Comparing residential long-term care regulations between nursing homes and assisted living facilities

Alison M. Trinkoff, Jung Min Yoon, Carla L. Storr, Nancy B. Lerner, Bo Kyum Yang, Kihye Han

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: Nursing homes (NHs) are federally regulated under uniform standards, whereas assisted living facilities (ALFs) use individual state regulations for staffing, training, and oversight of care quality and safety. Purpose: To describe ALF staffing, training, inspection, and enforcement regulations for 50 U.S. states and the District of Columbia, and compare them to NH regulations. Publication of ALF quality and safety outcomes data also was assessed and compared to NHs. Methods: Regulatory data were compiled from administrative and regulatory data sources, state websites, and regulatory compendia. Findings: NHs followed a standard set of regulations, whereas ALF regulations varied widely. Overall, state ALF regulations were less stringent than NH in all categories. Discussion: As ALF populations and acuity levels increase, staffing, training, nursing presence, and outcomes data requirements are warranted, and could be tailored from NH regulations to protect ALF quality and safety.

Original languageEnglish
Pages (from-to)114-122
Number of pages9
JournalNursing Outlook
Issue number1
StatePublished - 1 Jan 2020

Bibliographical note

Funding Information:
This work was funded in part by the National Council of State Boards of Nursing under grant #R81006 (to A.M.T.).

Publisher Copyright:
© 2019 Elsevier Inc.


  • Assisted living
  • Long-term care
  • Nursing home
  • Outcomes
  • Regulation
  • Staffing


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