Indiana Assisted Living
The following information can help you understand how Indian regulates long-term care communities in the state, what assisted living options are available, how much they cost, and how those costs compare to neighboring states.
The typical resident population in Indiana's assisted living communities is 68% female. Overall, 77% of residents are ages 75 and older, with 29% of residents ages 75 to 84 and 48% ages 85 and older.
In Indiana, all assisted living facilities are residential care facilities. Any provider that wants to use the term “assisted living” must file a disclosure form with the Family and Social Services Agency Division of Aging (FSSA). This is not a licensing procedure but has been established for the FSSA to know the number and types of facilities in the state.
If the facility wants to administer medication to residents, they must be licensed by the State Department of Health. An unlicensed housing with services facility may contract with a licensed home health agency to provide nursing care and medication administration. Residents can contract with their own agency for these services anytime during their stay.
Assisted living facilities are referred to as Housing with Services Establishments. ALFs provide room and board to a minimum of five residents or provide, for a fee, at least one regularly scheduled health service or two regularly scheduled support services. Health-related services include home health services, attendant and personal care services, professional nursing services, and the distribution of medications. Unlicensed housing with services establishments cannot administer medications but can assist residents with administering their own medications.
Supportive services include help with personal laundry, handling or assisting with personal funds, and arranging for medical, health-related, or social services. Supportive services do not include making referrals or assisting a resident in contacting a service provider that the resident has chosen.
Before admission, facilities must provide the resident or their representative with a copy of the contract between the resident and the facility. The contract must include information on the services covered with their base price, additional services, and their cost, the process for changing the contract, the compliance resolution process, the retention, discharge, and referral policies and procedures of the facility, and billing/paying policies and procedures.
Facilities may only admit or retain medically stable individuals who do not require 24-hour-a-day nursing care or oversight. If the resident requires this level of care, they must be discharged. The resident must also be discharged if they require care on a less-than 24-hour-a-day basis if the services are not contracted with an appropriately licensed contractor to provide the care and oversight.
A resident must be discharged if they become a danger to themself or other residents or meets two of the following three criteria:
Before admission, the facility must evaluate potential residents to see if they can be admitted. If they are admitted, a semi-annual evaluation must be performed or when a condition change occurs. The subsequent evaluations will determine if the resident's care is within the facility's capabilities. This evaluation will determine the type, scope, and frequency of services that will be provided to the resident.
Any services offered by the facility must meet residents’ needs regarding scope, frequency, and preferences. A facility that retains a professional staff may provide comprehensive nursing care services to residents needing care. If the administration of medications or nursing services is needed, a licensed nurse must be involved in determining and documenting the needed services. Medication administration must be ordered by a licensed nurse and supervised by a physician.
Nursing care may include, but is not limited to, identifying responses to health conditions; a nursing diagnosis; executing a minor regimen based on a nursing diagnosis or as prescribed by a physician, physician’s assistant, dentist, or another doctor; and, the administration, supervision, delegation and evaluation of nursing activities.
The facility must provide activity programs appropriate to the abilities and interests of the residents. Scheduled transportation for community-based activities must be provided or coordinated.
Each facility must have one licensed administrator who is responsible for the overall administration of the facility. The administrator must have either a nursing facility administrator's license or an RCF (residential care facility) administrator's license. If 50 or more residents require nursing services or medication administration, at least one nursing staff member must be on staff at all times. Any unlicensed employee providing more than limited ADL assistance must be a certified nursing assistant or a home health aide.
A consulting pharmacist must be employed or under contract by the facility. The facility must designate an activities director who is either a recreational therapist, an occupational therapist, a certified occupational therapist assistant, or someone who, within one year, completes an activities director training course.
Other than the requirement for a nursing staff member noted above, there are no minimum ratios for other staff; however, sufficient staff must be available to meet residents' needs 24 hours a day. A minimum of one staff member with CPR and first aid certification must be on duty and awake at all times.
Administrators must complete 40 hours of continuing education every two years. Prior to working independently, every employee must be given an orientation of the facility that must include the following:
Ongoing training is required and will cover residents' rights, infection prevention and control, fire safety, accident prevention, special needs of residents, medication administration, and nursing care. Nurse personnel requires 8 hours of training per year, and non-nursing personnel requires four hours of training per year.
Assisted living facilities that provide service for Medicaid Waiver residents must offer individual residential units that include a bedroom, private bath, substantial living area, and a kitchenette containing a refrigerator, food preparation area, microwave, and access to a stovetop or oven. Fifty percent of the units must have roll-in shower capability and be wheelchair accessible. Apartments can be shared only by choice.
For any facility that filed construction plans after July 1, 1984, resident rooms must contain at most four beds, and one toilet and sink is required for every eight residents. At least one toilet and one sink must be the appropriate height for a resident seated in a wheelchair and must be available for each sex on each floor containing such a resident.
The ratios of bathing facilities for residents without a private bath in their room are as follows:
Residents have the right to share a room with their spouse when they are married, and both spouses consent when a room is available to share. The facility must have a written policy addressing circumstances when persons of the opposite sex other than husband and wife agree to occupy a bedroom if the arrangement is agreeable to them both.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
In Indiana, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 75% of communities providing skilled nursing. Many have health care specialists and on-site services, with 62% of communities offering dental care. In addition, 73% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Indiana, 85% of communities conduct depression screenings, and 72% offer mental health counseling. Social work programs are also found in 67% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the necessary resources.
Some assisted living residents live with various medical conditions. In Indiana, 30% have Alzheimer's disease or another form of dementia. In addition, 53% have high blood pressure, 32% have heart disease, 35% have depression, and 22% have diabetes.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Indiana assisted living facilities often receive help with their ADLs. In Indiana, 14% of residents need help eating. Other commonly used services include bed transfer (30%), toileting (32%), and walking (45%). Caregivers in ALFs help 40% of residents dress, and 53% need help bathing.
The average cost of assisted living care in Indiana is $4,283. This cost is $217 lower than the monthly national average of $4,500 per month. The cost of living in Indiana is less than the national average by 9.4%, with health care costs less than the national average by 5.4%, and housing costs less than the national average by 21.7%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,250 in the Kokomo area to a high of $5,255 per month in the Lafayette area of Indiana.
If you live close to Indiana’s borders, you may find assisted living in a neighboring state is an affordable option. Seniors in Kentucky and Michigan pay less than seniors in Indiana, paying $3,448 and $4,250, respectively. Seniors in Ohio and Illinois pay a little more than in Indiana, paying $4,635 and $4,448, respectively.
How to Pay for Assisted Living
The Indiana Department of Health and the Indiana Department of Family and Social Services (DFSS) oversee assisted living communities. Both departments accept complaints from residents and community members. The Division of Aging within DFSS keeps track of licensed and unlicensed assisted living facilities. DFSS monitors facilities for compliance with state rules and regulations.
Elder law is an area of legal practice focusing on issues affecting older adults. This can include things like estate planning and advance directives. Unfortunately, these rights aren't always respected, so elder law also addresses the following:
Indiana state resources are available to protect seniors. The Long-Term Care Ombudsmen advocate for residents, educate them about their rights, and investigate facility complaints. This program is a free resource for anyone concerned about a particular assisted living facility. Adult Protective Services may also assist in situations of fraud and abuse.
Indiana Legal Services is a not-for-profit law firm that offers free legal services to low-income Indiana residents and provides services to help seniors protect their rights. Many private law firms throughout Indiana also practice elder law and can offer legal assistance to older adults.
The typical resident population in Indiana's assisted living communities is 68% female. Overall, 77% of residents are ages 75 and older, with 29% of residents ages 75 to 84 and 48% ages 85 and older.
Assisted Living Facility (ALF) Requirements
In Indiana, all assisted living facilities are residential care facilities. Any provider that wants to use the term “assisted living” must file a disclosure form with the Family and Social Services Agency Division of Aging (FSSA). This is not a licensing procedure but has been established for the FSSA to know the number and types of facilities in the state.
If the facility wants to administer medication to residents, they must be licensed by the State Department of Health. An unlicensed housing with services facility may contract with a licensed home health agency to provide nursing care and medication administration. Residents can contract with their own agency for these services anytime during their stay.
Assisted living facilities are referred to as Housing with Services Establishments. ALFs provide room and board to a minimum of five residents or provide, for a fee, at least one regularly scheduled health service or two regularly scheduled support services. Health-related services include home health services, attendant and personal care services, professional nursing services, and the distribution of medications. Unlicensed housing with services establishments cannot administer medications but can assist residents with administering their own medications.
Supportive services include help with personal laundry, handling or assisting with personal funds, and arranging for medical, health-related, or social services. Supportive services do not include making referrals or assisting a resident in contacting a service provider that the resident has chosen.
Resident Agreements and Admission
Before admission, facilities must provide the resident or their representative with a copy of the contract between the resident and the facility. The contract must include information on the services covered with their base price, additional services, and their cost, the process for changing the contract, the compliance resolution process, the retention, discharge, and referral policies and procedures of the facility, and billing/paying policies and procedures.
Facilities may only admit or retain medically stable individuals who do not require 24-hour-a-day nursing care or oversight. If the resident requires this level of care, they must be discharged. The resident must also be discharged if they require care on a less-than 24-hour-a-day basis if the services are not contracted with an appropriately licensed contractor to provide the care and oversight.
A resident must be discharged if they become a danger to themself or other residents or meets two of the following three criteria:
- Require total assistance with eating.
- Require total assistance with toileting.
- Require total assistance with transferring.
Before admission, the facility must evaluate potential residents to see if they can be admitted. If they are admitted, a semi-annual evaluation must be performed or when a condition change occurs. The subsequent evaluations will determine if the resident's care is within the facility's capabilities. This evaluation will determine the type, scope, and frequency of services that will be provided to the resident.
Assisted Living Services
Any services offered by the facility must meet residents’ needs regarding scope, frequency, and preferences. A facility that retains a professional staff may provide comprehensive nursing care services to residents needing care. If the administration of medications or nursing services is needed, a licensed nurse must be involved in determining and documenting the needed services. Medication administration must be ordered by a licensed nurse and supervised by a physician.
Nursing care may include, but is not limited to, identifying responses to health conditions; a nursing diagnosis; executing a minor regimen based on a nursing diagnosis or as prescribed by a physician, physician’s assistant, dentist, or another doctor; and, the administration, supervision, delegation and evaluation of nursing activities.
The facility must provide activity programs appropriate to the abilities and interests of the residents. Scheduled transportation for community-based activities must be provided or coordinated.
Assisted Living Staffing Requirements
Each facility must have one licensed administrator who is responsible for the overall administration of the facility. The administrator must have either a nursing facility administrator's license or an RCF (residential care facility) administrator's license. If 50 or more residents require nursing services or medication administration, at least one nursing staff member must be on staff at all times. Any unlicensed employee providing more than limited ADL assistance must be a certified nursing assistant or a home health aide.
A consulting pharmacist must be employed or under contract by the facility. The facility must designate an activities director who is either a recreational therapist, an occupational therapist, a certified occupational therapist assistant, or someone who, within one year, completes an activities director training course.
Other than the requirement for a nursing staff member noted above, there are no minimum ratios for other staff; however, sufficient staff must be available to meet residents' needs 24 hours a day. A minimum of one staff member with CPR and first aid certification must be on duty and awake at all times.
Assisted Living Staff Training Requirements
Administrators must complete 40 hours of continuing education every two years. Prior to working independently, every employee must be given an orientation of the facility that must include the following:
- Instructions on the needs of the specialized residents in the facility.
- A review of the facility’s policies and procedures.
- Instructions in first aid, emergency procedures, fire and disaster preparedness, and evacuation procedures.
- A detailed review of their job description and a demonstration of any equipment and procedures required for their position.
- Review ethical considerations and confidentiality requirements in resident care and records.
- An introduction and instructions on the specific needs of each resident who the employee will be caring for.
Ongoing training is required and will cover residents' rights, infection prevention and control, fire safety, accident prevention, special needs of residents, medication administration, and nursing care. Nurse personnel requires 8 hours of training per year, and non-nursing personnel requires four hours of training per year.
Assisted Living Housing Requirements
Assisted living facilities that provide service for Medicaid Waiver residents must offer individual residential units that include a bedroom, private bath, substantial living area, and a kitchenette containing a refrigerator, food preparation area, microwave, and access to a stovetop or oven. Fifty percent of the units must have roll-in shower capability and be wheelchair accessible. Apartments can be shared only by choice.
For any facility that filed construction plans after July 1, 1984, resident rooms must contain at most four beds, and one toilet and sink is required for every eight residents. At least one toilet and one sink must be the appropriate height for a resident seated in a wheelchair and must be available for each sex on each floor containing such a resident.
The ratios of bathing facilities for residents without a private bath in their room are as follows:
- 1-22 residents must have one bathtub or shower.
- 23-37 residents must have two bathtubs or showers.
- 38-52 residents must have three bathtubs or showers.
- 53-67 residents must have four bathtubs or showers.
- 68-82 residents must have five bathtubs or showers.
- 83-97 residents must have six bathtubs or showers.
Residents have the right to share a room with their spouse when they are married, and both spouses consent when a room is available to share. The facility must have a written policy addressing circumstances when persons of the opposite sex other than husband and wife agree to occupy a bedroom if the arrangement is agreeable to them both.
What Is Included With Assisted Living Care In Indiana?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In Indiana, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 75% of communities providing skilled nursing. Many have health care specialists and on-site services, with 62% of communities offering dental care. In addition, 73% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Indiana, 85% of communities conduct depression screenings, and 72% offer mental health counseling. Social work programs are also found in 67% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the necessary resources.
Some assisted living residents live with various medical conditions. In Indiana, 30% have Alzheimer's disease or another form of dementia. In addition, 53% have high blood pressure, 32% have heart disease, 35% have depression, and 22% have diabetes.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Indiana assisted living facilities often receive help with their ADLs. In Indiana, 14% of residents need help eating. Other commonly used services include bed transfer (30%), toileting (32%), and walking (45%). Caregivers in ALFs help 40% of residents dress, and 53% need help bathing.
Cost Of Assisted Living Care In Indiana
The average cost of assisted living care in Indiana is $4,283. This cost is $217 lower than the monthly national average of $4,500 per month. The cost of living in Indiana is less than the national average by 9.4%, with health care costs less than the national average by 5.4%, and housing costs less than the national average by 21.7%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,250 in the Kokomo area to a high of $5,255 per month in the Lafayette area of Indiana.
How Costs Compare In Nearby States
If you live close to Indiana’s borders, you may find assisted living in a neighboring state is an affordable option. Seniors in Kentucky and Michigan pay less than seniors in Indiana, paying $3,448 and $4,250, respectively. Seniors in Ohio and Illinois pay a little more than in Indiana, paying $4,635 and $4,448, respectively.
How to Pay for Assisted Living
Indiana Assisted Living Oversight
The Indiana Department of Health and the Indiana Department of Family and Social Services (DFSS) oversee assisted living communities. Both departments accept complaints from residents and community members. The Division of Aging within DFSS keeps track of licensed and unlicensed assisted living facilities. DFSS monitors facilities for compliance with state rules and regulations.
Legal Resources for Seniors
Elder law is an area of legal practice focusing on issues affecting older adults. This can include things like estate planning and advance directives. Unfortunately, these rights aren't always respected, so elder law also addresses the following:
- Elder abuse.
- Situations when older adults are the victims of fraud or financial mistreatment.
- Assisted living establishments that aren't following state regulations.
Indiana state resources are available to protect seniors. The Long-Term Care Ombudsmen advocate for residents, educate them about their rights, and investigate facility complaints. This program is a free resource for anyone concerned about a particular assisted living facility. Adult Protective Services may also assist in situations of fraud and abuse.
Indiana Legal Services is a not-for-profit law firm that offers free legal services to low-income Indiana residents and provides services to help seniors protect their rights. Many private law firms throughout Indiana also practice elder law and can offer legal assistance to older adults.
