Who cannot live in a Tennessee assisted living facility?
A Tennessee ACLF may not admit or keep anyone who needs treatment for stage III or IV pressure ulcers or exfoliative dermatitis, needs continuous nursing care, has an active reportable infection requiring contact isolation, shows aggressive behavior that poses an imminent physical threat, needs physical or chemical restraints, or has needs the facility cannot safely meet (0720-26-.08(1)).
Two details matter. The aggression test is “based on behavior, not diagnosis,” so a dementia or psychiatric diagnosis alone is not a bar. And psychotropic medication for a manageable mental condition is not treated as a chemical restraint. When a resident's needs outgrow the building, the resident, the family or legal representative, the administrator or the treating physician can each determine that a move is needed, and the state can require one (0720-26-.08(2)).
Can someone who qualifies for a nursing home live in assisted living in Tennessee?
Yes, with conditions: an ACLF may admit and keep a person who meets nursing facility level of care if the treating physician certifies in writing that the person's needs, including medical services, can be safely and effectively met there, and the facility can assure timely evacuation in a fire or emergency (0720-26-.08(3)).
This matters for TennCare. CHOICES Group 2 serves people who meet nursing facility level of care but choose home and community-based services, and Assisted Care Living Facility services are one of those services. A Memphis family whose parent qualifies for a nursing home may therefore be able to use CHOICES in an ACLF that participates, paying room and board separately. See TennCare CHOICES.
Can an ACLF resident have a feeding tube or IV therapy?
An ACLF may not admit someone who needs tube feeding, tracheotomy or nasopharyngeal suctioning, or IV therapy, but it may keep a current resident who needs them intermittently for up to three 21-day periods, with physician certification for the second and third periods (0720-26-.08(4)(a)).
Those treatments can continue on an ongoing basis only if the resident is on hospice, the resident does not meet nursing facility level of care and the board grants a waiver, or the resident can manage the treatment without help from staff or another licensed provider (0720-26-.08(4)(b)). Intravenous medications themselves are limited to existing residents who receive them intermittently and to hospice patients (0720-26-.07(1)(c)).
Can a Memphis assisted living resident receive hospice care at home?
Yes. A resident who qualifies for hospice can receive it in the ACLF and remain a resident if the treating physician certifies that the care can be appropriately provided there, with the hospice and the facility jointly responsible for the plan of care (0720-26-.08(5)).
The hospice must be available to assess, plan, monitor and evaluate palliative care with the physician and in cooperation with the ACLF. When a hospice patient dies in an ACLF, a registered nurse employed by the hospice may pronounce death if the death was anticipated and the attending physician has agreed in writing to sign the certificate (0720-26-.06(3)).
What is Tennessee's 13-minute evacuation rule for assisted living?
A Tennessee ACLF may not retain a resident who cannot evacuate within 13 minutes unless the building complies with Chapter 19 of the 2006 NFPA Life Safety Code and the institutional unrestrained occupancy of the 2006 International Building Code (0720-26-.08(8)).
That is why mobility shows up in every admission conversation. Tennessee's definition of ambulatory requires that a resident can bear weight, pivot and walk safely with a cane or walker with no more than minimal help, and be capable of self-preservation in an emergency; a wheelchair user must be able to transfer and propel the chair independently (0720-26-.02(6)). Ask any Memphis facility which building standard it is built to, because that decides how much mobility loss it can absorb before a move.
At a glance
| Tennessee ACLF rules allow | Tennessee ACLF rules do not allow | |
|---|---|---|
| Nursing-home-level residents | With written physician certification and evacuation assurance | Admission without either |
| Tube feeding / IV | Intermittent periods for current residents, or ongoing on hospice | Admitting a new resident who needs them |
| Dementia | Residents with dementia, including in secured units | Aggression posing an imminent threat |
| Mobility | Walkers, canes, self-propelled wheelchairs | Residents who cannot evacuate in 13 minutes (standard buildings) |
Sources include Tenn. Comp. R. & Regs. chapters 0720-26, 0720-21 and 0720-18, Health Facilities Commission and TennCare pages, CareScout and VA rate tables as cited above; see our editorial standards.
