Ready or Not: An Investigation of States’ Pandemic Regulations for Assisted Living

In light of the COVID-19 pandemic, researchers investigated assisted living’s preparedness for the outbreak by reviewing state regulations that had been established by the end of 2018. The researchers looked for policies related to epidemic, pandemic, and infection control policies in assisted living facilities throughout the United States.

The most common policies, established in 31 states, referenced infection control such as routine precautions, contact with bodily fluid, or reportable diseases, while 32 states required staff training in infection control. Additionally, resident isolation practices, such as restricting visitors, were only specified in the infection control policies of six states (North Dakota, Colorado, Kansas, Illinois, Indiana, and Massachusetts). Infection control regulations generally required providers to develop their own policies.

Regarding epidemic-related policies, only 10 states had such regulations in place, which tended to set disease reporting requirements and, in the case of an epidemic, to comply with public health guidelines. Massachusetts and Oregon were the only states to have outlined emergency preparedness protocols for a pandemic. Notably, nine states did not have a single policy related to epidemic, pandemic, or infection control in assisted living, at least as identified in this study.

Currently, most states are likely re-examining the policies they have in place so they can be better prepared for future outbreaks. This investigation sheds light on the forms of guidance (or lack of) that states provide their assisted living facilities to protect some of the most vulnerable residents. The researchers noted that regulations often varied widely and can conflict with personal, home-like models of care (as in the use of gloves and masks), leading to a potential disconnect between policy and practice. Future research may provide more insight into which policies are most effective.


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Bucy T, Winfree, J, and Thomas K. Variability in state regulations pertaining to infection control and pandemic response in US assisted living communities. JAMDA Research Letter (2020); 21, 701-705.


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