Although most states have infection control policies and procedures for residential care and assisted living communities, they vary in detail and requirements and could cause confusion during epidemics / pandemics, according to a new study in JAMDA – The Journal of Post-Acute and Long-Term Care Medicine.

The researchers, from Portland State University and Brown University, reviewed assisted living regulations in all 50 states and the District of Columbia and found:

  • 32 states list or describe infection control as a training requirement, although the level of detail in those regulations varies.
  • 31 states describe infection control policies, including the routine practice of standard precaution, guidelines for contact with blood and other bodily fluids, or reportable disease guidelines. 
  • 10 states include language about epidemics, primarily regarding reportable disease and requirements for reporting to local public health departments.
  • 6 states (Colorado, Illinois, Indiana, Kansas, Massachusetts and North Dakota) directly reference general resident isolation practices for communicable disease within their infection control policies.
  • 2 states (Maryland and Oregon) describe pandemic emergency preparedness.

Based on a review of the 31 states with infection and epidemic prevention regulations, states take one of two approaches — requiring communities to develop infection control policies, or requiring facility compliance with reporting and public health cooperation in an epidemic.

“It remains unclear if and how states require these communities to mitigate, prepare and respond to infection among their residents, a group particularly vulnerable to the effects of the current COVID-19 pandemic,” the authors wrote. “Although most states have regulations requiring infection control policies and procedures for residential care and assisted living communities, they range in the level of detail and requirements. There is potential for confusion during epidemics / pandemics in translating these regulations into practice without adequate support and resources.”

The authors also point out that the noninstitutional, homelike setting and practices inherent in assisted living can conflict with standard clinical and public health practices in federally regulated hospitals and nursing homes, such as wearing gloves, respirators or scrubs.

“These communities may face tension in providing an environment that captures the sociocultural model of residential care / assisted living, while ensuring resident safety during outbreaks,” they said.

This should be an area of focus as COVID-19 adversely affects older adults residing in these settings, according to the authors.