2025 -- H 5169

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LC000586

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING

ACT

     Introduced By: Representatives Donovan, McNamara, Carson, Speakman, Boylan,
Fogarty, Potter, Giraldo, Morales, and Cruz

     Date Introduced: January 24, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 23-17.4-2 and 23-17.4-16.3 of the General Laws in Chapter 23-17.4

entitled "Assisted Living Residence Licensing Act" are hereby amended to read as follows:

     23-17.4-2. Definitions.

     As used in this chapter:

     (1) “Activities of daily living (ADLs)” means bathing, dressing, eating, toileting, mobility

and transfer.

     (2) “Administrator” means any person who has responsibility for day to day administration

or operation of an assisted living residence.

     (3) “Alzheimer’s dementia special care unit or program” means a distinct living

environment within an assisted living residence that has been physically adapted to accommodate

the particular needs and behaviors of those with dementia. The unit provides increased staffing,

therapeutic activities designed specifically for those with dementia and trains its staff on an ongoing

basis on the effective management of the physical and behavioral problems of those with dementia.

The residents of the unit or program have had a standard medical diagnostic evaluation and have

been determined to have a diagnosis of Alzheimer’s dementia or another dementia.

     (4) “Assisted living residence” means a publicly or privately operated residence that

provides directly or indirectly by means of contracts or arrangements personal assistance and may

include the delivery of limited health services, as defined under subsection (12), to meet the

resident’s changing needs and preferences, lodging, and meals to six (6) or more adults who are

unrelated to the licensee or administrator, excluding however, any privately operated establishment

or facility licensed pursuant to chapter 17 of this title, and those facilities licensed by or under the

jurisdiction of the department of behavioral healthcare, developmental disabilities and hospitals,

the department of children, youth and families, or any other state agency. The department shall

develop levels of licensure for assisted living residences within this definition as provided in § 23-

17.4-6. Assisted living residences include sheltered care homes, and board and care residences or

any other entity by any other name providing the services listed in this subdivision which meet the

definition of assisted living residences.

     (5) “Capable of self-preservation” means the physical mobility and judgmental ability of

the individual to take appropriate action in emergency situations. Residents not capable of self-

preservation are limited to facilities that meet more stringent life safety code requirements as

provided under § 23-17.4-6(b)(3).

     (6) “Director” means the director of the Rhode Island department of health.

     (7) “Family council” means an independent, self-determining group of family members

and friends established pursuant to § 23-17.4-15.12 that:

     (i) Advocates for the needs and interests of the residents of a managed residential

community that offers assisted living services; and

     (ii) Facilitates open communication between the managed residential community

administration, the residents and family and friends of the residents.

     (8) “Licensing agency” means the Rhode Island department of health.

     (8)(9) “Qualified licensed assisted living staff members” means a certified nursing assistant

as provided under § 23-17.9-2(a)(3), a licensed practical nurse as provided under § 5-34-3(13)

and/or a registered nurse as provided under § 5-34-3(14).

     (9)(10) “Personal assistance” means the provision of one or more of the following services,

as required by the resident or as reasonably requested by the resident, on a scheduled or

unscheduled basis, including:

     (i) Assisting the resident with personal needs including activities of daily living;

     (ii) Assisting the resident with self-administration of medication or administration of

medications by appropriately licensed staff;

     (iii) Providing or assisting the resident in arranging for health and supportive services as

may be reasonably required;

     (iv) Monitoring the activities of the resident while on the premises of the residence to

ensure his or her health, safety, and well-being; and

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     (v) Reasonable recreational, social and personal services.

     (10)(11) “Resident” means an individual not requiring medical or nursing care as provided

in a healthcare facility but who as a result of choice and/or physical or mental limitation requires

personal assistance, lodging and meals and may require the administration of medication and/or

limited health services. A resident must be capable of self-preservation in emergency situations,

unless the facility meets a more stringent life safety code as required under § 23-17.4-6(b)(3).

Persons needing medical or skilled nursing care, including daily professional observation and

evaluation, as provided in a healthcare facility, and/or persons who are bedbound or in need of the

assistance of more than one person for ambulation, are not appropriate to reside in assisted living

residences. However, an established resident may receive daily skilled nursing care or therapy from

a licensed healthcare provider for a condition that results from a temporary illness or injury for up

to forty-five (45) days subject to an extension of additional days as approved by the department, or

if the resident is under the care of a Rhode Island licensed hospice agency provided the assisted

living residence assumes responsibility for ensuring that the required care is received. Furthermore,

a new resident may receive daily therapy services and/or limited skilled nursing care services, as

defined through rules and regulations promulgated by the department of health, from a licensed

healthcare provider for a condition that results from a temporary illness or injury for up to forty-

five (45) days subject to an extension of additional days as approved by the department, or if the

resident is under the care of a licensed hospice agency provided that assisted living residence

assumes responsibility for ensuring that the care is received. For the purposes of this chapter,

“resident” shall also mean the resident’s agent as designated in writing or legal guardian.

Notwithstanding the aforementioned, residents who are bed bound or in need of assistance of more

than one staff person for ambulation may reside in a residence if they are receiving hospice care in

accordance with the rules and regulations promulgated by the department of health. For the

purposes of this chapter, “resident” shall also mean the resident’s agent as designated in writing or

legal guardian.

     (11)(12) “Resident council” means an independent, self-determining group of facility

residents established pursuant to § 23-17.4-15.11 that:

     (i) Advocates for the needs and interests of the residents of a managed residential

community that offers assisted living services; and

     (ii) Facilitates open communication between the managed residential community

administration, the residents and family and friends of the residents.

     (13) “Supervision” means the supervision requirements of qualified licensed assisted living

staff delivering limited health services in accordance with this chapter, as defined through rules and

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regulations promulgated by the department of health.

     (12)(14) “Limited health services” means health services, as ordered by the resident’s

physician, provided by qualified licensed assisted living staff members with supervision as required

in rules and regulations promulgated by the department of health. Nothing in this definition shall

be construed to limit the right of assisted living residents to access home nursing care or hospice

provider services.

     23-17.4-16.3. Residency agreement or contract.

     (a) Prior to exchange of any funds and prior to admission, except as provided in subsections

(c) and (d) herein, the residence shall execute a residency agreement or contract, signed by both the

residence and the resident, that defines the services the residence will provide and the financial

agreements between the residence and the resident or the residence’s representative.

     (b) The department shall establish regulations specifying the minimum provisions of

residency agreements or contracts and a minimum prior notification time for changes in rates, fees,

service charges or any other payments required by the residence. The residency agreement shall be

set forth in plain language, made available in not less than fourteen (14) point type, and shall include

at a minimum:

     (1) An itemization of assisted living services, transportation services, recreation services

and any other services and goods, lodging and meals to be provided to the resident by the assisted

living residence;

     (2) A full and fair disclosure of all charges, fees, expenses and costs to be borne by the

resident including nonrefundable charges, fees, expenses and costs;

     (3) A schedule of payments and disclosure of all late fees or potential penalties;

     (4) For written residency agreements entered into on and after November 1, 2025, the

manner in which the managed residential community may adjust monthly fees or other recurring

fees, including, but not limited to:

     (i) How often fee increases may occur;

     (ii) The schedule or specific dates of such increases; and

     (iii) The history of rate and fee increases over the past three (3) calendar years;

     (5) The facility shall share a current copy of the residency agreement including all

disclosures with the long-term care ombudsman program.

     (c) Any advanced deposit, application fee, or other pre-admission payment shall be subject

to a signed document explaining fully the terms of the payment and the residence’s refund policy.

     (d) Any increase to monthly or recurring fees after November 1, 2025, shall be disclosed

to residents or residents’ representatives in writing with a minimum advance notice of one hundred

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twenty (120) days.

     (e) In cases of emergency placement, the residency agreement or contract shall be executed

within five (5) working days of admissions.

     SECTION 2. Chapter 23-17.4 of the General Laws entitled "Assisted Living Residence

Licensing Act" is hereby amended by adding thereto the following sections:

     23-17.4-15.10. Establishment of resident and family councils.

     On or before November 1, 2025, all assisted living facilities shall authorize and assist in

the establishment of resident and family councils pursuant to the provisions of §§ 23-17.4-15.11

and 23-17.4-15.12.

     23-17.4-15.11. Resident councils.

     (a) For the purposes of this chapter, “resident council” shall having the meaning set forth

in § 23-17.4-2.

     (b) The role of the resident council shall be to address issues affecting residents generally

at the facility, not to pursue individual grievances. The resident council shall not be entitled to

obtain information about individual residents or staff members, or any other information deemed

confidential under state or federal law,

     (c) The facility shall not willfully interfere with the formation, maintenance, or promotion

of a resident council, or with a resident council’s participation in governmental surveys or

inspection activities performed by any applicable departments or other governmental entities.

When requested by one or more facility residents, a resident council shall be allowed to meet in a

common meeting room of the assisted living facility at least once a month during mutually agreed

upon hours. For purposes of this section, "willful interference" shall include, but shall not be limited

to, discrimination or retaliation in any way against an individual as a result of their participation in

a resident council, refusal to publicize resident council meetings or provide appropriate space for

meetings or postings as required under this section, and failure to respond to written requests,

concerns, or recommendations by a resident council as required under this section.

      (d) Upon the admission of a resident, the assisted living facility shall inform the resident,

in writing, of their right to form a family council, or if a family council already exists, of the date,

time and location of scheduled meetings.

     (e) The assisted living facility administration shall notify the state long-term care

ombudsman of the existence or planned formation of an independent resident council at that

facility. With the consent of the resident council designated representative(s), the facility shall share

the name and contact information of the designated representative(s) of the resident council with

the long-term care ombudsman program.

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     (f) The resident council may exclude residents from meetings only for good cause, subject

to appeal by the excluded party to the state long-term care ombudsman. No member shall be

excluded on the basis of race or color, religion, gender, sexual orientation, disability, age or country

of ancestral origin.

     (g) A facility shall provide its resident council with adequate space in a prominent posting

area for the display of information pertaining to the resident council.

     (h) Staff or visitors may attend resident council meetings only at the council’s invitation.

     (i) The assisted living facility shall provide a designated staff person who, at the request of

the council, shall be responsible for providing assistance to the resident council and for responding

to recommendations and requests made by the resident council.

     (j) If a resident council submits written requests, concerns, or recommendations, the facility

shall consider those requests, concerns, or recommendations, and respond in writing regarding any

action or inaction taken in response within five (5) business days and shall detail its rationale for

that response.

     (k) A violation of the provisions of this section shall constitute a violation of the rights of

assisted living residents.

     23-17.4-15.12. Family councils.

     (a) For the purposes of this chapter, “family council” shall have the meaning set forth in §

23-17.4-2

     (b) The role of the family council shall be to address issues affecting residents generally at

the facility, not to pursue individual grievances. The family council shall not be entitled to obtain

information about individual residents or staff members, or any other information deemed

confidential under state or federal law; provided however:

     (1) A facility shall provide the family council with the names, email addresses, and other

contact information for each resident’s representatives, family members, or other individuals

designated by the resident if the person has not opted out of consent that their contact information

may be shared with the family council.

     (2) The facility shall inform the identified family members, friends, and representatives of

their right to have their contact information shared with the family council and their right to consent

or withhold consent to have their contact information shared with the family council pursuant to

subsection (b)(1) of this section.

     (c) The facility shall not willfully interfere with the formation, maintenance, or promotion

of a family council, or with a family council’s participation in governmental surveys or inspection

activities performed by any applicable departments or other governmental entities. When requested

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by a member of a resident’s family or a resident’s representative, a family council shall be allowed

to meet in a common meeting room of the assisted living facility at least once a month during

mutually agreed upon hours. For purposes of this section, "willful interference" shall include, but

shall not be limited to, discrimination or retaliation in any way against an individual as a result of

their participation in a family council, refusal to publicize family council meetings or provide

appropriate space for meetings or postings as required under this section, and failure to respond to

written requests, concerns, or recommendations by a family council as required under this section.

     (d)(1) If a facility has a family council, the facility shall inform the resident and the

resident’s representatives, family members, or other individuals designated by the resident or

identified during the admission process of the existence of the family council. The facility shall

provide the resident and those family members, friends, and resident representatives with the name

and contact information of the family council representative, as designated by the family council,

in writing, prior to or within five (5) business days after the resident’s admission or the resident’s

representative, family member, or other individual is designated or identified. When family council

meeting information is provided by the family council, the facility shall include notice of family

council meetings in routine communications to those family members, friends, and resident

representatives. The notice shall include the time, place, and date of meetings, and the name and

contact information of the family council representative, as designated by the family council.

     (2) If a facility does not have a family council, the facility shall provide, upon admission

of a new resident, written information to the resident’s family members, friends, or resident

representatives identified during the admission process of their right to form a family council.

     (3) The family council shall not allow a family member or friend of a resident to participate

in the family council over the objection of the resident.

     (e) The assisted living facility administration shall notify the state long-term care

ombudsman of the existence or planned formation of a family council at that facility. With the

consent of the designated representative(s) of the family council, the facility shall share the name

and contact information of the designated representative(s) of the family council with the long-term

care ombudsman program.

     (f) The family council may exclude members only for good cause, subject to appeal by the

excluded party to the state long-term care ombudsman. No member shall be excluded on the basis

of race or color, religion, gender, sexual orientation, disability, age or country of ancestral origin.

     (g) A facility shall provide its family council with adequate space in a prominent posting

area for the display of information pertaining to the family council.

     (h) Staff or visitors may attend family council meetings only at the council’s invitation.

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     (i) The assisted living facility shall provide a designated staff person who, at the request of

the council, shall be responsible for providing assistance to the family council and for responding

to recommendations and requests made by the family council.

     (f) If a family council submits written requests, concerns, or recommendations, the facility

shall consider those requests, concerns, or recommendations, and respond in writing regarding any

action or inaction taken in response within five (5) business days and shall detail its rationale for

that response.

     (k) A violation of the provisions of this section shall constitute a violation of the rights of

assisted living residents.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING

ACT

***

     This act would establish, encourage and support the establishment of family councils and

resident councils in managed residential communities providing assisted living services. This act

would further support the transparency of rates and fees to residents in managed residential

communities providing assisted living services and set a minimum notice period for rate increases

of one hundred twenty (120) days.

     This act would take effect upon passage.

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