ASSISTED LIVING

M.G.L. pt. Part I, tit. Title II, ch. c. 19D

in effect

M.G.L. c. 19D, § 1 Definitions

c. 19D, § 1. Definitions Section 1. When used in this chapter, unless the context otherwise requires, the following terms shall have the following meanings: ''Applicant'', any person applying to the department for original certification as a sponsor. ''Assistance with activities of daily living'', physical support, aid or assistance with bathing, dressing/grooming, ambulation, eating, toileting or other similar tasks. ''Assistance with'' or ''Supervision of instrumental activities of daily living'', providing support, aid, assistance, prompting, guidance, or observations of meal preparation, housekeeping, clothes laundering, shopping for food and other items, telephoning, use of transportation and other similar tasks. ''Assisted living residence'' or ''Residence'', any entity, however organized, whether conducted for profit or not for profit, which meets all of the following criteria: 1. provides room and board; and 2. provides, directly by employees of the entity or through arrangements with another organization which the entity may or may not control or own, assistance with activities of daily living for three or more adult residents who are not related by consanguinity or affinity to their care provider; and 3. collects payments or third party reimbursements from or on behalf of residents to pay for the provision of assistance with the activities of daily living or arranges for the same. ''Authorized medical professional'', an advanced practice registered nurse with prescriptive authority, a physician assistant or a physician; provided, however, that an authorized medical professional shall have been granted authority by a resident to issue care orders for the resident. ''Basic health services'', certain services provided at an assisted living residence by employees of the residence that are qualified to administer such services or a qualified third party in accordance with a care order issued by an authorized medical professional; provided, however, that such services shall include all of the following: (i) injections; (ii) the application or replacement of simple non-sterile dressings; (iii) the management of oxygen on a regular and continuing basis; (iv) specimen collection and the completion of a home diagnostic test, including, but not limited to, warfarin, prothrombin or international normalized ratio testing and glucose testing; provided, that such home diagnostic test or monitoring is approved by the United States Food and Drug Administration for home use; and (v) application of ointments or drops. ''Care order'', a written order for basic health services issued by an authorized medical professional. ''Department'', the executive office of aging and independence. ''Manager'', the individual who has general administrative charge of an assisted living residence. ''Personal services'', assistance with or supervision of activities of daily living, self-administered medication management, or other similar services specified by regulation, but not including concierge services, recreational or leisure services, or assistance with instrumental activities of daily living. ''Resident'', an adult who resides in an assisted living residence and who receives housing and personal services and, when the context requires or permits, such individual's legal representative. ''Self-administered medication management'', reminding residents to take medication, opening containers for residents, opening prepackaged medication for residents, reading the medication label to residents, observing residents while they take medication, checking the self-administered dosage against the label of the container, and reassuring residents that they have obtained and are taking the dosage as prescribed. ''Skilled nursing care'', skilled services described in 130 CMR 456.409 or any successor regulation. ''Sponsor'', the person who is named in the certification of an assisted living residence. ''Supervision of activities of daily living'', reminding residents to engage in personal hygiene and other self-care activities and, when necessary, observing or assisting residents while they attend to activities such as bathing or dressing to assure their health, safety or welfare. ''Unit'', a portion of an assisted living residence designed for and occupied pursuant to residency agreements by one or more individuals as the private living quarters of such individuals.

M.G.L. c. 19D, § 2 Sponsor duties

c. 19D, § 2. Sponsor duties Section 2. Every sponsor of an assisted living residence shall: (i) obtain and maintain certification as provided in sections three and four; (ii) be subject to oversight as provided in section 16CC of chapter 6A and section 5; (iii) afford residents the rights set forth in section nine; (iv) provide self-administered medication management as set forth in section ten; (v) provide services to residents in accordance with service plans developed through a process by which employees of the residence discuss the service plan and the needs of the resident with the resident and their representative or designee and ensure the consequences of a decision, including any inherent risk, are understood by all parties; provided, however, that such parties shall review the service plan periodically and consider changes in the resident's status and the ability of the residence to respond accordingly and as set forth in section 12; provided further, that if a resident is receiving basic health services, the staff of the residence shall consult the resident's authorized medical professional when developing the resident's service plan; (vi) coordinate and provide personal services, basic health services, where applicable, and other services required under service plans as set forth in section 12; (vii) maintain a written progress report on each person who receives such services which describes the type, amount, duration, scope, and outcome of services that are rendered and the general status of the resident's health; (viii) enter into a residency agreement with each resident as set forth in section fourteen; and (ix) meet the minimum management and staffing qualifications as set forth in section fifteen.

M.G.L. c. 19D, § 3 Certification of assisted living residences; exemptions

c. 19D, § 3. Certification of assisted living residences; exemptions Section 3. (a) No person shall advertise, operate or maintain an assisted living residence without the certification required under this chapter, including assisted living residences sponsored by the following entities; provided, however, that the provisions of this chapter shall not apply to entities for the original facilities and services for which said entities were originally licensed or organized to provide: (i) convalescent homes, licensed nursing homes, licensed rest homes, charitable homes for the aged or intermediate care facilities for persons with an intellectual disability licensed pursuant to section 71 of chapter 111; (ii) hospices licensed pursuant to the provisions of section 57D of said chapter 111; (iii) facilities providing continuing care to residents, as those terms are defined by section 76 of chapter 93; (iv) congregate housing authorized by section 39 of chapter 121B; (v) group homes or supported living programs operating under contract with the department of mental health, the rehabilitation commission or the department of developmental services; or (vi) housing operated for only those duly ordained priests or for the members of the religious orders of the Roman Catholic church in their own locations, buildings, residences or headquarters to provide care, shelter, treatment and medical assistance for any of the said duly ordained priests or members of the said religious order. (b) The provisions of this chapter shall not apply to any residential premises available for lease by elderly or disabled individuals that is financed or subsidized in whole or in part by local, state or federal housing programs established primarily to develop or operate housing rather than to provide housing and personal services in combination; provided, however, that such premises are not currently licensed under chapter 111.

M.G.L. c. 19D, § 4 Application for certification; renewal; fee; operating plan; basic health services

c. 19D, § 4. Application for certification; renewal; fee; operating plan; basic health services Section 4. (a) The department shall issue a certification for a term of 2 years, and shall renew for like terms, to any applicant whom the department determines meets the regulatory requirements promulgated by the department in accordance with this chapter; provided, however, that a certification shall be subject to corrective action, modification, suspension or revocation for cause, as determined by the department. Such certification shall: (i) not be transferable or assignable; (ii) be issued only to the person and for the premises named in the application; (iii) indicate whether the residence has been approved to provide basic health services; and (iv) indicate the certification's expiration date. The department shall issue a certificate, which shall be posted by the residence in a conspicuous place on the approved premises and on the residence's website. (b) Upon applying for initial certification or renewal, an applicant shall pay the department a fee based on the number of units at the assisted living residence, established by the secretary of administration and finance pursuant to the provisions of section 3B of chapter 7; provided, however, that a minimum fee shall be established notwithstanding the number of units at the residence. No fees for initial certification or renewal shall be due from any provider for assisted living units created under the United States Department of Housing and Urban Development Assisted Living Conversion Program. (c) If an application for renewal of a certification is filed not less than 30 days before the expiration date, such certification shall not expire until the department notifies the sponsor that the application for renewal has been denied. (d) Applicants for initial certification shall file with the department an operating plan that includes: (i) the number of units; (ii) the number of residents allowed per unit; (iii) the location of resident units, common spaces and egresses by floor; (iv) the base fee to be charged for each such unit; (v) the services to be offered, including basic health services, if applicable, and arrangements for providing such services, including linkages with hospitals and nursing facilities, if any; (vi) the number of staff to be employed; and (vii) other information the department deems necessary. (e) Residences may seek certification by the department to provide basic health services; provided, however, that such residences shall offer all such basic health services defined in section 1; and provided further, that residences offering basic health services shall not restrict resident choice in the delivery of said services by third party providers. The residence shall submit a revised operating plan to the department in the event of a change in the scope of basic health services offered to residents. A residence seeking to provide basic health services shall include in its operating plan: (i) a proposed administrative and operational structure to ensure the safe and effective use of basic health services and meet the needs of its residents; and (ii) a compliance plan to meet the requirements established under this chapter and promulgated regulations, which shall include, but not be limited to: (A) staff qualifications and training; and (B) effective policies and procedures to ensure the availability of adequate supplies necessary for basic health services and the safe administration and secure storage of medications. (f) Applicants and sponsors shall file material changes to the assisted living residence's operating plan prior to the change's effective date and as may otherwise be required by the department. A sponsor shall file annually on a date established by and on a form prescribed by the department, a statement and a professional opinion prepared by a certified public accountant or comparable reviewer indicating whether the assisted living residence is in sound fiscal condition and is maintaining sufficient cash flow and reserves to meet the requirements of the service plans established for its residents. (g) Applicants for initial certification or renewal shall disclose the name and address of each officer, director, trustee and limited partner or shareholder with not less than 5 per cent interest in the assisted living residence and shall provide to the department documentation of the history of each such individual or entity, including, but not limited to: (i) all multifamily housing, assisted living residences or health care facilities in which the individual or entity has been an officer, director, trustee or partner and, if applicable, evidence from the relevant regulatory authority that said applicant has met criteria for licensure or certification; (ii) documentation of any enforcement action against the applicant and, if applicable, evidence that the applicant has corrected all cited deficiencies without revocation of licensure or certification; and (iii) any other evidence, as determined by the department. (h) The department may deny certification to an applicant who had an ownership interest in an entity licensed under chapter 111, a licensed medical provider or a home health agency certified under Title XVIII of the Social Security Act, as amended, that: (i) has been subject to a patient care receivership action; (ii) has ceased to operate such an entity as a result of: (A) suspension or revocation of license or certification; (B) receivership; or (C) a settlement agreement arising from suspension or revocation of a license or certification; (iii) has a settlement agreement in lieu of or as a result of subclause (B) of clause (ii); (iv) has been the subject of a substantiated case of patient abuse or neglect involving material failure to provide adequate protection or services for the resident in order to prevent such abuse or neglect; or (v) has over the course of its operation been cited for repeated, serious and willful violations of rules and regulations governing the operation of said entity that indicate a disregard for resident safety and an inability to responsibly operate an assisted living residence.

M.G.L. c. 19D, § 5 Biennial review; initial and for cause reviews; reports

c. 19D, § 5. Biennial review; initial and for cause reviews; reports Section 5. (a) The department or its authorized designee shall biennially review all assisted living residences; provided, however, that an authorized designee shall not include sponsors of assisted living residences. (b) Prior to the issuance of the sponsor's initial certification, the department shall conduct a review to determine whether an assisted living residence is compliant with this chapter; provided, however, that the department may conduct such review of an assisted living residence at any time the department has probable cause to believe that such assisted living residence is in violation of a provision of this chapter or any regulation promulgated thereunder. Such review shall include: (i) an inspection of every part of the common areas of the assisted living residence and the living quarters of a resident with the resident's prior consent; (ii) an examination of the operating plan; (iii) an examination of a resident's service plan and written progress reports with the resident's consent; and (iv) resident satisfaction surveys. An inspector shall have authority to confidentially and privately interview the sponsor, manager, staff and residents. (c) Reviews of assisted living residences certified to provide basic health services shall include an inspection of records associated with the provision of basic health services, a review of residence employee qualifications and the residence's operating plan. (d) Upon the completion of an annual or biennial review, the department shall prepare a written report summarizing all pertinent information obtained during the review and shall not disclose confidential or privileged information obtained in connection with such review. The department shall promulgate rules and regulations necessary to ensure the sponsor receives such report and, if applicable, has the opportunity to respond to and resolve any findings of noncompliance prior to departmental enforcement action. Completed reports, responses and notices of final action shall be made available to the public at the department during business hours together with the responses of the applicants or the sponsors and said reports, responses and notices of final action shall be posted on the website of the department.

M.G.L. c. 19D, § 6 Denial, suspension or revocation of certification

c. 19D, § 6. Denial, suspension or revocation of certification Section 6. (a) If the department determines a sponsor or applicant has failed or refused to comply with requirements established under this chapter or the regulations promulgated thereunder, the department may: (i) deny an application for recertification; (ii) modify, suspend or revoke a certification; or (iii) issue a fine of not more than $500 for each day of such failure or refusal to comply. (b) Notice of enforcement action and a sponsor's right to an adjudicatory proceeding shall be governed by the provisions of chapter 30A.

M.G.L. c. 19D, § 8 Operating without certification; penalty

c. 19D, § 8. Operating without certification; penalty Section 8. (a) Any person operating an assisted living residence without certification under this chapter shall be subject to liability for a civil penalty of not more than five hundred dollars for each day of such violation assessable by the superior court. Any such violation also shall constitute grounds for refusing to grant or renew, modifying or revoking the certification of the assisted living residence or of any part thereof. Notwithstanding the existence or use of any other remedy, the department may, in the manner provided by law, maintain an action in the name of the commonwealth for an injunction or other process against any person to restrain or prevent the operation of an assisted living residence without certification under this chapter. (b) No person shall knowingly refer an individual for residency to an uncertified assisted living residence. A violation of this subsection shall constitute a violation of chapter 93A and shall be punishable by a civil penalty of not more than five hundred dollars for each such violation assessable by the superior court.

M.G.L. c. 19D, § 9 Resident rights

c. 19D, § 9. Resident rights Section 9. (a) Every resident of an assisted living residence shall have the right to: (1) Live in a decent, safe, and habitable residential living environment. (2) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy. (3) Privacy within the resident's unit, subject to rules of the assisted living residence reasonably designed to promote the health, safety and welfare of residents. (4) Retain and use the resident's own personal property, space permitting, in the resident's living area so as to maintain individuality and personal dignity. (5) Private communications, including receiving and sending unopened correspondence, access to a telephone, and visiting with any person of the resident's own choosing. (6) Freedom to participate in and benefit from community services and activities and to achieve the highest possible level of independence, autonomy, and interaction within the community. (7) Directly engage or contract with any licensed health care professionals and providers to obtain necessary health care services, in the resident's unit or in such other space in the assisted living residence as may be made available to residents for such purposes to the same extent available to persons residing in private homes. (8) Manage the resident's own financial affairs. (9) Exercise civil and religious liberties. (10) Present grievances and recommended changes in policies, procedures, and services to the sponsor, manager or staff of the assisted living residence, government officials, or any other person without restraint, interference, coercion, discrimination, or reprisal. This right includes access to representatives of the ombudsman program under section 16CC of chapter 6A. (11) Upon request, to obtain from the residence in charge of the resident's care the name of the service coordinator or any other persons responsible for the resident's care or the coordination of the resident's care. (12) To confidentiality of all records and communications to the extent provided by law. (13) To have all reasonable requests responded to promptly and adequately within the capacity of the residence. (14) Upon request, to obtain an explanation as to the relationship, if any, of the residence to any health care facility or educational institution insofar as said relationship relates to the resident's care or treatment. (15) To obtain from a person designated by the residence a copy of any rules or regulations of the residence which apply to the resident's conduct as a resident. (16) To privacy during medical treatment or other rendering of services within the capacity of the residence. (17) To informed consent to the extent provided by law. (18) To not be evicted from the assisted living residence except in accordance with the provisions of landlord tenant law as established by chapter one hundred and eighty-six or chapter two hundred and thirty-nine. (b) The manager shall ensure that a written notice of the rights, obligations and prohibitions set forth in this chapter is posted in a prominent place in the assisted living residence. This notice shall include the name, address, and telephone numbers of the statewide long-term care ombudsman office established under section 16CC of chapter 6A and the department where complaints may be lodged.

M.G.L. c. 19D, § 10 Services for residents

c. 19D, § 10. Services for residents Section 10. (a) The sponsor of the assisted living residence shall provide or arrange for the provision of the following: (1) Opportunities for socializing and access to community resources. (2) For all residents whose service plans so specify, such services, supervision of and assistance with activities of daily living including, at a minimum, assistance with bathing, dressing and ambulation. (3) Up to three meals daily. (4) Housekeeping. (5) For all residents whose service plans so specify, self-administered medication management by personnel meeting standards for professional qualifications and training set forth in the regulations. (6) Ability to provide timely assistance to residents and to respond to urgent or emergency needs, by the presence of twenty-four hour per day on-site staff capability, by the provision of personal emergency response devices for all residents or similar means for the purpose of signaling such staff, and by such other means as the department may deem necessary for each assisted living residence, taking into account the service plans of its residents. (7) Laundry services at a fee if necessary. (b) The sponsor of the assisted living residence may provide or arrange for the provision of additional services, including: (i) barber and beauty services, sundries for personal consumption and other amenities; (ii) local transportation for medical and recreational purposes; (iii) assistance with and supervision of instrumental activities of daily living; (iv) assistance to residents with accessing telehealth services; (v) basic health services for residents whose service plan includes basic health services, in accordance with the requirements set forth within this chapter, by personnel who meet standards for professional qualifications and training set forth in regulations promulgated pursuant to this chapter; and (vi) ancillary services for health-related care including, but not limited to, restorative therapies, podiatry, hospice care, home health or other such services; provided, however, that such services shall be delivered by an individual licensed to provide such care. (c) No employee of an assisted living residence shall control or manage the funds or property of an assisted living resident; provided, however, that if a resident is unable to manage their funds or property, the assisted living residence shall arrange money management and other financial arrangements with an independent party. (d) A residence certified to provide basic health services may advertise, market and otherwise promote offered services under this chapter and inform residents of the option to directly procure such services from qualified third parties. (e) The residence shall disclose to each resident through the assisted living residence's residency agreement the fees associated with basic health services and shall review such fees with the resident upon the implementation of and any revision to a service plan that includes provision of basic health services. The residence shall notify residents of any changes in fees in advance and in a timely manner. Residents who receive basic health services shall receive an additional service plan review on a quarterly basis and shall have the opportunity to discontinue receiving basic health services from the residence upon written notice to the residence and shall not be charged a cancellation fee or a fee for services not provided due to discontinuation of the services. (f) The department, in consultation with the department of public health, shall promulgate regulations governing the application, criteria for approval or disapproval of such application, and ongoing oversight of residences that elect to offer basic health services authorized in this section. The department may impose an annual fee on assisted living residences that offer basic health services. (g) To ensure patient safety and clinical competence in the application of subsections (d) to (f), inclusive, the department and the department of public health shall establish operating plan requirements for residences that opt to provide basic health services, including staff access to a licensed practical nurse or registered nurse for consultation at all times; provided, however, that the nurse shall not be required to be on the premises. The department shall make available electronic copies of the required components of operating plans on the department's website and shall conduct annual compliance reviews on the documentation created and maintained by assisted living residences for an assisted living resident who received basic health services within the previous 12–month period. (h) No residence shall offer or provide basic health services without first being certified by the department. If the department determines that a residence is offering basic health services without certification, the department shall issue a fine of not more than $1,000 per day. (i) A residence shall report an incident involving basic health services that causes a resident harm at the residence not later than 24 hours of said incident. The department shall investigate said incidents and may, at the department's discretion, impose a fine or otherwise take an enforcement action if the department determines that the basic health services resulted in injury to a resident. (j) The department shall establish criteria to evaluate the quality of basic health services offered by a residence and shall annually publish its evaluation of residences on the department's website. Such evaluation shall include history of incidents leading to an enforcement action by the department pursuant to subsection (i).

M.G.L. c. 19D, § 11 Admittance requirements

c. 19D, § 11. Admittance requirements Section 11. No assisted living residence shall admit a resident who requires 24–hour skilled nursing supervision unless such resident elects to receive basic health services from residences that are certified to provide such services or from qualified third parties. No assisted living residence shall provide skilled nursing care or admit or retain a resident in need of skilled nursing care unless such resident elects to receive basic health services and the following criteria are met: 1. The care will be provided by a home health agency certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended or an entity licensed under chapter one hundred and eleven, on a part-time, intermittent basis for not more than a total of ninety days in any twelve-month period, or by a licensed hospice. 2. The certified home health agency, entity licensed under chapter one hundred and eleven of the General Laws, or hospice does not train assisted living residence staff to provide the skilled nursing care. 3. The individual to whom the skilled nursing care is provided is suffering from a short-term illness. For the purposes of this section ''short-term illness'' is defined as either a medical condition for which recovery can be expected to occur with not more than ninety consecutive days of skilled nursing care or a medical condition requiring skilled nursing care on a periodic, scheduled basis. For the purposes of this section, nursing services provided by a certified home health agency or entity licensed under chapter one hundred and eleven such as injection of insulin or other drugs used routinely for maintenance therapy of a disease, or licensed hospice care may be provided without respect to the ninety day limitation.

M.G.L. c. 19D, § 12 Individualized plans for residents

c. 19D, § 12. Individualized plans for residents Section 12. (a) Each assisted living residence shall develop and maintain together with each resident, an individualized plan for each resident describing in lay terms the needs of the resident for personal services and the providers, or intended providers thereof, and the frequency and duration of such services, and containing such other information as the department may reasonably require by regulation. Such plan shall be confidential, shall be in writing signed by the resident and available for inspection by the resident, the department and its authorized designees under subsection (a) of section five. For residents receiving assistance under chapter one hundred and eighteen E, such service plans shall be developed in consultation with the pre-screening assessor as set forth in section thirteen of this chapter. (b) Each assisted living residence shall designate one or more persons to help coordinate the preparation and periodic review and revision of service plans for each resident as service coordinator. The service coordinator may be an employee of the sponsor. The service coordinator shall be qualified by experience and training to develop, maintain and implement or arrange for the implementation of individualized service plans. (c) Each assisted living residence shall maintain written policies and procedures for the initial evaluation and periodic reassessment of the functional and health status and service requirements of each consenting resident, until such time that the department establishes regulations for uniform requirements relative to said evaluation and periodic reassessments.

M.G.L. c. 19D, § 13 Pre-screening and service plan monitoring assessments for medical assistance recipients

c. 19D, § 13. Pre-screening and service plan monitoring assessments for medical assistance recipients Section 13. All older adult residents or residents with special needs who seek admission to an assisted living residence and who are eligible for the medical assistance program under chapter one hundred and eighteen E, shall: 1. Be afforded the opportunity to apply for assisted living residence services, and be informed about the eligibility requirements and the resident's rights and obligations under the program. 2. Have an initial pre-screening assessment conducted for the purposes of determining eligibility for and need of assisted living services. Such assessment shall consider the appropriateness of assisted living services for said resident, and other community-based alternatives that are appropriate and available. 3. Have a service plan monitoring assessment conducted by an assessor at the site of the assisted living resident annually from the date of initial occupancy. Said monitoring assessment shall determine if the services provided to the resident are meeting the resident's needs as determined in the service plan, the assessor shall report any instances of resident abuse or neglect pursuant to section fifteen of chapter nineteen A and section seventy-two G of chapter one hundred and eleven of the General Laws. With the consent of the division of medical assistance, the secretary may contract for the purpose of administering subparagraphs 1 to 3, inclusive, with one or more non-profit agencies, one or more home care corporations as defined in clause (c) of the third paragraph of section four of chapter nineteen A of the General Laws, a combination of such home care corporations as determined by the department, or a state agency. Privately paying older adult residents or residents with special needs who are not eligible for medical assistance under chapter one hundred and eighteen E of the General Laws, may be offered the services specified in said subparagraphs 1 to 3, inclusive, on a fee for service basis; provided, however, that the executive office of aging and independence shall promulgate such regulations as are necessary to carry out the provisions of this section.

M.G.L. c. 19D, § 14 Written residency agreement

c. 19D, § 14. Written residency agreement Section 14. The sponsor shall enter into a written residency agreement with each resident clearly describing the rights and responsibilities of the resident and the sponsor, including all requirements in section two of this chapter. The residency agreement shall be signed by the sponsor or the sponsor's authorized agent and by the resident and shall include the agreement of the sponsor to provide personal services and other services and goods, lodging and meals, the charges, expenses and other assessments for personal services, lodging and meals, the agreement of the resident to make payment of such charges, expenses and other assessments and the arrangements for such payment, a grievance procedure, the sponsor's covenant to comply with applicable federal and state laws and regulations regarding consumer protection and protection from abuse, neglect and financial exploitation of older adults and persons with disabilities, the conditions under which the agreement may be terminated by either party, reasonable rules for conduct and behavior, and such other similar provisions as the department may reasonably require by regulation.

M.G.L. c. 19D, § 15 Managers and staff; qualifications

c. 19D, § 15. Managers and staff; qualifications Section 15. (a) The manager of an assisted living residence shall be at least twenty-one years of age, qualified by education or experience to be responsible for the operation of the residence in conformance with the applicable laws and regulations, and of good moral and responsible character, and shall never have been convicted of a felony. (b) The sponsor may employ staff directly, in which case it shall comply with department's standards for personal care homemaker services and personnel as from time to time in effect. The sponsor may also engage an agency approved by the department to offer personal care homemaker services. All personnel providing personal care shall be qualified by training or experience to assist with activities of daily living and to provide self-administered medication management. (c) No assisted living residence shall discharge, discipline, discriminate against or otherwise retaliate against an employee or resident who, in good faith, files a complaint with or provides information to the department relative to what the employee or resident reasonably believes is a violation of law, rule or regulation or poses a risk to public health or safety or resident or staff well-being. An assisted living residence in violation of this section shall be liable to the person retaliated against by a civil action for up to treble damages, costs and attorney's fees in the event such violation shall be determined to be egregious or willful.

M.G.L. c. 19D, § 16 Residence requirements

c. 19D, § 16. Residence requirements Section 16. Any assisted living residence shall meet the requirements of all applicable federal and state laws and regulations, including, but not limited to, the state sanitary code, state building and fire safety codes and regulations, and laws and regulations governing accessibility for adults with disabilities. In order to facilitate compliance with these laws and regulations, the department, in consultation with the executive office of housing and livable communities and the executive office of public safety, shall compile and make available a list of all such applicable laws and regulations. In order to ensure the maximum residential setting possible, any assisted living residence shall provide only single or double living units with lockable doors on the entry door of each unit. All newly constructed assisted living residences shall provide a private bathroom for each living unit which is equipped with one lavatory, one toilet, and one bath tub or shower stall. All other assisted living residences shall provide at a minimum a private half bathroom for each living unit which is equipped with one lavatory and one toilet, and shall provide at least one bathing facility for every three residents. All assisted living residences shall provide at a minimum either a kitchenette or access to cooking capacity for all living units. The secretary of aging and independence may, when the secretary determines that public necessity and convenience require and to prevent undue economic hardship, waive the requirements relative to bathrooms and the bathing facilities; provided, however, that the secretary finds that the residence will otherwise meet the purposes of assisted living to provide a home-like residential environment, which promotes privacy, dignity, choice, individuality and independence for its residents.

M.G.L. c. 19D, § 17 Assisted living advisory council

c. 19D, § 17. Assisted living advisory council Section 17. Notwithstanding any general or special law to the contrary, there shall be established an assisted living advisory council within the executive office of aging and independence. Said advisory council shall advise the secretary of aging and independence relating to the regulations authorized under this chapter. Said advisory council shall be comprised of the secretary of aging and independence or a designee who shall serve as chairperson, the secretary of housing and livable communities or a designee; the secretary of health and human services or a designee, and six members to be appointed by the governor upon nomination by the secretary of aging and independence, three of whom shall represent resident consumer interests and two of whom shall represent sponsors and managers of assisted living residences. The advisory council shall by majority vote establish its own rules and procedures. Members of the council shall be appointed for terms of one year each. The council shall meet not less than on a quarterly basis, and it shall prepare a report of its activities, not less than annually, that shall be made available to the public and the general court.

M.G.L. c. 19D, § 18 Classification of assisted living residences

c. 19D, § 18. Classification of assisted living residences Section 18. (a) Assisted living residences shall not be subject to the provisions of sections twenty-five B to twenty-five H, inclusive, section fifty-one and sections seventy E to seventy-three B, inclusive, of chapter one hundred and eleven or the seventh full paragraph of section nine of chapter forty A of the General Laws. (b) No person or residential facility offering, providing or arranging for the provision of assistance with or supervision of instrumental activities of daily living only shall be required to obtain certification under this chapter or a license pursuant to section seventy-one of chapter one hundred and eleven of the General Laws. (c) For the purposes of this chapter, and any other general or special law classifying real estate property for the purpose of taxation, and notwithstanding the provisions of section twenty-seven C of chapter twenty-nine of the General Laws, a municipality shall classify the portion of any building operated as an assisted living residence in the same category as property held or used for human habitation. (d) Regardless of the designation of an assisted living residence as a residential, institutional or other use under any zoning ordinance, assisted living residences certified under this chapter shall be regarded as residential uses for the purposes of the state building code and shall be so regarded by the building inspectors of each city and town in the commonwealth.

M.G.L. c. 19D, § 19 Regulations; standards for education and training of managers and residence employees

c. 19D, § 19. Regulations; standards for education and training of managers and residence employees Section 19. The department shall promulgate regulations necessary to implement the requirements of this chapter. Such regulations shall include the establishment of standards concerning the education, training and experience of the managers and residence employees, including service coordinators.

Source: Massachusetts General Court (malegislature.gov)URL: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleII/Chapter19DFetched: 10/20/2026