Arizona Assisted Living Admission Requirements: A Resident Intake Checklist

This guide puts those requirements in the order a manager can use them. It focuses on assisted living homes, which Arizona defines as facilities providing resident rooms to ten or fewer residents. It does not replace a separate review of adult foster care, ALTCS or payer requirements, or a resident's individual clinical needs. A.R.S. § 36-401(A)(10)

Start with the right dates

Under R9-10-801(1), acceptance means the person begins living in and receiving assisted living services from the facility, or begins receiving adult day health care or respite services. A tour, a reservation, or a promised room is not the definition given in the rule. R9-10-801(1)

Record the acceptance date and the occupancy date accurately. They may be the same, but the rules do not use the terms interchangeably. Record the acceptance time too so the 24-hour orientation deadline can be tracked.

The main admission deadlines

Sources: R9-10-807 and 808, R9-10-819(B).

1. Confirm that your home can meet the resident's needs

Start with the home's license, written scope of services, staffing capabilities, and the person's actual care needs. The governing authority must establish the scope of services in writing. The home must have personnel with the qualifications, experience, skills, and knowledge needed to provide its services and meet residents' needs. R9-10-803(A)(2); R9-10-806(A)(5)

Obtain the clinical needs documentation before or at acceptance

For a person requesting or expected to receive supervisory, personal, or directed care, the documentation must state whether the person requires:

• Continuous medical services.
• Continuous or intermittent nursing services.
• Restraints.

It must be dated within 90 calendar days before acceptance and signed and dated by a physician, registered nurse practitioner, registered nurse, or physician assistant. The rule does not limit this particular document to a physician's signature. R9-10-807(B)(1)

If the person is requesting or expected to receive behavioral health services other than behavioral care from the home, the documentation must also address whether continuous behavioral health services are required and be signed and dated by a behavioral health professional. Additional behavioral care and behavioral health requirements are discussed below. R9-10-807(B)(2)

Know when the general admission rule says no

R9-10-807(C) prohibits accepting or retaining an individual when:

• Continuous medical services are required.
• Continuous nursing services are required, unless the facility complies with the specific exception in A.R.S. § 36-401(C).
• Continuous behavioral health services are required.
• The primary condition creating the need for assisted living services is a behavioral health issue.
• Needed services are outside the home's scope and a home health agency or hospice service agency is not involved in the person's care.
• The home cannot provide the assisted living services the person needs.
• The individual requires restraints, including the use of bedrails.

The referenced statutory nursing exception concerns an adult foster care licensee who is a licensed nurse, with services limited to those allowed by law and records of nursing services kept. It is not a general exception for every assisted living home that employs a nurse. R9-10-807(C); A.R.S. § 36-401(C)

Home health or hospice involvement does not erase the other admission restrictions. Review what the outside agency will provide and what the home must still be able to do.

Review personal care and directed care restrictions separately

A facility authorized to provide personal care cannot accept or retain a resident who is unable to direct self-care under R9-10-814(A)(1). A resident's need for directed care should be matched to the home's authorization and capabilities.

There are also specific restrictions and exceptions for a resident who cannot ambulate even with assistance and is confined to a bed or chair, or who has a stage 3 or stage 4 pressure sore. Do not reduce these provisions to “uses a wheelchair” or “has any wound.” Those are not the tests stated in the rules. R9-10-814(A)-(D); R9-10-815(B)

When the R9-10-814(B)(2) pathway applies, the requirements include:

1. A request from the resident or representative for acceptance or continued residency.
2. Examination by the primary care provider or another medical practitioner at the onset of the condition, or within 30 calendar days before acceptance, and at least every six months while the condition continues.
3. That practitioner's review of the home's scope of services and signed, dated determination that the resident's needs can be met within that scope, and are being met for continued residency.
4. A service plan that includes the increased need for personal care services.

Personal care has a separate short-term illness or injury provision for bed or chair confinement in R9-10-814(B)(1). Directed care's restriction in R9-10-815(B) specifically points to R9-10-814(B)(2). Do not automatically carry the personal care short-term exception into directed care. R9-10-814(B)-(D); R9-10-815(B)

These are individual acceptance decisions. A generic “hospice approved” checkbox is not enough to show that an applicable exception has been met.

2. Prepare the agreement and give the resident their copies

Before or at acceptance, the documented residency agreement must include all ten items in R9-10-807(D):

1. The resident's name.
2. Occupancy terms, including the actual or expected occupancy date and the responsibilities of the resident and facility.
3. Services the facility will provide.
4. Services available for an additional fee or charge.
5. For an assisted living home, whether the manager or a caregiver is awake during nighttime hours.
6. The policy for refunding fees, charges, or deposits.
7. The resident's termination policy and procedure, including termination because services were not provided according to the service plan.
8. The facility's termination policy and procedure.
9. The complaint process.
10. The manager's signature and date.

The resident or another signer permitted under R9-10-807(E) must sign before or within five working days after acceptance. Permitted signers include the resident's representative, legal guardian, or an individual designated under A.R.S. § 36-3221 to make health care decisions.

That signature window does not postpone the agreement itself. Before or at acceptance, provide the resident or representative with the agreement, resident rights, and the policy and procedure on health care directives. Keep the original agreement in the medical record. R9-10-807(D)-(F)

Resident rights also require information about rates and charges before services begin. Use the home's actual pricing and refund terms. R9-10-810(B)(3)(f)(i)

3. Open a usable resident record

R9-10-811 requires a medical record for each resident. At intake, build the record so the people providing care can find the information they need. The following items come directly from the rule, with applicable items completed as the corresponding services or events occur:

Source: R9-10-811(A)-(C).

The rule requires dated, legible, authenticated entries by authorized individuals, protection against loss or unauthorized use, and additional safeguards for electronic records. It does not require the manager to create a termination notice or an incident record for an event that has not happened.

4. Make medication arrangements usable from the first dose

The medical record must contain an order from a medical practitioner for each medication the home administers or helps the resident self-administer. Administration and assistance must be documented. The two services are distinct under R9-10-817. R9-10-811(C)(12)-(14); R9-10-817(B)-(C)

If a manager or caregiver receives a verbal medication order from a medical practitioner, it must be documented, and a written order verifying it must be obtained within 14 calendar days after receipt. This is a verbal-order verification deadline, not permission to administer medication without an order. R9-10-817(A)(2)

For residents receiving personal or directed care, employees may not provide nonprescription medication without the required practitioner order. “Over the counter” does not remove that requirement. R9-10-814(G); R9-10-815(D)

5. Complete exit orientation within 24 hours

Each resident must receive orientation to the home's exits and the evacuation route within 24 hours after acceptance, and the orientation must be documented. Keep that documentation in the medical record. R9-10-819(B); R9-10-811(C)(18)

A medical determination that participating in an evacuation drill would cause harm is a separate issue. Do not use a drill exception as an automatic waiver of the orientation requirement. The rule sets out the drill exception in R9-10-819(A)(5), separately from orientation in subsection (B).

6. Verify the TB evidence and the applicable pathway

The assisted living rule requires evidence of freedom from infectious tuberculosis before or within seven calendar days after occupancy, as specified in R9-10-113. R9-10-807(A)

R9-10-113 requires baseline screening that includes exposure-risk assessment, checking for signs or symptoms, and obtaining acceptable evidence. The evidence pathway depends on the person's test results and history. It is not always “get another skin test.”

• One pathway is documentation of a negative Mantoux or other CDC-recommended TB screening test administered within the 12 months before admission, including the test date and type.
• A history of TB or documented latent TB infection follows the pathway cross-referenced in R9-10-113(A)(2)(b).
• A positive screening test without that history or documented latent infection has its own signed-statement requirements under R9-10-113(B)(1)(c).

Source: R9-10-113(A)(2)(a)-(b), (B)(1).

The current rule also requires signed documentation of freedom from TB symptoms as part of the facility's annual exposure-risk assessment. Avoid confusing that documentation with a universal annual repeat skin-test requirement. R9-10-113(B)(2)

The limited respite exception

A resident receiving respite care who is not expected to be present for more than seven calendar days is not required to comply with R9-10-807(A). This is a specific exception in R9-10-808(B)(2), not a blanket exemption for every short stay or every respite admission.

If a planned stay changes, reassess the requirements promptly. Do not assume an extension creates a fresh seven-day period. R9-10-808(B)(2)

7. Complete the service plan with the right people

Except for respite care, the initial service plan must be completed no later than 14 calendar days after acceptance. It is developed with assistance and review from the resident or representative, the manager, and anyone the resident or representative requests. R9-10-808(A)(1)-(2)

The plan must describe the resident's medical or health problems, expected service level, and the amount, type, and frequency of assisted living and ancillary services, including medication administration or assistance. It must also address applicable behavioral-care needs and bedroom medication storage and control. R9-10-808(A)(3)

Additional review is required when:

• The resident requires intermittent nursing services or medication administration: review by a nurse or medical practitioner.
• The resident requires behavioral care: review by a medical practitioner or behavioral health professional.

When initially developed and when updated, the plan must be signed and dated by the resident or representative, the manager, and the applicable required clinical reviewer or reviewers. Do not simplify this to either “every plan needs a doctor” or “only the resident and manager need to sign.” R9-10-808(A)(3)(d)-(e), (A)(5)

Set the next review before closing intake

The plan must be reviewed and updated based on the specified changes no later than 14 calendar days after a significant change in physical, cognitive, or functional condition, and at least:

• Every 12 months for supervisory care.
• Every six months for personal care.
• Every three months for directed care.

These are separate calendar intervals, not a single annual review for every resident. R9-10-808(A)(4)

Respite uses three working days

For respite, a written plan based on current needs must be completed within three working days after acceptance. If a service plan developed within the previous 12 months is already in the resident's medical record, it may instead be reviewed and updated for the specified changes within that same three-working-day period. A significant change during respite also requires the applicable update within three working days. R9-10-808(B)(1)

8. Add the resident-specific requirements

Directed care and memory care

A resident unable to direct self-care must have a designated representative. Directed-care service plans require additional content, including personal safety strategies, cognitive stimulation, meal and snack encouragement, weight documentation or a practitioner's statement that weighing is contraindicated, and coordination of communications with the representative and others identified in the plan. Personal-care elements such as skin maintenance, hydration, and incontinence care also apply. R9-10-815(A), (C); R9-10-814(F)

If memory care services are provided, review the additional plan, environment, staffing, and program requirements in R9-10-815(C)(8) and R9-10-816. The facility may admit or retain only residents whose cognitive and physical needs can be safely managed in its memory care areas. A dementia diagnosis alone does not replace that assessment. R9-10-816(F)

Behavioral care and behavioral health services

These are not interchangeable labels. R9-10-812 requires a medical practitioner or behavioral health professional to evaluate a resident requesting or receiving behavioral care within 30 calendar days before acceptance or before behavioral care begins, review the scope of services, and sign and date the required determination. Reevaluation is required at least every six months while the need continues.

For authorized behavioral health services other than behavioral care, R9-10-813 has separate requirements, including evaluation by a behavioral health professional within 30 calendar days before acceptance and at least every six months while the need continues. R9-10-812; R9-10-813

A psychotropic prescription or a qualifying dementia-related diagnosis does not by itself establish that the home is providing behavioral care or behavioral health services. R9-10-808(F) explains the circumstances. Evaluate the services actually being provided and the rule's conditions. R9-10-808(F)

Hospital discharges and transfers

R9-10-809 distinguishes transport from transfer, contains separate coordination and documentation requirements, and includes exceptions for specified situations. It is not a blanket waiver of admission requirements when a person arrives from another health care institution. R9-10-809

9. Close intake with evidence and a working handoff

• What is missing.
• Who is responsible for obtaining it.
• The actual rule-based deadline, if there is one.
• What follow-up has occurred.
• Where the final evidence will be stored.

Do not mark a requirement complete because a document has been requested. Check that the correct person signed it, the dates satisfy the rule, and the contents answer the question the rule asks.

Keep the process visible

Use the companion Resident Intake Checklist to assign tasks and keep the evidence easy to find. It is an organizing tool for the requirements in this guide, not an ADHS form or a determination that a person is appropriate for admission.