20; ADPH Bureau of Health Provider Standards; ADPH Health Care Facilities Directory and Deficiencies applications; Alabama DHR Adult Protective Services. See our editorial standards.
