Office of the Assisted Living Registrar

Operating an Assisted Living Residence

Operators of assisted living residences in British Columbia are expected to embrace the philosophy and core principles of assisted living. The philosophy of assisted living is to provide housing, with appropriate support and personal assistance services to enable residents to maintain an optimal level of independence. The core principles of assisted living — choice, privacy, independence, individuality, dignity and respect — derive from the recognition that adults, even when they need support and assistance in daily life, retain the ability and right to manage their own lives.

To become registered with the Office of the Assisted Living Registrar and to maintain their registration, operators must meet the obligations set out below.

Obligations of an Operator

Operators of assisted living residences in British Columbia must:

  • comply with the Community Care and Assisted Living Act, the Assisted Living Regulation and the Community Care and Assisted Living Regulation, the provincial Health and Safety Standards [PDF 272 Kb], and the Office of the Assisted Living Registrar’s policies and procedures.
  • not house people who are unable to make decisions on their own behalf. This is a requirement under the Community Care and Assisted Living Act, except if:

    • the spouse of the resident is housed in the same residence and is able to make decisions on behalf of that resident; or
    • the resident is an involuntary patient on leave under section 37 of the Mental Health Act.

  • implement an effective process to ensure that employees, contracted resources and volunteers do not have a criminal record or personal histories that would place the health and/or safety of residents in jeopardy.
  • maintain a “watchful eye” over residents’ health and safety.
  • provide professional oversight of non-professional staff, as required.
  • communicate the residence’s internal complaint process in a manner that is readily accessible to residents, staff and visitors.
  • communicate the Office of the Assisted Living Registrar’s complaint process and contact information in a manner that is readily accessible to residents, staff and visitors.
  • not prevent anyone from reporting their concerns to the Office of the Assisted Living Registrar.
  • renew their registration annually.
  • advise the Office of the Assisted Living Registrar in a timely manner of any changes to registration information.

For more information on the policies and procedures for operating assisted living residences and maintaining registrations in good standing, see the Registrant Handbook excerpts below.

Health and Safety Standards

Operators must ensure that assisted living residences are operated in a way that does not jeopardize the health or safety of residents. The provincial Health and Safety Standards [PDF 272 Kb] set out the requirements, which are detailed in the Registrant Handbook. The Assisted Living Registrar enforces the standards through a complaint investigation process.

The Health and Safety Standards are high-level and outcome-based. Rather than prescribing how to do something, the standards state the outcome to be achieved and include examples of what constitutes compliance.

The Health and Safety Standards are as follows:

  • Registrants must provide a safe, secure and sanitary environment for residents.
  • Registrants must ensure hospitality services do not place the health or safety of residents at risk.
  • Registrants must ensure sufficient staff are available to meet the service needs of residents and that staff have the knowledge and ability to perform their assigned tasks.
  • Registrants must ensure residents are safely accommodated in their assisted living residence, given its design and available hospitality services and prescribed services.
  • Registrants must develop and maintain personal services plans that reflect each resident’s needs, risks, service requests and service plan.
  • Registrants must ensure personal assistance services are provided in a manner that does not place the health or safety of residents at risk.

Within the framework of the Health and Safety Standards, the Community Care and Assisted Living Act and regulations, operators may develop policies, systems, methods and procedures to achieve their organizational goals and objectives.

Registrant Handbook

The Office of the Assisted Living Registrar issues the Registrant Handbook to operators of registered assisted living residences (i.e., registrants). The handbook sets out operators’ obligations and the Office of the Assisted Living Registrar’s policies and procedures. It also provides reference material to assist operators in fulfilling their obligations. The handbook is intended to be used as a guide for day-to-day residence operations, interaction with the OALR and staff training.

The OALR issues a complimentary copy of the handbook to the residence site manager after receiving an application for registration and the application fee. It is also available for purchase from the OALR — contact the office for more details.

Overview

Introduction [PDF 55 Kb] — outlines the purpose and use of the Registrant Handbook and explains the Assisted Living Registrar’s mandate and the OALR’s guiding principles.

Policies

Complaint Resolution [PDF 69.3 Kb] — discusses the operator's and the OALR’s complaint resolution processes.

Food Safety [PDF 50.6 Kb] — outlines safe food-handling practices for operators who house six or fewer residents. Operators of larger residences, who must have a Food Premises Permit, may also be interested in reviewing this policy.

Health and Safety Standards [PDF 272] — the six high-level outcome-based health and safety standards for assisted living residences, related outcomes, and examples of how operators can demonstrate compliance with the standards.

How to Maintain Your Registration [PDF 57.3 Kb] — outlines what an operator needs to do on an ongoing basis to keep the OALR’s information about the registered residence up to date.

Meal and Dietary Services [PDF 91.3 Kb] — explains the difference between meal service (one of the five required hospitality services) and therapeutic diets (one of the personal assistance areas an operator can offer in an assisted living residence).

Medication Services [PDF 91.7 Kb] — details four levels of medication assistance that can be provided in assisted living, and the policies and procedures an operator must have in place to provide medication assistance at the prescribed level.

Operating an Assisted Living Residence [PDF 67.3 Kb] — an overview of key features of the assisted living service delivery model.

Personal Assistance Guidelines [PDF 639 Kb] — details how operators ensure appropriate professional oversight of non-professional staff.

Personal Assistance Services [PDF 57 Kb] — an overview of the difference between offering personal assistance at the support and prescribed levels, the health and safety standards that apply to providing personal assistance at the prescribed level, and how operators ensure appropriate professional oversight of non-professional staff.

Registrant Obligations [PDF 46.3] — an overview of registrants’ obligations under the Community Care and Assisted Living Act.

Resident Entry and Exit [PDF 321 Kb] — this key policy details how operators should interpret and apply section 26(3) of the Community Care and Assisted Living Act. The section prohibits an assisted living operator from housing people who are unable to make decisions on their own behalf. It explains how operators should screen residents for suitability for entry, keep a watchful eye over residents during their stay at the residence to ensure ongoing suitability, and start the exit process when residents are no longer able to make the range of decisions necessary to function safely in the residence.

More information on Entry and Exit Requirements >
More information on Transferring to Other Care >

Serious Incident Reporting [PDF 50.8 Kb] — details what constitutes a serious incident that must be reported to the OALR, and how to report it.

Forms

Personal Assistance Services Self-Assessment Worksheet [PDF 304 Kb] — this worksheet helps operators and applicants assess the extent to which they are offering personal assistance in any of the six service areas, and whether they are doing so at the prescribed level. Applicants for registration should submit the completed worksheet with their application.

Serious Incident Report Form [PDF 185 Kb] — this form must be filled in by residence site managers when reporting serious incidents such as attempted suicides, unexpected deaths, disease outbreaks, abuse or neglect by staff, medication errors and fires. The form must be submitted to the Office of the Assisted Living Register no later than the next business day after a serious incident.

Building Inspections

Registered assisted living operators must ensure that:

  • all required inspections are conducted at the prescribed intervals;
  • all orders and other requirements of the applicable authorities are complied with; and
  • copies of inspection reports, orders and correspondence with applicable authorities are retained and made available to the Registrar upon request.

Marketing an Assisted Living Residence 

The Office of the Assisted Living Registrar does not refer clients to operators. However, operators of private-pay assisted living units can advertise for residents:

  • at local health units
  • in seniors’ and community centres
  • in newspapers and seniors’ publications (including Internet publications) — especially those about housing.

Also, health authority case managers can refer private-pay clients to private-pay assisted living units. The case manager’s role is to provide information about any services or resources that might be of assistance to the client, including both publicly subsidized and private-pay services. For publicly subsidized units, a health authority case manager determines whether someone is eligible and refers that person to the assisted living residence.

Pricing Assisted Living Services

The Office of the Assisted Living Registrar does not have information about the market rates for assisted living services.

Operators of private-pay assisted living units must determine how much it will cost to provide services and how much profit they want to make, and then price their services accordingly. Some operators charge a fixed rate for a package of services; others charge on a fee-for-service basis; still others charge a combination of the two.

Operators of publicly subsidized assisted living units negotiate multi-year agreements with health authorities and BC Housing for Independent Living BC projects, which include a monthly per-unit cost for the provision of services.

Staffing

Type of Staff Required

Assisted living has a non-professional staffing environment. This is in keeping with the assisted living philosophy, which is to deliver housing with supports rather than medical care. There are several requirements in terms of staff qualifications:

  • All staff (whether they are employees or on contract) and volunteers must have the necessary knowledge, skills, abilities and training to perform their designated tasks and meet the health and safety needs of the residents. For example:
    • Staff who provide personal assistance services must have either a college-level home support/resident care aide certificate or an equivalent combination of education and experience; and
    • Operators must ensure that a person with appropriate training and skills develops personal services plans.
  • Operators must maintain documentation on staff selection and training and have it available for review by the Registrar.

Number of Staff Required

There are no specific staffing requirements or ratios (i.e., rules about the maximum number of residents per staff person) in assisted living. However, operators must ensure that sufficient staff are available to meet the service needs of residents and that staff have the knowledge and ability to perform their assigned tasks.

The Role of Health Professionals

Even though assisted living provides a non-professional staffing environment, the Personal Assistance Guidelines and the Medication Services Policy require a professional (e.g., a registered nurse or registered psychiatric nurse) to delegate some tasks, such as assisting with medication. Delegation of a task means that the professional is responsible for determining that it is safe and suitable to delegate a particular task for a specific resident to an unregulated care provider. The professional teaches the staff member to perform the task and supervises the performance of the delegated task. In assisted living for seniors, typically a registered nurse performs delegation.

Licensed practical nurses can also assign a task to a non-professional staff member, provided the task is already within the education and knowledge base of the staff member. However, licensed practical nurses cannot educate or train non-professional staff to perform a task that is not already within their scope of education and knowledge.

 

24-Hour Emergency Response System 

Operators must provide a 24-hour emergency response system that is appropriate to the needs of the assisted living residents (Health and Safety Standards [PDF 272 Kb], Outcome 2.4.1). Some operators have staff on-site to provide a 24-hour emergency response. Other operators provide a 24-hour response by staff or an emergency contact being in close proximity or otherwise available (i.e., able to respond in 15 minutes or less). Operators also need protocols that define response times and the type of response to be provided.

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