Chapter VIII.

Assisted Living: Information & Resources

Overview

In general, assisted living is a combination of housing, personal care and some health services. It is intended for people who need help  with activities of daily living (eating, bathing, dressing, getting to and using the bathroom, getting in or out of a bed or chair, and walking), but who do not need round-the-clock nursing care and supervision.

Services usually include:

• Individual apartments.

• Meals served in a common dining area.

• Housekeeping and laundry services.

• Transportation.

• Assistance with activities of daily living. 

• Access to health and medical services.

• Medication management.

• Social and recreational activities.

• 24-hour security.

• Emergency call systems for each resident’s apartment.

There are two kinds of assisted living facilities in Indiana: licensed assisted living facilities and legally unlicensed facilities (not required by the state to be licensed).

Licensed Assisted Living Facilities

These facilities are also called residential care facilities. In these residences, facility staff may administer medications, provide some nursing services, or

do both.

You must check with the individual facility to find out which of the above services are provided.

Residential care facilities are licensed by the state of Indiana and must follow a specific set of regulations. The Indiana State Department of Health inspects these facilities once a year to see if they are in compliance with the regulations, and sanctions can be imposed if the facility is violating the requirements. If you have a complaint regarding care or services, you can file the complaint with the Department of Health, and the agency will investigate.

Legally Unlicensed Assisted Living Facilities

These facilities generally provide limited assistance with personal care, such as help with dressing and bathing. However, they do not have staff that administer medications or provide nursing services. This means that your loved one cannot receive medication administration or nursing services in this facility or must arrange with a home health agency or other caregiver to deliver these services.

These facilities are not required to be licensed. As a result, there are no regulations or standards that the facility must follow (e.g. how much training a person must have to provide care to a resident), there are no inspections by an outside entity (such as the Indiana State Department of Health), and the only place to turn if you have a complaint may be to the facility itself or to the ombudsman (see section on "Addressing Problems").

One of the best things you can do as a consumer is to obtain a copy of the facility’s Housing With Services Establishment Disclosure form. Both licensed and legally unlicensed assisted living facilities are required by state law to complete this form, which provides information about the facility's services and costs. The form allows you to better compare one facility to another.

An assisted living facility must provide potential residents with a copy of the form. If the assisted living facility does not give you the form, make sure to ask for it!

For more information about the differences between licensed and unlicensed assisted living residences, see the handout, Assisted Living Residences: Knowing the Difference Between Licensed and Unlicensed Facilities.

Important Points To Consider In Indiana

Because assisted living residences vary so much in Indiana, there is not a standard set of services that these facilities provide. The following are some points to research if you are considering assisted living for a loved one.

Standards/Monitoring/Oversight

While there are many good licensed and unlicensed assisted living facilities, think about whether it is important to you that the facility be held to certain established standards and that there be outside oversight and monitoring.

Services

Do not make any assumptions about what will or won’t be provided. Find out exactly what services will be provided. ASK!! Check the contract! (See below.)

Nursing Services

• Does the facility provide nursing services? If so, are those services provided by a nurse or by a nursing assistant/home health aide? If you learn that services from a nurse are available, find out if the nurse is on-site, and if so, for how many hours a day or per week. Don’t assume that a nurse is there 24 hours a day. Licensed assisted living facilities are only required to have a licensed nurse on call or on the premises if the facility administers medications.

Ask what the role of the nurse is. In some cases, the nurse may just be there to conduct required assessments. It is very important to find out the extent and nature of any services to be provided by a nurse.

• If no nursing services are provided, can those services be brought in? Who makes those arrangements?

Medication administration

• Does the facility provide medication administration (actually giving the medication, not just reminding the resident to take it or handing it to them to take)? If not, can that service be brought in? Who makes those arrangements?

• If facility staff does administer medications, can you use the pharmacy of your choice or order by mail?

Physician services

• Can the resident see the doctor of his or her choice?

• Would you have to arrange for your loved one to get to the doctor’s office?

• Does the residence provide transportation to doctor's appointments?

Meals

• Are meals available 7 days a week?

• How many meals are offered per day?

• Can residents only eat at designated times?

• Are special diets available?

• Do residents get a credit for meals not eaten?

• Can residents have a tray in their apartment if they want or only when they are sick? Is there an extra charge for trays brought to their unit?

Transportation

• Does the facility actually provide transportation or just arrange it?

• If the facility provides it:

  
  

• Where can residents be taken (just to medical appointments or on social outings or shopping too)? How far can residents be driven?

• Is there a charge for the transportation?

• How often is transportation provided (every day, three times a week, etc.)?

• Are vehicles equipped to accommodate residents with disabilities? Is the van wheelchair-accessible?

  
  

• Can residents have their own vehicles? Is there a parking fee for a car?

Housekeeping

• Does housekeeping include only light dusting and vacuuming or does it also include cleaning the bathroom and floors and emptying the trash?

• How frequent is the cleaning?

• If only light housekeeping is done, is there an extra charge for heavy cleaning?

Laundry

• Are bed linens and towels provided? Does the residence launder these items? If so, how often? Is this service included in the monthly fee?

• Is personal laundry done as well? Is that service included in the monthly fee? Can residents/families do the laundry if they wish?

Levels of Care

• Are different levels of care provided in the facility? If so, what services are included in each level?

• Is level of care linked to cost? Many assisted living residences have formulas for determining how much care an individual needs, and costs can go up when the level of care changes (see section on "Cost").

• What kind of assessment of the resident is conducted? How often are assessments done?

• Who decides when a resident’s care needs change and another level of care is required? Can the decision be appealed if the resident or family disagrees with the decision?

• Can residents bring in home health agency staff or hire their own aides/personal attendants to help if their care needs increase and the facility staff can’t provide that level of care?

• Do residents have to change units or move if their needs increase?

Service Plan/Plan Of Care

• Who develops the plan?

• Is involvement by residents and family encouraged and sought after?

• How often is the plan reviewed?

Staff

• What kind of training does staff have?

• Who provides personal care? What are their credentials? Note that even in licensed residential care facilities, staff that assist residents with personal care generally don’t have to be certified nursing assistants or home health aides; they just have to be “qualified” according to what the assisted living residence feels “qualified” means.

• Is there an on-site staff member trained and certified in life-saving techniques for heart attack and choking 24 hours a day, 7 days a week?

• Is there over-night awake staff? What are their credentials?

• What is the ratio of nursing staff to residents during the day, evening, and night?

Dementia Care

• Is there a special unit, wing or building for residents with dementia? If so, what makes it different from the rest of the facility?

• Is there special training for staff who care for residents with dementia?

• Are there special activities for residents with dementia?

• What measures are taken to prevent residents who wander from leaving the residence or unit unsupervised?

• Under what circumstances might a resident with dementia be asked or required to leave this unit?

If the residence states it has a dementia care unit, it must complete a Alzheimer's/Dementia Special Care Unit Disclosure form. This form provides information about the unit, such as staffing levels, staff training, and admissions/discharge criteria. Ask the residence to give you a copy.

Building Safety

• Does each apartment have its own sprinkler system?

• Are there hard-wired smoke detectors in each apartment?

Fees/Pricing

The way fees are calculated varies enormously from one facility to another. Use the Housing with Services Disclosure Form to help you in trying to compare “apples to apples.”

Examples of different pricing systems include:

• A flat or bundled rate. In this system, the facility estimates the average amount of care residents will need. Everyone pays the same for personal care services that are folded into the basic rent for the living unit.

• A tiered rate. A facility may offer different levels of care at different rates. The facility assesses the resident and determines what level he or she needs. The resident then pays for the cost of care at that level, even if he or she doesn’t need all the care that comes with that level.

• A flat rate plus charges per service. This is a menu-like approach where the resident pays a flat rate that includes certain set features and then pays per additional service needed. For instance, a resident might pay for help getting dressed every time that service is provided.

Other questions you should ask are:

• What is included in the rates? For instance, are utilities included (telephone, cable, water, gas, electricity)? Are maintenance and repair fees included?

• Under what conditions can monthly payments be increased? How much notice will be given?

• What happens if the resident goes to the hospital? Is payment still due?

• Does the facility accept Medicaid? If not, will the resident have to move if he or she becomes a Medicaid recipient?

Transfer/Discharge

Do not assume that once a resident has moved into the facility, he or she can automatically “age in place” and never have to move again. In fact, that is rarely the case. The average length of stay for a resident was only 27 months in 2006.*

*Source: 2006 Overview of Assisted Living, Assisted Living Federation of America.

Ask:

• What are the criteria for transferring or discharging the resident to another facility? Under what circumstances would a resident be forced to leave?

• How much notice will be given?

• What if the resident or family disagrees with the decision?

• Will the assisted living residence staff help your loved one find another place to live?

Contract

Review the contract to see what it specifically requires the facility to do. Since legally unlicensed assisted living residences do not have to follow state requirements, the contract becomes very important because a facility can only be held to what the contract says. Make sure you understand the contract. Consider having the contract reviewed by an attorney before it is signed.

Regulation

Residential care facilities

As noted above, only assisted living residences that are residential care facilities are licensed and required to follow state regulations. You can access these regulations by clicking here.

Medicaid Waiver Providers

Some assisted living facilities are “Medicaid Waiver Providers.” This means that the facility can provide care and services to a certain number of residents who are on Medicaid and need nursing home level of care. Assisted living facilities that are Medicaid Waiver Providers must be licensed residential care facilities and must also apply the “Assisted Living Medicaid Waiver” rules to any resident whose stay is funded through a Waiver. To read those regulations, go to: FSSA Assisted Living Provider Application Packet.

Unlicensed assisted living residences

Although there are no regulations for non-licensed facilities, the contract/agreement outlines the assisted living residence’s obligations. Reading the contract will tell you what you can expect from the facility. State law requires that any facility using the term “ assisted living” to describe itself must provide certain information in the resident contract/agreement. This information includes:

• A description of the services to be included in the base rate and those available at an additional cost.

• Conditions for transfer/discharge from the residence.

• A description of how the resident will be assessed to determine his or her needs.

• Billing and payment requirements.

To learn more about what the contract must contain, go to:

Housing with Services Establishment contracts.

Rights

Residents in assisted living residences that are licensed as residential care facilities have rights under state regulations. You can learn what those rights are by going to: Residents' Rights.

Residents in assisted living facilities that are also Medicaid Waiver providers have an extra set of rights that include the right to have control over their time, space and lifestyle as long as it doesn’t disturb other residents, and the right to exercise decision making to the fullest extent possible.

Even though there are no regulations and therefore no residents’ rights regulations for unlicensed assisted living residences, state law gives residents a number of rights. These rights must be posted in the residence. They include:

• The right to receive a complete copy of your contract with the assisted living community.

• The right to be transferred/discharged from the residence only for the reasons stated in the contract.

• The right to participate in activities away from the community, regardless of the time, duration and distance of the activities.

• The right to have visitors and to receive family members and guests (restrictions may be applied to protect the rights of other residents).

Check the contract to see what additional rights your loved one may have.

Listing of Facilities

Assisted Living Facilities In Central Indiana

This listing identifies all assisted living facilities (licensed and unlicensed) in Marion and the seven surrounding counties, including Medicaid Waiver Providers.

Directory of licensed residential care facilities

This directory lists all licensed assisted living residences (residential care facilities) that are free-standing (not connected to a nursing home). Facilities are listed in alphabetical order.

Housing With Services Establishment Directory

This list includes both licensed residential care facilities and unlicensed assisted living residences that have complied with the law requiring completion of the Housing With Services Establishment Disclosure Form.

Assisted living facilities by Area Agency on Aging and County
www.in.gov/fssa/da/3453.htm

This list indicates free-standing, licensed assisted living residences according to county and Area Agency on Aging.

Checklists and Guides for Choosing an Assisted Living Residence

Finding an Assisted Living Facility

Choosing an Assisted Living Facility
Includes an assisted living checklist and “cost calculator.”

Assisted Living Checklist

Guide to Choosing an Assisted Living Residence

Thinking of Moving to an Assisted Living Residence?

Choosing Assisted Living...What You Need To Know
www.ccal.org/bookstore.htm#choosing_video
Video available for purchase.

Comparing Assisted Living Residences

The Indiana State Department of Health offers a “Residential Consumer Report” to help consumers evaluate and compare licensed residential care facilities.

The report contains:

• A profile of the facility that includes the name of the administrator, the name and address of the entity that hold the license, the number of beds, and more.

• Information about the facility’s past three annual inspections (surveys).

• Information about the number of complaints that have been substantiated.

These reports are currently only for licensed residential care facilities that are free-standing (not part of a nursing home). You should never select a residential care facility solely based on a review of this report. It is very important to visit the residence yourself with your loved one, if possible, and to consult with medical/health care professionals, the ombudsman, elder law attorneys, care managers and others familiar with these facilities.

You can access the site by going to: www.in.gov/isdh/reports/QAMIS/ltc/resrpt/index.htm/.

Costs and Payments

Costs

The average monthly base rate for Indiana in 2008 was $2,573 ($2,448 in Indianapolis).* Note that this is the “base rate;” you usually pay more once you add in the cost of whatever personal care assistance is needed and any medication management.

*Source Metlife Market Survey of Nursing Homes & Assisted Living Costs. 2008.

Payment

Assisted living can be paid for by:

1. Medicaid Waiver

Federal law requires Medicaid to pay for long term care services only when they are delivered in a nursing home or other long term care facility. However, states may negotiate a "waiver" of that requirement in order to provide a full array of home and community based long term care services. To qualify for Medicaid Waiver services, a person must be eligible for Medicaid, and in need of the same level of care as those who qualify for Medicaid nursing home care. Eligibility for a Waiver is based on an in-home assessment done by a care manager from the local Area Agency on Aging, and then reviewed by a state Medicaid case manager.

There are a number of different kinds of waivers. The most common waiver for older adults is known as the Aged and Disabled Waiver. To access Medicaid Waiver services, you must work with your local Area Agency on Aging. For more information read this Consumer Waiver Guide.

Medicaid Waiver only covers services and does not pay for room and board.

2. Long Term Care Insurance

Long term care insurance policies cover long term care expenses once an individual has met a pre-defined set of qualifying criteria. Depending on the policy, assisted living may be covered. Long term care insurance is not for everyone, and it is very important that consumers carefully evaluate the pros and cons and their own financial situation before purchasing a policy. One evaluation tool available to consumers is “The 2007 Self-Assessment Guide for Long Term Care Insurance,” which is produced by the Indiana Long Term Care Insurance Program. That guide, and "The Buyer's Guide to Long-Term Care Insurance," are useful resources for anyone looking into long term care insurance.

3. Veterans Aid and Attendance Benefit

The Aid and Attendance Pension Program provides financial assistance to a qualifying veteran, veteran and one dependent, or a surviving spouse. This benefit can cover care in assisted living. To qualify, a veteran must be eligible for a VA pension, meet service requirements, meet certain disability requirements, and meet income and asset limitations. Aid and attendance is paid in addition to a veteran’s basic pension. It can take up to six months to process an application, so starting early is important. For more information, go to: www.veteranaid.org/.

4. Private pay

Your loved one (or someone else) pays out of their own pocket. The vast majority of assisted living in Indiana is paid for privately.

Getting Good Care For a Loved One

The following are tips to help you get quality assisted living care (in no particular order).

1. Educate yourself. Learn what you have the right to expect.

Make sure you know what the assisted living residence is supposed to provide to your loved one.

• Familiarize yourself with the regulations (if the facility is a licensed residential care facility).

• Read any contract or agreement to learn about the facility’s responsibilities.

• Learn about your loved one’s rights (look in the contract, read written information provided at the time of admission, check out postings in the facility).

If your loved one’s care is paid for through a Medicaid Waiver, familiarize yourself with the Assisted Living Medicaid Waiver rules.

2. Share information about your loved one with staff.

The more staff know about your loved one, the better care they can provide and the better job they can do of giving care in a way that respects what is important to your loved one. Encourage your loved one, if possible, to tell staff what choices he or she would prefer. For instance, if he or she needs help getting out of bed and dressing in the morning, what time should that help be provided? Ask staff what information they need to assist them in creating a good experience for your loved one.

3. Participate in the development of the service/care plan.

The service or care plan states what the staff will do for the resident and when. Residents have the right to take part in developing this plan and can have their family participate as well. Family members who serve as legal representatives for residents who no longer have decision-making capacity should make a point of participating.

• In licensed residential care facilities, the service plan is created or reviewed after an evaluation of the resident. Evaluations must be conducted at least twice a year, upon a major change in the resident’s condition, or when requested by your loved one or you.

• If your loved one’s care is funded through Medicaid Waiver or CHOICE , the care plan will be reviewed every 90 days or when the services your loved one needs/wants change.

• In unlicensed residences, assistance with personal care and medication management is often provided by a home health care agency. The agency will develop a care plan for your loved one. How often the plan is reviewed will depend on the type of care your loved one is receiving.

Regardless of the type of assisted living setting, your loved one or you on your loved one’s behalf can request a service/care plan review at any time.

If your loved one is in an unlicensed residence, it is a good idea to get input from assisted living staff who see your loved one on a daily basis and can tell you if they have observed any changes or increased needs. You can then share that information with home health agency staff or any private caregivers to help in creating or revising the care plan. You will also want to make sure there is good communication between the home health agency staff/private caregivers and the assisted living residence staff.

4. Ask that the same caregivers be assigned to care for your loved one most of the time. This is called consistent assignment and can improve your loved one's quality of care.

5. Visit as often as you can.

In addition to adding pleasure to your loved one’s day, visiting gives you an opportunity to see for yourself how he or she is doing and to send a message to staff that someone is overseeing the care.

Also, try to vary the times you visit and include evenings, weekends, and mealtimes if at all possible.

6. Monitor the care.

• Observe your loved one.

• Talk with your loved one. Ask how things are going and what improvements he or she might like.

• Talk with staff.

• Review the medical records (you must have legal authority or the resident’s permission). Look for:

  
  

  • Information about the resident’s condition and status.

  • Any problems you are not aware of and what is being done about the problems.

  • Whether you are being contacted when there is any significant decline in your loved one’s condition or a need to start/stop any treatment.

  • Whether your loved one is getting the care/services outlined in the service/care plan.

7. Monitor medication assistance or administration for your loved one.

• Ask staff to keep you informed of any issues or problems they observe if your loved one administers his or her own medications or that they experience in administering medications to him or her.

• Keep staff up-to-date on all medications your loved one is taking, including over–the-counter drugs, vitamins, and herbal supplements.

• Share any negative side effects you observe with staff and your loved one’s doctor.

  Read the handout, Taking Medication, for additional information about medication in assisted living facilities.

8. Develop a positive working relationship with staff.

• Get to know staff.

• Treat staff with respect.

• Show appreciation for good work! A "thank you" means a lot.

9. Communicate effectively!!

• Find out who is in charge of what and the best way to contact administration/staff if you have questions or concerns.

• Ask questions when something is unclear.

• State what you mean clearly, politely, respectfully and in language that is free of blame and judgment. Speak up nicely, if something isn’t done, or if it isn’t done the right way. How you communicate is just as important as what you communicate.

• Reinforce positives. Thank staff when a problem has been addressed or when good care has been provided.

10. Keep a journal.

Make notes about:

• Your loved one’s condition and appearance.

• Any change in your loved one’s condition or incidents involving your loved one.

• Any problems. Write down when the problem occurred, the people involved, what happened, where it happened, and indicate what staff said they would do about the problem. Include staff names if you know them.

11. Connect with other families.

If possible, get to know the family members of other residents. Becoming acquainted with other families gives you the opportunity to compare notes about how things are going and to join together if there is a problem affecting not only your loved one, but other residents as well.

Join a family council if there is one. A family council is a group of family members who work to improve the quality of care and quality of life at the assisted living residence. Families have the right to form and participate in a family council in licensed residential care facilities. Start one if none exists. For information about family councils, contact United Senior Action for its manual, “Building Strong & Effective Family Councils in Indiana," or go to: www.nccnhr.org/public/50_152_496.cfm/.

12. Take action when there is a problem!

The sooner you address a concern, the better—problems that go unaddressed can build up over time and can become more difficult to resolve. Don’t be afraid to ask questions or voice concerns if you feel your loved one’s needs are not being met.

Addressing Problems

Listed below are some approaches that you can take to address a problem in an assisted living residence (these steps do not have to be followed in this order).

If possible, check with your loved one to make sure he or she wants action to be taken—remember your loved one has to live in the residence 24 hours a day. In addition, try to involve your loved one as much as possible in problem resolution.

Working with the assisted living residence to resolve the problem

1. Speak with staff.

Start by discussing the problem with the staff that are most directly involved to see if the problem can be corrected. If that is not successful, speak with a supervisor. If your concern has still not been addressed, meet with the administrator/director (whoever is the person responsible for the running and administration of the residence). Document your conversations.

2. Use the assisted living residence’s grievance procedure.

Both licensed and unlicensed assisted living facilities must have a process for handling concerns and complaints. In a licensed residence, the facility has to have a policy for investigating and responding to complaints. Unlicensed facilities must provide a description of the residence’s complaint resolution process in the contract.

Find out what the process is for filing a concern in your loved one’s assisted living facility and use it.

3. Request a special service/care plan review or raise your concerns at the next service/care plan review meeting.

4. Write a letter citing the Fair Housing Act and requesting that accommodations or modifications be made if the residence is seeking to evict your loved one.

Depending on the circumstances, you may be able to use the Fair Housing Act to avoid the transfer/discharge of your loved one. The Fair Housing Act applies to people with disabilities, and this definition includes residents of assisted living residences.

Under The Fair Housing Act, a person with a disability is entitled to:

• “reasonable accommodation:” a change, exception, or adjustment to a rule, policy, practice, or service of a facility;
  
  or

• “reasonable modification:” a structural change to the premises of a facility if such a change would allow the person to continue to live in the residence or to better enjoy his or her living situation.

Sometimes just mentioning the Fair Housing Act to the head of the assisted living residence or writing a letter requesting “reasonable accommodation” or “modification” is enough to stop an eviction. You can access a sample letter by clicking here: "Request for Reasonable Accommodation/ Modification Letter."

For additional help with transfers/discharges, contact the long term care ombudsman (see below).

5. Raise the concern at the family council or to the president of the family council.

A family council is a group of families that work together at the assisted living community to improve the quality of care and quality of life of residents. Councils have the right to form in licensed residential care facilities.

Find out if your loved one’s assisted living residence has a family council. If there is one, talk to the president of the council and ask that the problem be discussed at the next meeting. Even better, attend the council meeting and raise the issue yourself. If other families are experiencing the same problem, the council can communicate the concern to administration and advocate for the problem to be resolved. The facility must respond to concerns expressed by the council.

As noted earlier consider starting a council if none exists. You can start a council even if your loved one resides in an unlicensed assisted living community. There are no regulations prohibiting councils in this setting.

6. Go up the ladder.

If you can’t resolve the matter after having discussed the problem with the administrator/director, go up the “chain of command.” Take the issue to the person to whom the administrator/manager reports. In a large corporation, that might be a regional director or a director of quality assurance. In a nonprofit home, you could go to the board of directors. Ultimately you may want to contact the owner(s) if the problem continues. The contract must provide you with the name and mailing address of the owner or owners of the residence.

For guidance on communicating with and presenting a problem to staff, see:

• Guidelines for Presenting the Problem

• Coaching-based Communication

Seeking help outside the assisted living residence

If one or a combination of the approaches listed above does not resolve the problem, there are organizations, agencies and programs you can turn to for help outside the assisted living residence (these are not listed in any particular order).

1. Contact the Indiana Long Term Care Ombudsman Program.

Long term care ombudsmen serve as advocates for assisted living residents. Ombudsmen work to ensure the health, safety, welfare and rights of residents by:

• Investigating/working to resolve complaints, concerns or problems voiced by residents or their representatives.

• Providing information about residents’ rights and facility responsibilities.

• Working for improvements in the long term care system.

Ombudsman services are free and confidential. Ombudsmen cover both licensed and unlicensed assisted living communities. Each assisted living residence community is covered by a long term care ombudsman. If you don’t know who your local ombudsman is or how to reach your local ombudsman, you can contact the state office.

Indiana Long Term Care Ombudsman Program

Division of Aging

402 West Washington Street

P.O. Box 7083 MS 21

Indianapolis, IN 46207-7083

(317) 232-7134 or (800) 622-4484
www.in.gov/fssa/da/3474.htm

2. Consult a private geriatric care manager or your loved one’s CHOICE or Medicaid Waiver care manager.

Care managers can help resolve problems. A private geriatric care manager is usually either a nurse or a social worker and brings knowledge and expertise to the problem. Geriatric care managers charge a fee for their services and most will also bill for out-of-pocket expenses (mileage, long-distance calls, etc.). To learn more about private geriatric care managers and get a list of geriatric care managers in Indiana go to: caremanager.findlocation.com/.

If your services are funded through the Medicaid Waiver or CHOICE programs, you can ask your care manager to help solve the problem. The care manager can work with you and the agency to reach a solution.

3. File a complaint with the Indiana State Department of Health (for licensed residential care facilities only).

The Indiana State Department of Health (ISDH) investigates complaints about care, treatment, rights, staffing, food and other conditions and services in licensed residential care facilities.

It is important that you provide ISDH with as much detail as you can when filing a complaint. See the ISDH website at www.in.gov/isdh/21533.htm for guidance in preparing a complaint.

You can file a complaint by:

• Phoning: 1-800-246-8909. You should follow up the call with a written letter that includes as much detail about the problem as you can provide.

• Emailing: complaints@isdh.in.gov

• Writing to the:

  Indiana State Department of Health
  Division of Long Term Care
  2 North Meridian Street, 4B
  Indianapolis, IN 46204

4. File a complaint with the Indiana Division of Aging.

If your loved one’s services are funded through the Medicaid Waiver or CHOICE program and working with the AAA or other care manager has not resolved the problem, contact the Division of Aging to report the problem.

Division of Aging

402 W. Washington Street

P.O. Box 7083, MS21

Indianapolis, IN 46207-7083

317-232-7132 or 800-545-7763, ext. 2-7132

www.in.gov/fssa/2329.htm

Other Resources For Complaint Resolution

Adult Protective Services (APS)

Adult Protective Services investigators investigate reports of abuse, neglect or exploitation of endangered adults 18 years or older. If you do not know the address of your local APS investigator, you can contact the state office.

Adult Protective Services

Division of Aging

402 West Washington Street

P.O. Box 7083 MS 21

Indianapolis, IN 46207-7083

317-232-0135 or 1-800-992-6978
www.in.gov/fssa/da/3479.htm

Medicaid Fraud Control Unit

The duties of the Medicaid Fraud Control Unit include investigation of abuse and neglect of residents of assisted living facilities that receive Medicaid funding through the Medicaid Waiver and theft of residents’ personal funds. They can also be reached at:

Medicaid Fraud Control Unit

8005 Castleway Drive

Indianapolis, IN 46250

317-232-6520 or 800-382-1039
www.in.gov/attorneygeneral/consumer/medicaid

Law Enforcement Agencies

Local law enforcement agencies are responsible for investigating crimes wherever they occur. Should you believe that your loved one has been the victim of a crime in an assisted living residence, contact a local law enforcement agency immediately.

Protection and Advocacy Services

Protection and Advocacy Services works to address concerns about care, treatment and rights of residents who are developmentally disabled and/or mentally ill. They can be reached at:

Protection and Advocacy Services

4701 N. Keystone Avenue

Suite 222

Indianapolis, IN 46205

317-722-5555 or 800-622-4845
www.in.gov/ipas

Licensing Boards

There are a variety of boards that license health professionals such as residential care facility administrators, doctors, and nurses. These boards also investigate complaints filed against these health care professionals. To file a complaint, you must submit a complaint form to the Indiana Attorney General. You can obtain a complaint form by calling 800-382-5516 or 317-232-6330. Once completed, submit the form to:

Consumer Protection Division

Office of the Indiana Attorney General

302 W. Washington St., 5th Floor

Indianapolis, IN 46204
www.in.gov/attorneygeneral

Legal Assistance

Elder Law Firms

Private attorneys can often resolve a problem or assist you in seeking compensation and justice when your loved one has been harmed or neglected in an assisted living residence. It is important to get help from an attorney who is knowledgeable about assisted living laws and regulations and who is familiar with issues involving care in this setting.

“Elder law” attorneys may be of particular assistance in resolving a concern since they focus their practice on issues frequently confronted by older adults and their families. In Indiana, certain attorneys have been certified as specialists in Elder Law. To locate an elder law attorney in your area, go to: www.naela.org/MemberDirectory/.

Indiana Legal Services, Inc.

Indiana Legal Services provides free assistance to those who meet certain financial criteria. For more information and to locate an office, go to: www.indianajustice.org/Home/PublicWeb/LegalSvcs/.

Appeals Process: For Medicaid Waiver Clients Only

If your concern is related to a decision about services, there is an appeal process you can use to challenge the decision. For information about how to appeal a Medicaid Waiver decision, read “Your Appeal Right as an Applicant for HCBS Benefits.”

Additional Resources

Resident’s Guide for Assisted Living
www.assisted-living411.org

Assisted Living Consumer Alliance

www.assistedlivingconsumers.org

Consumer Consortium on Assisted Living(CCAL)

www.ccal.org

Center for Excellence in Assisted Living

www.theceal.org/clearinghouse