Operating a Seniors' Assisted Living Residence

In British Columbia, the goal of assisted living is to provide individuals with housing, appropriate support and personal assistance services that enable them to maintain an optimal level of independence. The principles of assisted living — choice, privacy, independence, individuality, dignity and respect — come from the recognition that adults, although they may need support and assistance in daily life, maintain the right to manage their own lives. Operators of assisted living residences play an important role in supporting and promoting the goal and principles of assisted living.

Obligations of Operators

To become registered in British Columbia and to maintain registration, operators must operate assisted living residences in a way that does not jeopardize the health or safety of residents, which includes:

  • Meeting the terms of 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, and the assisted living registrar’s administrative policies and procedures.
  • Not accepting or continuing to provide housing and services to people who are unable to make decisions on their own behalf unless:
    • the resident lives with a spouse who is able to make decisions on behalf of the resident.
    • the resident has been sent to the residence on leave from a designated facility, such as a provincial mental health facility, psychiatric unit or observation unit (as an involuntary patient on leave under section 37 of the Mental Health Act).
  • Ensuring that owners, site managers, employees, volunteers and contractors where appropriate have a current criminal record review (within 5 years) as required under the Criminal Records Review Act.
  • Maintaining a watchful eye over residents’ health and safety.
  • Providing professional oversight of non-professional staff, as required.
  • Informing residents, staff and visitors about how to make a complaint, including:
    • how to make an internal complaint at the residence;
    • how to make a complaint to the assisted living registrar;
    • how to make a complaint to the health authority patient care quality office (for residents living in publicly subsidized units); and,
    • ensuring the complaint process and contact information for the assisted living registrar and the health authority patient care quality office is readily accessible.
  • Not preventing or intimidate anyone from reporting their concerns to the assisted living registrar and/or the health authority patient care quality office.
  • Renewing registration annually.
  • Advising the registrar in a timely manner of any changes to registration information.

The registrant handbook provides more information on the required administrative policies and procedures for operating assisted living residences and maintaining registration.

Registrant Handbook

The registrant handbook is a guide for day-to-day residence operations, staff training and interaction with assisted living registry staff. It sets out the health and safety standards and guidelines and the registrar’s administrative policies and procedures. The handbook also includes additional reference material to assist operators in fulfilling their responsibilities. Health and safety standards are the same for publically subsidized and private-pay assisted living units and are not optional.

Registry staff provide a copy of the handbook to operators after receiving an application for registration and the application fee. Additional copies can be purchased by contacting registry staff or downloaded here.

Health and Safety Standards

The registrar sets out minimum provincial health and safety standards and guidelines. Registry staff assist operators in understanding the standards through the registration process, and further educate operators upon request or in the event that a residence undergoes a complaint investigation. There are specific health and safety standards for different resident populations:

Serious Incident Reporting

A serious incident report form must be filled in by residence site managers after a serious incident has occurred. Serious incidents include: 

  • attempted suicide by a resident;
  • unexpected deaths;
  • abuse or neglect;
  • medication errors;
  • fire or flood;
  • missing persons;
  • police calls; and
  • other incidents that the site manager believes are serious and should be reported.

Forms must be faxed to the assisted living registry (1-250 952-1119), using a cover sheet, no later than the next business day after a serious incident occurs.

Staffing

Assisted living provides housing with supports (hospitality and prescribed services) rather than ongoing care. There are no specific staffing requirements about the maximum number of residents per staff person in assisted living. All staff (whether they are employees or on contract) and volunteers must have the necessary knowledge, skills, abilities and training to perform their tasks and meet the health and safety of residents. Operators must provide professional oversight of unregulated care providers – i.e., by a registered nurse, registered psychiatric nurse or licensed practical nurse. Site managers do not need specific background or training, though site management must be effective and appropriate to the resident population. The health and safety standards require that operators:

  • ensure that staff who provide prescribed services have a home support and/or resident care aide certificate or equivalent;
  • maintain documentation on staff selection and training; and,
  • assign a person with appropriate training and skills to develop a personal service plan for each resident.

Operators must provide a 24-hour emergency response system that is appropriate to the needs of the residents and meets the unique features of their building and location. An operator can adopt a combination of staffing, procedural and/or mechanical or electronic emergency call devices. Many residences have staff on-site to provide a 24-hour emergency response.

The Role of Health Professionals

The provincial Personal Assistance Guidelines and the medication services health and safety standards require a professional (e.g., a registered nurse, registered psychiatric nurse, occupational therapist or physical therapist) to delegate certain 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 unregulated care provider how to perform the task and is responsible for supervising how the delegated task is carried out. In assisted living for seniors, typically a registered nurse performs delegation.

Licensed practical nurses (LPN) can accept a delegated task, provide oversight and assign tasks to an unregulated care provider, provided the task is within the LPN’s scope of practice and the LPN is competent to do the task them self,  but they cannot delegate tasks. For more information about delegating and assigning tasks, please see the Personal Assistance Guidelines (PDF, 172KB).

Finding Information About an Assisted Living Residence

All registered seniors’ residences (as they become registered) are listed on the assisted living registry website by community and by health authority. The listing includes the address and contact information of the residence and any substantiated complaint information about the residence.

Assisted living registry staff cannot:

  • provide information about marketing of assisted living residences;
  • promote particular assisted living residences;
  • refer individuals or families to assisted living residences; or
  • have or provide information about financing or funding for operators of assisted living residences.

Complaints

Assisted living registry (ALR) staff investigate complaints related to the health and safety of persons living in assisted living residences. Anyone with a concern about the health or safety of an assisted living resident can make a complaint to the registry, including: a resident, a family member, a friend of a resident, residence staff, health authority staff or a member of the public.

Substantiated complaints are posted on the assisted living registry website next to the residence contact information for two years.

Cost of Assisted Living Services

Regional health authority staff provide information on the cost of assisted living services in publicly subsidized residences.

Operators of private-pay assisted living residences provide information on the cost of assisted living services to prospective residents and their families. Some private operators set a fixed price for a package of services; some charge on a fee-for-service basis; and others charge a combination of the two.

Legislation

Operators of assisted living residences must comply with all applicable legislation, which includes:

British Columbia Building Code Regulation

The B.C. Building Code Regulation establishes minimum standards for health, safety, accessibility, fire and structural protections of buildings and protection of the building from water and sewer damage.

British Columbia Fire Code Regulation

The B.C. Fire Code Regulation establishes minimum standards for health, safety and fire protection of buildings and facilities, including assisted living residences.

Community Care and Assisted Living Act

The Community Care and Assisted Living Act establishes a mandatory registration requirement for all assisted living residences and provides for an Assisted Living Registrar to administer the part of the Act that relates to assisted living residences. It also requires community care facilities, which house a more vulnerable and dependent population, to be licensed under the Act.

Community Care and Assisted Living Regulation

The Community Care and Assisted Living Regulation defines the prescribed services. An assisted living operator may not offer more than two prescribed services to residents. By contrast, an operator of a community care facility may offer three or more prescribed services.

Assisted Living Regulation

The Assisted Living Regulation specifies the length of a registration, application and registration fees, and health and safety standards for medications.

Drinking Water Protection Act and Regulation

The Drinking Water Protection Act and Regulation set out certain requirements for drinking water operators to ensure the provision of safe drinking water to their customers.

Food Premises Regulation

The Food Premises Regulation of the Public Health Act sets out public health requirements for businesses that supply and serve food to the public. Operators of assisted living residences who house seven or more residents must have a food premises permit. Public Health Inspectors (Environmental Health Officers) in the health authorities are responsible for inspecting food premises, issuing permits and investigating complaints.

Health Act

The Health Act and its regulations deal with a range of public health matters relevant to assisted living residence operators, such as food safety, drinking water safety, personal services establishments, communicable disease management, sewerage systems, and pools and spas.

Health Act Communicable Disease Regulation

The Health Act Communicable Disease Regulation sets out what a reportable communicable disease is, and appropriate control measures.

Personal Services Establishment Regulation

The Personal Services Establishment Regulation specifies that operators of personal services establishments must maintain and operate their establishments, and equipment and instruments used for the service, in a way that prevents health hazards from occurring. Some health authorities require personal services establishments to be inspected and approved before operating.

Sewerage System Regulation

The Sewerage System Regulation to the Public Health Act applies to private sewerage systems; holding tanks and domestic sewage; waterborne waste from the preparation and consumption of food and drink, dishwashing, bathing, showering; and general household cleaning and laundry.

Swimming Pool, Spray Pool and Wading Pool Regulations

The Pool Regulation to the Public Health Act apply to all pools in B.C., except private residential pools, and to all auxiliary structures and equipment required for the use or operation of pools.

Operators are also expected to meet local government bylaws and should consult their local government to find out what bylaws apply to assisted living residences.

Registering a Seniors’ Assisted Living Residence

If a residence or a part of a residence meets the definition of assisted living according to the Community Care and Assisted Living Act, an operator is required to register the residence with the assisted living registrar, whether publicly subsidized or private-pay. Before approving an application for registration, the assisted living registrar must be satisfied that housing, hospitality services and personal assistance services (referred to as prescribed services), such as regular assistance with activities of daily living, medication services, or psychosocial supports will be provided to residents in a way that does not jeopardize their health or safety.

Refer to Should I register my residence? (PDF, 1.1MB) for assistance with determining whether you will need to register your residence.

The Goal of Registration

The goal of registration is to strengthen services by:

  • ensuring individuals have access to accurate and relevant information needed to make informed choices about residences that provide housing, supports and services when planning for their future;
  • providing a consistent standard of health and safety, including clear policies and standards;
  • strengthening protections for vulnerable individuals from abuse and neglect; and
  • increasing transparency and accountability for resolving health and safety concerns and complaints.

The Application Process

Prescribed Services

An operator should complete the Personal Assistance Services: Self-Assessment Worksheet to determine if they are providing prescribed services in any of the six service areas described in the Community Care and Assisted Living Regulation. If an operator is or intends to provide one or two prescribed services, they are required to register their residence. A residence providing more than three prescribed services cannot be registered as an assisted living residence.

Application Form and Package

The application package is available by selecting the relevant link below or by contacting the assisted living registry.

Supporting and Required Information

In addition to the completed application form, an operator must also provide copies of information and/or documents as set out in the relevant health and safety standards:

Fees

Fees are established in the Assisted Living Regulation. A one-time non-refundable application fee of $250 must be included with the completed application. Applications will not be processed until payment is received.

An annual registration fee of $12.50 per registered unit must be paid separately when the application is approved. For the purpose of registration, a suite/apartment is counted as one unit regardless of how many people living in the suite are receiving assisted living services.

The registration year runs April 1 – March 31. Registration fees are prorated semi-annually.

  • Residences that begin operation between April 1st and September 30th, pay $12.50 per unit.
  • Residences that begin operation between October 1st and March 31st, pay $6.25 per unit.

All cheques must be made payable to the Minister of Finance.

Submission

Submit the application form, the prescribed services worksheet and/or the personal assistance services self-assessment worksheet, required documentation, along with cheques for required fees, to the assisted living registry. The application must be submitted at least two months before opening a residence. An applicant cannot operate an assisted living residence until the application is approved. It is the responsibility of the applicant to meet all registration requirements and follow up with third parties such as local governments and fire departments to obtain supporting documents. If accompanying documents are not available at the time of submission, applicants can submit them as they become available, but they must be received by the assisted living registry before the application can be approved.

The Application Review Process

When an operator’s application is received, registry staff will:

  • contact the applicant by phone or by email to inform them that their application has been received;
  • send the applicant a registrant handbook and complaint brochures;
  • review the application and identify if information is incomplete or missing or if the information does not appear to meet health and safety standards;
  • inform the applicant if information is incomplete or missing;
  • follow up on any outstanding gaps in the application, or in meeting the health and safety standards that need to be addressed;
  • schedule and conduct a telephone interview with the operator and site manager to review the application and ensure the applicant is aware of and complies with the health and safety standards; and
  • arrange a site inspection.

Approval of Registration

The application will be approved for registration when the registrar is satisfied that the housing, hospitality services and prescribed services will be provided to residents in a manner that will not jeopardize their health and safety.

When the application has been approved, registry staff will:

  • Issue an invoice for the registration fees;
  • Upon receipt of payment, issue a registration certificate; and
  • Update the assisted living registry and the assisted living registry website listings.

Refusal of Registration

If the registrar is not satisfied that services can be provided in a manner that will ensure resident health and safety, and decides to refuse the registration, the registry staff will advise the applicant in writing of the reasons for the decision and the reconsideration process.

The applicant will then have 30 days in which to submit reasons why the decision should be reconsidered. If the application for registration is still refused, the applicant may appeal to the Community Care and Assisted Living Appeal Board.