Assisted Living Packet
Information For Providers
- Change of Ownership Packet
- Licensure Application Letter from Becky Fleming-Siebenaler, Licensure Bureau Chief (Contains Licensure Requirements and Check List)
- Change of Ownership Licensure Application Form
These forms are optional. SB 420 (2001) directed the Department to provide sample forms for Assisted Living facilities. Please check this page frequently for updated and new sample forms.
If you use your own forms, please check the samples to ensure you have the fundamental required information incorporated in your documentation.
These forms are not copy write protected. You may add to these forms, including your business logo’s etc.
BASIC FORMS AND SAMPLES TO MEET MCA AND ARM REQUIREMENTS
- Accident - Incident Report
- Assisted Living Assistance with Self-administration
- Certification Form for Licensed Health Care Professionals
(For Category B/C: admissions and change of level of care, including changing from Category B to A level of care) - Involuntary Discharge guide and checklist
- Resident Agreement Guide and Checklist
- Resident Needs Assessment
- Service Plan for Category A Assisted Living Residents*
- Service Plan for Category B Assisted Living Residents
- Service Plan for Category B / C Assisted Living Residents
- Service Plan for Category A / C Assisted Living Residents
- When the license expires
- The Survey Process and "the what and the how" of a Statement of Deficiency/Plan of Correction
Life Cycle of a Task Order (The internal processing of a license, how and when it is assigned to a contracted surveyor or staff surveyor).
Statutes
- Assisted Living Application Attachment (Montana Code Annotated 50-5-101 through 50-5-228)
- Montana Elder and Persons with Developmental Disabilities Abuse Prevention Act 52-3-801 through 52-3-825 MCA
- Rights of long-term care facility residents 50-5-1104
- Safety Devices MCA 50-5-226, 50-5-1201 through 1204 & 72-1-203
Rules:
- ARM 37.106.2801 through 37.106.2898 Minimum Standards for Assisted Living Facilities
- ARM 37.110.201 to 37.110.259 - Food Service Establishments
- ARM 37.106.2901 through 37.106.2908 - Safety Device
- ARM 37.106.311 through 37.106.331-All Health Care Facilities
Survey Tools:
The survey tool consists of the applicable ARMs and MCAs. It is formatted in a table for easier understanding and application. This is the same form surveyors use to determine compliance when they visit your facility. The additional forms used during an on-site survey are also provided.
- Assisted Living ARM Survey Tool:
- Index to Assisted Living Arm Survey Tool:
- Assisted Living ARM Definitions:
- ARM for License Application Process:
- Assisted Living MCA Survey Tool:
- Restraint and Safety Device Survey Tool:
- Restraint and Safety Device ARM 37.106.2902 Definitions
- Entrance Conference Tool:
- Resident Agreement Criteria
- Statement of Deficiencies and Plan of Correction Form
- ARM 37.106.2901 to 37.106.2908 - Restraints, Safety Devices, Assistive Devices, and Postural Supports
- FDA Hospital Bed Safety Home Page. This page includes a variety of guidelines and tools.
- Informed Consent - Safety Devices
- Restraints, Safety Devices, Assistive Devices & Postural Supports in Assisted Living Facilities
- Safety Devices - One Daughter's Story
For older adults, the benefits of healthy eating include increased mental acuteness, resistance to illness and disease, higher energy levels, faster recuperation times, and better management of chronic health problems. As we age, eating well can also be the key to a positive outlook and staying emotionally balanced. But healthy eating doesn’t have to be about dieting and sacrifice. Eating well as an older adult is all about fresh, colorful food, creativity in the kitchen, and eating with friends.
~Helpguide.org
Montana’s assisted living facility regulations pertaining to food service can be found at ARM 37.106.2860 FOOD SERVICE (see statutes and rules governing assisting living). They state, in part, that foods must be served in amounts and variety sufficient to meet the nutritional needs of each resident. The facility must provide therapeutic diets when prescribed by the resident’s practitioner. Records of menus as served must be filed on the premises for three months after the date of service for review by the department. In addition, the facility shall take into consideration the preferences of the residents and the need for variety when planning the menu.
Meal planning and preparation should not be stressful! In today’s internet environment, many resources are available regarding menu planning, meal preparation, planning a shopping list, recipes, and senior nutrition. A simple Google search will reveal many options. Be sure to include residents in the meal planning process – what a great way to celebrate their traditions, customs, and cultural backgrounds!
The department does not suggest or endorse the following resources, but assisted living providers may find them to be helpful.
Menu Planning and Preparation:
Grove Menus
SYSCO
Sample 5-week menu
Food Services of America
Nutrition:
TUFTS Food Guide Pyramid
TUFTS Food Guide Pyramid for Older Adults
The following diagrams have been developed to aid facilities in meeting the requirements of 37.106.2838 RESIDENT TOILETS AND BATHING (4) which requires:
All doors to resident bathrooms shall open outward or slide into the wall and shall be unlockable from the outside.
- Dutch doors, bi-folding doors, sliding pocket doors and other bi-swing doors may be used if they do not impede the bathroom access width and are approved by the department. A shared bathroom with two means of access is also acceptable."
If you are in need of additional assistance, please contact QAD Licensure Construction Consultant, Joe Merrill at: jmerrill@mt.gov or (406) 444-6794 for additional information.
This program is operated by the Montana Board of Nursing. Please click the link below to leave this web page and go the Board of Nursing web page.
