NY MPA Proposal 9: Assisted Living Reform

Proposal 9 of New York’s Master Plan for Aging aims to raise the bar for assisted living residences (ALRs) by 2028 through stricter care standards, expanded specialized services, and broader use of modern technology. Key measures include requiring ALRs to secure national accreditation (Joint Commission, CARF International, or ACHC), revising regulations to permit higher-acuity care, and promoting digital integration with healthcare providers. Together, these steps are intended to strengthen consumer trust, reduce operational risks, and enhance both clinical outcomes and residents’ social well-being.

The MPA Stakeholder Advisory Committee determined that this proposal's potential impact (based on ROI, consensus/support, and urgency) is medium and its feasibility (based on cost and difficulty of implementation) is high. The MPA Council determined that the potential timeline would be long-term and would have fiscal implications.

Summary of Proposal 9

Here are the key points:

• Accreditation Requirement: All ALRs must seek accreditation from recognized organizations (Joint Commission, CARF International, ACHC) by 2028. Dementia certification will also be required, with accreditation becoming a condition of licensure and re-licensure.
• Regulatory Reforms: Amend state laws and regulations (including social services law 460–461) to allow ALRs to serve higher-acuity residents.
• Enhanced Case Management: Establish programs to coordinate primary care, therapies, and ancillary services on-site, with access to social workers, nurses, and physicians.
• Infection Control and Training: Require infection control standards and staff training across all ACFs to reduce dependence on local health departments.
• Electronic Health Platforms: By 2027, require and fund electronic health platforms for nursing homes and ALRs, with support for providers lacking broadband access.
• Provider Partnerships: Mandate that ALRs have agreements with healthcare providers (NPs, PAs, RNs, social workers, pharmacists, mental health providers) to ensure comprehensive, wraparound services for residents.

Full Text of Proposal 9

Summary

Combine accreditation programs and regulatory reforms to drive higher quality care and improved access to specialized services at assisted living residences. Encourage integration, including digital systems, into larger network of care providers.

Justification

Accreditation of assisted living residences (ALRs) through tested and comprehensive quality metrics and the establishment of enhanced case management programs for ALRs to improve coordination of care will bolster consumer trust. This will also reduce the risk to ALR operators. Overall, this set of actions will result in improved clinical and social health outcomes.

Full Proposal

1. All ALRs would begin the process of seeking accreditation from either the Joint Commission, CARF International or the Accreditation Commission for Health Care by 2028. This would provide ample time to focus on quality, secure funding and be actively engaged (after application) to prepare for survey readiness with the accrediting organization. Accreditation would allow for thoughtful building of quality driven organizations and would allow benchmarking of assisted living providers and would be considered as a requirement of licensure and re-licensure.
2. Amend state law and regulations that currently prohibit ACFs from meeting the needs of higher-acuity residents that result in inefficient and untimely off-site medical and clinical care, ineffective segregated memory care units, low staffing ratios, and insufficiently trained staff. Ultimately, this will result in a less stressed healthcare ecosystem and recognizes the complexity of needs of an aging New York by:

a. Creating a separate enhanced case management program which coordinates primary care, ancillary services, and therapies onsite at the  ALRs.

b. Requiring in-house or contract with social workers, nurses, and physicians to efficiently and timely address acute medical needs, including a repeal of sections of social services law 460-461.

c. Requiring infection control standards and training for all ACFs that will result in decreased reliance on local health departments.

d. Requiring all ALRs, as a condition of licensure, to obtain accreditation from a nationally accepted accrediting organization, including need for dementia certification from such accrediting institution to promote quality and standardization of how ALRs operate, professionalization of the staff employed by these facilities and overall decrease in reliance of emergency departments.

e. By 2027, require and fund electronic health platforms for all nursing homes and assisted living providers, and recognize additional support may be needed, especially for those with limited access to broadband.

f. Require that all ALRs have agreements in place to partner with other types of providers, including nurse practitioners, physician assistants, registered nurses, care managers, social workers, pharmacists, and others, including mental health providers that ensure residents are offered wrap-around services.

---

MPA Council Commentary: This proposal is categorized as long-term. Implementation of this proposal would require changes to existing policy and additional resource allocation, which would be subject to the annual budget process and the availability of resources. DOH has already issued several rounds of Transformational Grant and IT Modernization funding to support such initiatives. DOH is currently developing quality metrics and could pursue accreditation in future NYS budget cycles.

Sources: Final MPA Report at 92-93, MPA website.

Q&A

What is an ALR?

Proposal 9 focuses on reforms to assisted living residences (ALRs), which are residential facilities that provide housing, personal care services, and some health-related services to individuals—typically older adults—who need assistance with daily activities such as bathing, dressing, medication management, and meals, but do not require the intensive medical and nursing care provided in nursing homes.

Why does accreditation matter?

Accreditation isn’t just a badge—it’s a commitment to continuous improvement, safety, and quality. It helps ALRs benchmark their services against national standards and builds public trust.

• Quality Improvement: Accreditation provides a framework for continuous improvement and helps organizations implement best practices.
• Benchmarking: It allows facilities, such as assisted living residences, to compare themselves against national standards and peer institutions.
• Regulatory Impact: While accreditation by the Joint Commission (or similar bodies like CARF International or the Accreditation Commission for Health Care) is voluntary, states sometimes require it as a condition for licensure or re-licensure.
• Public Trust: Accredited organizations often enjoy higher credibility with patients, residents, and families because accreditation signals a commitment to safety and quality.

What challenges lie ahead?

Implementation will require significant investment in staffing, training, and IT systems. Rural providers may face difficulties meeting broadband and partnership requirements, and accreditation costs could strain smaller operators. The MPA Council notes that success depends on future budget cycles and resource allocation.