Des Moines Senior AdvisorWho can an Iowa assisted living program not admit or keep?
Under 481 IAC 69.23 a program may not knowingly admit or retain a tenant who is bed-bound, needs routine two-person help to stand, transfer or evacuate, is dangerous to self or others despite intervention, is medically unstable, needs maximal help with daily activities, or needs more than part-time or intermittent health-related care.
- Is bed-bound
- Requires routine two-person assistance with standing, transfer or evacuation
- Is dangerous to self or other tenants or staff despite intervention
- Is in an acute stage of alcoholism, drug addiction or uncontrolled mental illness
- Is under 18
- Requires more than part-time or intermittent health-related care
- Has unmanageable incontinence on a routine basis despite an individualized toileting program
- Is medically unstable
- Requires maximal assistance with activities of daily living
- Chronically urinates or defecates in places that are not acceptable despite intervention
These are the outer limits. A program may add its own criteria if they are disclosed in the written occupancy agreement before the tenant signs, so two buildings in West Des Moines can reasonably have different limits.
What does part-time or intermittent care mean in Iowa assisted living?
Licensed nursing services and professional therapies, combined with nurse-delegated help with medications or daily activities, that do not exceed 28 hours a week (481 IAC 67.1).
The 28-hour line is the most common reason a tenant has to leave assisted living for a nursing facility. Hospice is different: Iowa Code 231C.3 lets a terminally ill tenant receive Medicare hospice in the program under a written agreement between the program and the hospice, which keeps professional management of the hospice care. Rules also define “maximal assistance” as total dependence on staff for at least four daily activities for more than 21 days, and “medically unstable” as three or more significant hospitalizations in three months plus frequent RN supervision.
Can an Iowa program keep a tenant who exceeds the limits?
Sometimes. A program may ask DIAL for a waiver of the retention criteria for a particular tenant (481 IAC 67.7), and Iowa Code 231C.3 contemplates short-term waivers so a tenant can stay while the situation is evaluated.
Ask early whether the program has ever sought a retention waiver and how it went. Programs on a campus with nursing facility beds often prefer an internal move instead. If a waiver is not possible, the program must help the tenant and family arrange a safe and orderly transfer (481 IAC 69.23(3)), which in practice means time to tour alternatives and coordination with the next provider.
What happens if a Des Moines assisted living program wants a tenant to move out?
The program must notify the tenant in the way the occupancy agreement describes, give the reason and the tenant advocate's contact information, and offer its internal appeal process; the tenant advocate, part of the State Long-Term Care Ombudsman's office, can help with that appeal (Iowa Code 231C.6).
If DIAL itself finds during a monitoring or complaint investigation that a tenant exceeds the criteria, a separate procedure applies: the program may appeal DIAL's finding, and the tenant may stay while the appeal is pending, with a hearing within 30 days. Families should call the ombudsman's office at 1-866-236-1430 as soon as a transfer notice arrives.
What evaluations come before and after a move-in?
The program must evaluate the tenant's functional, cognitive and health status before the occupancy agreement is signed, again within 30 days of moving in, and at least once a year or after a significant change, using a scored, objective cognitive tool (481 IAC 69.22).
When the cognitive score shows moderate decline, the program switches to the Global Deterioration Scale to track it. A service plan must exist before move-in for tenants who need personal or health-related care and be updated within 30 days of occupancy, and an RN, or an LPN through nurse delegation, reviews tenants receiving health-related care at least every 90 days (481 IAC 69.27). Ask to attend the 30-day review.
Side by side
| Iowa assisted living can serve | Iowa assisted living cannot serve | |
|---|---|---|
| Health care | Part-time nursing and therapy, up to 28 hours a week | Continuous skilled nursing |
| Mobility | Tenants who need one-person help or a wheelchair | Routine two-person transfers or bed-bound tenants |
| End of life | Medicare hospice under a written agreement | Care that becomes maximal for more than 21 days, absent a waiver |
| Behavior | Tenants whose behavior can be managed with intervention | Tenants dangerous to others despite intervention |
Drawn from Iowa Code chapter 231C, 481 IAC chapters 67 and 69, Iowa HHS and DIAL publications, CareScout, CMS, the VA and the aging agencies cited in the text; our editorial standards explain how we check them.
