In some states, the period may be for periods as short as seven consecutive bed-ridden days. Issues associated with the provision of skilled nursing services in an assisted living residence As ALRs were envisioned, there are circumstances under which residents might need to receive skilled nursing care in the ALR, just as the resident would need this care if they were in their home. The extent to which a resident who needs skilled nursing services can be admitted or retained has been a point of contention in some states. The concern was that the restrictions might violate the Americans with Disabilities Act or the federal Fair Housing Act Amendments of 1988, because the limitations pro-hibit prospective residents from living in an ALR based on health status. Where residents in assisted living facilities need specialized, skilled medical care for short periods of time, there are several ways that assisted living facilities accommodate their residents needs.
Some large facilities employ a full-time nursing staff to provide care.
1 Other facilities arrange for care from visiting nursing associations and home health agencies. Since, for an increasing number of the elerly, home is the ALR, home health care services will be provided at the ALR, either in the residential unit or space in the ALR which is available for this purpose. Arrangements to provide this care are either done informally through referral, or more formally, as is the case when an ALR contracts with the home health agency to be the provider for all residents when care is needed. Alternatively, some providers may view this as the opportunity to esta-blish their own home health agency. The market for home health services has increased dramatically over recent years, and services in ALRs are only one aspect of this.