# Title 50 — Public Welfare

## Chapter 50-32 — Assisted Living Facilities

### § 50-32-01. Definitions.

In this chapter, unless the context otherwise requires:
1. "Assisted living facility" means a building or structure containing a series of at least five
living units operated as one entity to provide services for five or more individuals who
are not related by blood, marriage, or guardianship to the owner or manager of the
entity and which is kept, used, maintained, advertised, or held out to the public as a
place that provides or coordinates individualized support services to accommodate the
individual's needs and abilities to maintain as much independence as possible. An
assisted living facility does not include a facility that is a congregate housing facility,
licensed as a basic care facility, or licensed under chapter 23-16, chapter 23-17.7,
chapter 25-16, or section 50-11-01.4.
2. "Department" means the department of health and human services.
3. "Entity" means an individual, institution, organization, limited liability company, or
corporation, whether or not organized for profit.
4. "Individualized support services" means services provided to individuals who may
require assistance with the activities of daily living of bathing, dressing, toileting,
transferring, eating, medication management, and personal hygiene.
5. "Living unit" means a portion of an assisted living facility that contains a sleeping area,
an entry door that can be locked, and a private bath with a toilet, bathtub or shower,
and sink and which is occupied as the living quarters of an individual who has entered
into a lease agreement with the assisted living facility.
6. "Related by blood or marriage to the owner or manager" means an individual who is a
spouse or former spouse of the owner or manager or is a parent, stepparent,
grandparent, stepgrandparent, child, stepchild, grandchild, stepgrandchild, brother,
sister, half-brother, half-sister, stepbrother, or stepsister of the owner or manager or the
owner's or manager's spouse or former spouse.
### § 50-32-02. Licensing of assisted living facilities - Penalty.

1. An entity may not keep, operate, conduct, manage, or maintain an assisted living
facility or use the term "assisted living" in its advertising unless it is licensed by the
department.
2. An assisted living facility shall pay to the department an annual license fee of
seventy-five dollars for each facility. License fees collected under this section must be
deposited in the department's operating fund in the state treasury. An expenditure from
the fund is subject to appropriation by the legislative assembly.
3. An assisted living facility shall apply annually to the department for a license. After the
fifty-ninth day following the notification of noncompliance with annual licensing, the
department may assess a fine of up to fifty dollars per day against an entity that
provides assisted living services or uses the term assisted living in its marketing
without a license approved by the department. Fines collected under this section must
be deposited in the department's operating fund in the state treasury. An expenditure
from the fund is subject to appropriation by the legislative assembly.
4. If there are one or more deficiencies or a pattern of deficiencies related to quality of
care or compliance with licensing requirements, the department may issue a
provisional license. A provisional license may not be valid for more than ninety days. A
provisional license may be renewed once for no longer than an additional ninety days.
If the deficiencies have not been corrected upon the expiration of a provisional license,
the department may deny the assisted living facility's application or revoke its license.
5. Religious orders providing individualized support services to vowed members residing
in the order's retirement housing are not subject to this chapter.
6. No more than two people may occupy one bedroom of each living unit of an assisted
living facility.

### § 50-32-02.1. Continuation of existing licenses.

1. An assisted living facility that possessed a valid license issued by the department
before August 1, 2005, may not be subsequently denied a license by the department
merely due to failure to meet the requirements of sections 23-09-01, 50-32-01, and
requirements.
2. If there is a change in ownership of an assisted living facility that possessed a valid
license issued before August 1, 2005, the department shall allow a continuance of the
exception to the licensure requirements under subsection 1 for the new owner. The
continuance provided under this subsection applies to the first change in ownership
after July 31, 2005, and does not apply to any subsequent change in ownership.
### § 50-32-03. Powers and duties of the department.

The department shall:
1. Take action and give directions necessary to implement this chapter.
2. Establish a method to receive complaints related to assisted living facilities and to
forward the complaints to the appropriate agency for investigation.
3. Establish rules governing the licensing of assisted living facilities to regulate the
application for, approval, denial, revocation, and requirements of a license.
### § 50-32-04. Assisted living facility health services - Limitations on hospice services.

1. An entity may provide health services to individuals residing in an assisted living
facility owned or operated by that entity. For purposes of this subsection, health
services means services provided to an individual for the purpose of preventing
disease and promoting, maintaining, or restoring health or minimizing the effects of
illness or disability.
2. A tenant of an assisted living facility who is in need of hospice services and who
exceeds tenancy criteria, as determined by the facility, may remain in the facility only if
the tenant contracts with a third party, such as a hospice agency, or utilizes family
support, or both, to meet those needs.
### § 50-32-05. Assisted living facilities - Duties - Educational requirements.

1. Each assisted living facility must have clear, concise, and understandable tenancy
criteria that is fully disclosed to all tenants, in writing, before the tenancy agreement is
signed. Before a facility unit is rented, the facility or landlord shall evaluate the tenant's
ability to meet the facility's tenancy criteria.
2. Each assisted living facility shall require the administrator of the facility to complete
twelve hours of continuing education per year. The assisted living facility shall require
all direct care staff to receive annual education or training in the areas of:
a. Resident rights;
b. Fire and accident prevention and training;
c. Mental and physical health needs of tenants;
d. Behavior problems and prevention; and
e. Control of infection, including universal precautions.
3. Each assisted living facility shall maintain a record for each tenant. The tenant record
must include:
a. An initial evaluation to meet tenancy criteria;
b. The tenancy agreement signed by the tenant or the tenant's legal representative;
c. If applicable, a medication administration record that documents medication
administration consistent with applicable state laws, rules, and practices; and
d. An itemized list of services provided for the tenant.
4. Before hiring, the assisted living facility shall conduct a reference and previous
employment check and a check of applicable registries of each applicant being
considered for employment at the facility.

5. At least once every twenty-four months, each assisted living facility shall conduct a
consumer satisfaction survey. The assisted living facility shall provide each tenant with
a copy of the results of the survey.
