For the second year in a row, more than half of the states have changed their assisted living requirements, indicating a potential trend that the National Center for Assisted Living expects to continue, executives said Thursday in releasing the group’s annual  “Assisted Living State Regulatory Review.”

Twenty-seven states updated their assisted living-related regulations, statutes and policies from June 2018 to June 2019, according to the latest report.

Since 2015, 84% of states have reported changes that affect assisted living, NCAL said, with 23 states making changes in 2015-2016, 17 doing so in 2016-2017 and 29 making changes in 2017-2018, according to previous “Assisted Living State Regulatory Review” reports.

“Changes each year can vary from big to small, but it is evident that state regulations are increasing in assisted living,” Lilly Hummel, NCAL’s senior policy director and the report’s author, said in a statement. “Each state is determining how to enhance assisted living for their specific resident population, and we anticipate this trend to continue.”

NCAL and other industry groups previously have expressed a desire that regulation of assisted living remain primarily at the state level.

“Assisted living is doing a great job at the state level, and states should continue to be incubators for the growth of assisted living in the future,” NCAL Executive Director Scott Tittle told McKnight’s Senior Living last year.

“Once again, states are demonstrating their ability to respond to the evolving assisted living environment to foster quality improvement, provider transparency and resident safeguards,” he said Thursday in a statement. “NCAL supports ongoing collaborative efforts between assisted living providers, state regulators and other stakeholders to find the proper balance of oversight while still honoring the specific needs and desires of each resident.”

The most common changes to state regulations in 2018-2019, according to NCAL, were made with the goal of enhancing resident protections, most frequently related to resident disclosure and notification requirements. Four states (Colorado, Minnesota, Oregon and Virginia) and Washington, DC, passed laws requiring new types of notification either to the resident or to the state. Three other states (Alabama, California and Utah) finalized “small regulatory revisions” affecting required resident notifications, NCAL said.

Efforts to protect residents from elder abuse and neglect also were common, according to the report.

The regulatory review summarizes key selected state requirements for assisted living licensure or certification. Among the 20 areas covered include resident agreements, admission and discharge policies, scope of care and life safety. The report also describes which state agencies license assisted living.

The full report along with summaries for each state are available on the association website.