What it is

“Assisted Living Facilities" (ALFs) and “Shared Housing Establishments” (SHEs) are alternatives to nursing homes. ALFs and SHEs are for elderly people who do not need nursing care. Residents live in their apartments. They are provided with necessary services. This includes meals, housekeeping, laundry and help with other activities. Residents pay for these facilities with their resources. Medicaid will not pay for them.

Where to apply

The Illinois Department of Public Health must license ALFs and SHEs. For a list of ALFs and SHEs in Illinois, see the IDPH website at the end of this Section.

Who may be eligible

Adults who want assistance with activities of daily living but do not require nursing care. People with specific conditions or who need more assistance may not qualify.

Assisted living and shared housing, in general

In January 2001, the Illinois Department of Public Health (IDPH) began requiring licenses for ALFs and SHEs to make residential environments with supportive services. IDPH wanted services to meet changing needs and preferences. ALFs and SHEs encourage residents to remain independent.  ALFs and SHEs are required to offer certain mandatory services. This includes secure housing, laundry, housekeeping, and three meals per day. It includes an emergency response system and health-related services. ALFS and SHEs must assist with some activities of daily living.

Activities of daily living are eating, dressing, bathing, toileting, transferring and personal hygiene.

Licenses are required for facilities not offering all mandatory services. Facilities can have another entity provide a service.

ALFs and SHEs are not Supportive Living Facilities (SLFs). SLFs will be discussed in the next Section.

An ALF is a residence for at least three unrelated adults. At least 80% must be age 55 or older. ALFs have to meet requirements for services, care, and physical environment.

A SHE is a residence for 16 or fewer persons. At least 80% must be age 55 or older.  SHEs must meet the same requirements for services and care as ALFs. SHEs have different requirements for physical environment and staffing.

Most residents pay the cost of care from their financial resources. Some pay with long-term care insurance. Medicaid will not pay for rent at an ALF or a SHE.

Advocacy tip

An ALF provides a level of care similar to that of a Supportive Living Facility (SLF). Payment is the biggest difference. Medicaid can pay for a SLF but not for an ALF.

ALFs come in all shapes and sizes. Some are homes with only a few residents. Some are large apartment buildings with hundreds of residents. ALFs can be freestanding. ALFs can be part of a retirement community or a continuing care community. They can be independent or connected with a nursing home.

Choices vary from single or double rooms to studios, suites or apartments. They are usually within a multi-unit residential setting. You may have your own living quarters. Or you may choose to share quarters with a spouse or roommate.

Who is eligible to live in an ALF or SHE?

Residency requirements

To live in a facility, you must be an adult. There is no other age requirement. For the ALF or SHE licensure, at least 80% of the residents must be 55 or older.

For you to be accepted or remain in residence at an ALF or SHE: 

• The facility must be able to provide services for you either itself or with another entity;
• You need a level of service or type of service for which the facility is licensed; and
• The facility must have enough staff with appropriate skills to provide those services.

Who can be excluded from residency

Your residency can be rejected or terminated if:

• You pose a serious threat to yourself or others;
• You are unable to communicate your needs and do not have a representative. (Your representative must live in the facility. A "representative" directs services for you and has a prior relationship with you);
• You require help from more than one caregiver at a time;
• You need “total assistance” with 2 or more activities of daily living. “Total assistance” means staff performs the entire activity for you;
• You need more than “minimal assistance” getting to a safe area in an emergency. “Minimal assistance” means you can respond to protect yourself in an emergency. This can be with or without assistance. This accounts for the staffing and construction of the building;
• You have a severe mental illness which changes your needs.  For example, you may struggle a lot with social functioning. Or you struggle with activities of community living and work skills. The mental illness must be expected to be present at least one year. This includes Alzheimer’s disease and other forms of dementia;
• You need treatment that cannot be self-administered or administered by a “licensed health care professional.” Treatments include intravenous therapy; intravenous feedings; gastronomy feedings; insertion, sterile irrigation and replacement of catheter; sterile wound care; and routine insulin injections for diabetics. A licensed health care professional means a registered professional nurse, an advanced practice nurse, a physician assistant or a licensed practical nurse;
• You need treatment for stage 3 or stage 4 decubitus ulcers or exfoliative dermatitis; or
• You need 5 or more skilled nursing visits per week for three consecutive weeks or more. This does not include temporary rehabilitation;
• If any of these exclusions apply to you, the facility could still let you stay there. The facility may do so if you are terminally ill and qualify for licensed hospice care.

Many of the above exclusions will not apply if you are quadriplegic or paraplegic. Many will not apply if you have a neuro-muscular disease. This includes muscular dystrophy and multiple sclerosis, or other chronic diseases and conditions, and:

• You can communicate your needs
• You do not require assistance with complex medical problems and
• The facility can accommodate your needs

Admission and intake

Assessment by a physician

A doctor must complete an assessment of your condition before your admission to a facility. The doctor will evaluate your physical, cognitive, and psychosocial condition. You will be tested for tuberculosis. The assessment must be done within four months of admission. It must reflect your current condition. It is your duty to complete assessments.

After you move in, a doctor must perform a new assessment. This will take place every year. Significant changes in your condition require new assessments.

Service plan

The facility must develop a service plan based on your assessment. You and the facility must agree on the plan. The facility must respect your choices. The service plan will determine a service delivery contract. The plan may involve disconnecting or removing a kitchen appliance.

The service plan must be reviewed and revised every year. It must be reviewed after a significant change in your condition, preferences, or service needs. 

All persons involved in the development of the service plan must sign and date it. The service plan must be developed by:

• You, your representative, or anyone that you request be involved;
• The manager or manager’s designee; and
• A registered nurse. This applies if you receive nursing or medication administration. It also applies if you are unable to direct self-care.

Service plans must address all of the following: 

• The level of service you are receiving, including assistance with activities of daily living. This includes dietary needs. It also includes special accommodations for the resident;
• The amount, type and frequency of health-related services you need;
• Staff responsible for the provisions of the service plan;
• All support services that the facility provides or arranges;
• Whether you need help with medication. This includes reminders, supervision or administration; and
• Any negotiated risk.

“Negotiated Risk” is what you negotiate with the facility. It includes what risks you are willing to take for services, as well as which risks you are unwilling to assume. The facility must explain to you the risks of these decisions. The facility must explain the potential results. See the sub-section below on Negotiated Risk Agreements.

You or your representative can direct your care and negotiate the terms of your care. You also have the right to refuse services or approaches. You must have received clear information about the risks and benefits of a choice. The choice must not put other residents or staff at risk. The service plan must document the risks of refusing services or approaches.

Service requirements

Facilities must provide all “mandatory services.” Facilities may provide “optional services.” Facilities may not prevent your doctor from providing services to you.

Mandatory services

These are the services that each facility must provide for you:

• Three (3) meals per day, prepared by the facility or an outside contractor;
• Housekeeping services like vacuuming, dusting and cleaning your unit;
• Personal laundry and linen services. This can be provided or arranged by the facility;
• 24-hour security like locked entrances and building or contract personnel;
• An emergency communication response system. This must be in place 24-hours. You must be able to notify building management or an emergency response vendor for help; and
• Help with activities of daily living (eating, dressing, bathing, toileting, transferring or personal hygiene).

Optional services

Medication services

A facility is not required to provide medication-related services. If they do, they must follow the rules described below. Fee schedules must be included in the resident contract. Fee schedules outline the cost of these services.

Some facilities do not have medication administration. Without this optional service, you will need a medical consultation. The facility staff must advise you to consult a physician. The physician will see if you need vaccination against pneumonia, the flu, or both. 

Facilities without medication administration must give the flu vaccine. Residents must get it before moving in. Residents must get the vaccine each year. You have the right to refuse this vaccine. If the shot is harmful to your health, you should not get it.

Medication policies need approval. This can be by doctors, pharmacists or registered nurses. Those policies must address:

• Obtaining and refilling medication,
• Storing and controlling medication,
• Disposing of medication,
• Assisting in the self-administration and giving of medication, and
• Documenting medication assistance and maintaining medical records.

Medication reminders

Staff can remind you to take pre-dispensed medication. Staff can observe and document you taking medication.

Supervision of self-administered medication

Some tasks require a licensed healthcare worker's supervision. With this supervision staff can:

• Read the label to you,
• Compare the prescription to the label,
• Confirm you took the correct dosage,
• Document if you took or refused medication, and
• Staff may open the container for you if you cannot.

Only employed, licensed health care workers may administer:

• Regular insulin and vitamin B- injections,
• Oral medications,
• Topical treatments,
• Eye and ear drops, and
• Nitroglycerin patches.

The facility must maintain a drug reference guide. The guide must be within two years from the copyright date. It must be accessible to employees.

Medication storage

Medication the facility stores must meet the following requirements:

• Stored in a locked container, cabinet or area kept from residents,
• Attended by an employee,
• Stored how the label indicates and in the original labeled container. This does not include medication organizers,
• Not stored in bathrooms or laundry room, and
• Correctly disposed of when expired or discontinued.

Medication records

Each resident receiving medication must have a separate record. The record must include the:

• Name of resident;
• Name of medication, dosage, directions, and route of administration;
• Date and time the medication is given;
• Date and time when actually given; and
• Signature or initials of the employee giving medication.

Other optional services

Many ALFs provide optional services at an additional cost. Services could include:

• Transportation to the doctor,
• Money management or banking,
• Mailing services,
• Help with shopping,
• Meals for visitors and guests, or
• On-site restaurants and beauty salons. 

The contract must describe these services. Prices need to be listed.

People with quadriplegia, paraplegia, or neuro-muscular diseases

If the facility accepts you then it must:

• Create a written agreement with you describing how it will meet your needs, and
• Allow assistance by more than one person for safety reasons.

Persons with dementia and Alzheimer's disease

There are additional evaluations for admittance. The facility must see if it can provide secure, appropriate care. It must see if it has the appropriate staff and skills. The regulations describe the required assessments.

There are facilities with programs for Alzheimer’s and dementia patients. These facilities must meet additional standards to maintain a license. The special care provided must be disclosed to residents who request it. As part of those standards, the facility must:

• Designate a representative for the resident,
• Provide activities to maximize brain functioning. This includes comfortable and predictable structure and rhythm,
• Offer a balance of rest, activity, private and social time,
• Allow residents to express their accustomed social roles,
• Offer familiar events to tap memory and retain abilities,
• Accommodate changes in the resident’s mood and energy level,
• Provide at least 1.4 hours of services per resident per day. This includes assistance with daily living and activities. This includes outside services for dementia needs,
• Provide sufficient experienced staff to meet 24-hour needs of residents,
• Require the manager and care staff to complete dementia and cognitive deficit training. The training must be comprehensive and ongoing,
• Develop emergency procedures for residents' needs,
• Develop staffing patterns to respond residents' needs,
• Encourage snacks and meals and to take liquids,
• Have an Alzheimer’s program supervisor with specified training, and
• Keep residents safe who wander or need assistance in an emergency.

Resident rights

Basic rights

You have rights guaranteed under the Constitutions of the United States and the State of Illinois. You have other rights. You have the right to:

• Live in an environment that promotes and supports your dignity,
• Individuality, independence, and self-determination,
• Privacy, choice, consideration, and respect,
• Respect for bodily privacy and dignity. This includes care and treatment,
• Keep personal property. Your property must not endanger others,
• A locked space to store items,
• Designate someone to help you or create the service plan for you,
• Receive services specified in the service plan,
• Review and revise the service plan at any time,
• Review the cost of service plan changes,
• Direct and negotiate the terms of your care,
• Refuse services. This does not apply to court-ordered services. This could be for the health, safety or welfare of other residents. You may not refuse if doing so endangers yourself or others,
• Choose selected activities, schedules, and daily routine,
• Choose a service provider. This could be a primary care provider, pharmacy, or home health provider. You assume additional costs,
• Request to relocate or refuse to relocate to the facility,
• Exercise religion freely. This includes refusing to participate. This covers social, recreational, rehabilitative, political or community activities,
• Be free of chemical and physical restraints,
• Be free of abuse, neglect, financial exploitation,
• Refuse to perform labor, and
• Confidentiality of your medical, financial or other records.

The facility can release your records only with your written consent. Your representative can consent for you. You must specify when your record may be released. There are certain exceptions specified by law.

Resident's rights guaranteed by Illinois statutes

You have the following additional rights provided by statute:

• Privacy in financial and personal affairs,
• Review and copy your files that the facility maintains. This applies to business hours or at an agreed time,
• Privacy about mail, phone calls, and visitors,
• Uncensored access to the State Ombudsman or designee. You also have the right to refuse access to a State Ombudsman or IDPH reviewer,
• Freedom from retaliation for making complaints. This applies to complaints to any agency or person,
• 24-hour access to the building and common areas of the building,
• At least 30-days notice of fee changes or charges. This also applies to the availability of a service,
• To a minimum of 90-day notice of a planned facility closure,
• At least 30-days notice of involuntary residency termination. This does not apply if you pose a threat to yourself or others. This does not apply in some emergency situations. You have the right to appeal termination, and
• A 30-day notice of late payment and at least 15 days to pay it.

You also have a right to choose an essential support person. This person can visit you outside of regular visiting hours. An essential support person:

• Assists with daily living activities, and
• Provides support, such as:
  • Physical,
  • Emotional,
  • Mental, and
  • Social support.

The Illinois Long-Term Care State Ombudsman works for the Illinois Department on Aging. Their purpose is to advocate on behalf of residents in long-term care facilities. The State Ombudsman will only act with the resident's permission. Learn more about how to contact the Ombudsman. 

Prevention and reporting of abuse, neglect, and financial exploitation

If a facility reasonably believes there is abuse, it must act. It must remove the abusive employee or volunteer. The abuser must not be in contact with residents. Abuse comes in many forms, including neglect and financial exploitation.

The facility must also:

• Notify IDPH within 24 hours after receiving the allegation. This requires contacting the Assisted Living Complaint Registry. A record must be kept for 12 months, and
• Conduct an investigation. It must prepare a written statement within 14 days of reporting to IDPH. The report must be sent to IDPH within 24 hours of the investigation.

The facility report must contain the following at a minimum:

• Dates, times and description of the alleged abuse,
• Description of injury to you or any change in your condition,
• Any actions the facility has taken,
• People and agencies the facility interviewed or notified,
• Names of witnesses, and
• Action the facility will take to prevent future abuse. This applies if the abuse was substantial.

Right to a representative

You have a right to make decisions about your health care now and in the future. You can choose an agent to make health care decisions for you and in the future with a Power of Attorney for Health Care document. If you lack the capacity to name a Power of Attorney agent, there could be a surrogate decision-maker named for you through the Illinois Healthcare Surrogate Act or a legal guardian appointed for you under the Probate Act. Informally, you can choose to have family or friends join a care plan conference at the assisted living facility.

The resident contract

Contract rights and terms

You will have a contract between you and the facility. It needs to be titled one of two things. Either “assisted living establishment contract” or “shared housing establishment contract.” It must be printed in at least 12 point font. You or your representative have a right to a copy of the contract. The facility must keep an extra copy on the premises throughout your stay.

The contract must include certain items. They can be in the actual contract or in supporting documents:

• Name, street address and mailing address of the facility,
• Name and mailing address of the owner(s) of the facility,
• Type of business entity of the owner(s),
• Name and mailing address of the managing agent. This is only if it's different from the owner,
• Name and address of who is authorized to accept service of process. This is on behalf of the owners and managing agent,
• License status of the facility,
• License status of all health and supportive service providers,
• Duration of the contract,
• Base rate you will pay. A description of the services must be included,
• Description of any additional services and fees,
• Fee schedule that outlines the cost of those services,
• Description of how to modify, amend or terminate the contract,
• Description of the facility’s complaint resolution process,
• A notice that you can call for complaint resolution. This covers the Department on Aging’s Senior Helpline. It includes the Long-Term Care Ombudsman Program for assistance,
• Name of your designated representative, if any,
• Your obligations to maintain residency and receive services. Services include compliance with all required assessments,
• The billing and payment procedures,
• Your right to receive services from outside providers. This includes ones the facility does not have a contract with,
• Statement that medical assistance under the Illinois Public Aid Code is not available for payment for services,
• Report detailing admission and residency termination standards,
• Statement indicating the facility maintains a risk management process,
• A statement listing resident rights. This includes what is specified above. It must also acknowledge those rights cannot be forfeited, 
• A report from IDPH. This must detail their annual on-site review process. This includes what the on-site reviewer will review, and
• Whether a community fee is charged, the amount of the fee, and if the fee is refundable.

The terms must include:

• Your responsibilities and obligations,
• Fees, charges, and deposits,
• The purposes of fees,
• Any fee or charge on days you were absent,
• The facility’s policy for refunding fees, costs or deposits, and
• The facility's 30-days written notice before any change in a fee or charge. This does not apply if fees increase with your changing needs, and
• Policy for alerting relatives/designee in an emergency. This applies to a significant change in your condition. It applies to termination of your residency.

The contract auto-renews each year. This does not apply if terminated. Changes to the contract must be in writing and signed by both parties. But if the parties agree, the contract can be terminated at any time.

Negotiated risk agreements

The facility may want you to sign a negotiated risk agreement. Your representative can do this on your behalf. A negotiated risk agreement is about services you require. It includes the risks you are willing to take and risks you are unwilling to assume.

Examples:

A resident is unsteady on her feet. The facility notifies her of the dangers in wearing high heels. It notifies her of the danger in exploring the neighborhood. The resident can choose to accept the risks.

The resident is recommended to take medication. The resident accepts the risk of not taking the medication.

A resident has diabetes. The resident accepts the risk of eating chocolate cake.

The agreement must describe the following:

• The problem, issue or service that is the subject of the agreement,
• The choices available to the resident,
• The major risks with each choice,
• The resulting agreement,
• Your and the facility's responsibilities,
• Any other involved person's responsibilities, and
• A time frame for review.

The facility must sign the agreement. Agreements must be limited to your care and personal environment. The agreement cannot waive any of your resident rights, as discussed above.

 The negotiated risk agreement can be made at any time. You can make changes at any time. You may have a physician’s assessment. You must renegotiate as necessary. You may create more agreements. This may require evaluation of the service delivery plan.

Advocates have noted problems with these agreements, in that:

• The facility sets a standard of care that does not meet your needs, and
• The facility is not liable for injury caused by inadequate care.

Advocacy tips

Negotiated risk agreements release facilities from liability. It releases them from responsibility to provide adequate care. You may not get any real benefit from the agreement. These agreements may be illegal under existing law. They may be unenforceable. You may be forced to enter into one. You should ask that an attorney, Ombudsman, or designee be present. They can help when you discuss the terms of the agreement.

Termination of residency

Voluntary termination

There are reasons you may terminate residency right away.  You or your representative will give notice if:

• You have suffered any neglect, abuse or financial exploitation, or
• The facility put you in imminent danger of life, health, or safety. If you die, the lease agreement terminates when your possessions are removed.

Outside these scenarios, you can terminate residency with 30-days notice. The notice must be in writing. Your representative can do this for you.

Reasons for involuntary termination

A facility can terminate your residency only for the following reasons:

• Failure to meet any of the residency requirements discussed above in the subsection titled “Who is Eligible To Live in an ALF or SHE?”
• Failure to pay your bill, but only after the facility has sent you or your representative notice giving you at least 15 days to pay the delinquency
• Failure to sign a service delivery contract or to substantially comply with its terms
• Failure to comply with the requirements of the physician’s assessment and service plan
• Failure to substantially comply with the terms and conditions of the lease agreement

Notice of involuntary termination

The facility must provide a 30-day written notice of involuntary termination. You, your representative, and the Ombudsman must receive this. The facility must use a specific IDPH form notice. The notice must contain the following: 

• The stated reason for the termination,
• The proposed date of the termination,
• A statement of your right to appeal,
• The steps that you or your representative must take to start an appeal,
• A statement you may continue to live in the facility until a decision is made,
• A toll-free telephone number to initiate an appeal,
• A written hearing request form with postage paid, pre-addressed envelope to IDPH, and
• Name, address, and telephone number of the person at the facility offering relocation assistance.

If you are not able to read English, the facility must provide the notice in a language you can understand or provide a translator to assist in the appeal process.

If there is imminent danger of death or serious physical harm, no 30-day notice is needed.

Remediation efforts

The facility must take steps before termination. It must try to resolve the problem with you. The facility must document those efforts in your file. These efforts may occur before or during the 30-day notice period. They must occur before the termination. No efforts are needed where there is imminent danger of death or serious physical harm to a resident.

Appeals

You need to request a hearing to IDPH to appeal termination. Any request for a hearing postpones an involuntary termination. A hearing is held, and then IDPH renders a final decision. During this period, the facility cannot terminate. It cannot reduce services.

Advocacy tip

Contact the Ombudsman's Office, an attorney, or your local legal aid office for assistance in the appeal. You are not required to have an attorney represent you at the appeal.

The IDPH hearing officer can only hear certain issues at the hearing:

• If there is a legal reason to terminate your residency,
• If the facility followed involuntary termination procedures, and
• If the facility attempted to resolve the circumstances leading to involuntary termination.

Decision and further appeals to circuit court

Following a hearing, the IDPH hearing officer will make a final decision. This will include if you can stay at the facility. If you disagree with the IDPH decision, you can appeal the decision by filing suit in the county circuit court within 35 days of the IDPH decision. 

Residency termination and relocation assistance

The facility must offer “residency termination and relocation assistance.” This helps find available alternative placement. Your involvement is required to plan the move. You are exempt if you cannot help due to emergency. You must choose among the available alternative placements. Emergency placements are temporary. A final placement decision requires your input. You cannot be forced to remain in a temporary or permanent placement.

IDPH may offer you and the facility assistance with residency termination and relocation plans. IDPH can help with the transition to protect your health, safety, welfare, and rights. Emergencies may prevent facilities from implementing a plan before transfer. If possible, the facility must implement the transition plan. This would take place before transfer or residency termination.

Notice of closure

Your residency may terminate if the facility closes, or if part of the facility closes. The facility must give 90-days notice before any voluntary closure. This includes closing only one part. The closure notice must state the proposed date of closing. It must include the reason for closing. The facility must also give this notice to IDPH. The facility must give this notice to your representative. The facility must give this notice to your relevant family.

The facility must offer to help you find alternative placement. It must advise you on available alternatives. The facility must notify IDPH if you need assistance. This applies if you do not have a guardian. It applies if you cannot choose alternative placement. The facility must comply with applicable laws until closing.

Staffing

In general

ALF’s and SHE’s are not required to have nurses on staff. The facility must have a sufficient number of qualified staff. The staff must meet the 24-hour scheduled and unscheduled needs of residents. This includes mandatory services and services in service plans. It includes crisis intervention and evacuation during emergencies. The staff must have ongoing training to serve the resident population. All direct care staff must be at least 16 years old.

The facility must have at least one direct-care staff on duty with CPR training. The training must be specific for adults. Certification must be current. The staff person must be able to perform CPR.

SHEs must have at least one staff member on site at all times. This does not apply to situations that are brief. For example, taking a resident to the emergency room. Or planned and unplanned trips to the grocery store.  Arrangements must be made to monitor the safety of the residents. This should be in the service delivery plan.

ALFs must have at least one staff member awake, on duty 24 hours per day.

Manager

Each ALF must have a full-time manager. A SHE must have a manager overseeing at most three facilities. This applies if they are located within 30 minutes of each other. This accounts for non-rush hour traffic. A manager must be contactable. The manager must meet specific qualifications outlined in the law. The manager must designate someone to act in an emergency when the manager is absent.

Physical requirements for facilities

Structural requirements

ALFs and SHEs must conform to applicable building, fire and life safety codes. They must meet the accessibility standards of the Americans with Disabilities Act. They must comply with State codes and ordinances for zoning, water supply and sewage.

Facilities must comply with the following requirements:

• They may not require your apartment to serve as access to common rooms, common bathroom or another apartment,
• They must provide you your own mailbox and mail delivery,
• ALFs cannot have any units below ground level.
• SHEs may have units below ground level if a window has direct access to the outside,
• Lights must be installed and maintained. Lights must provide for reading and night lighting for corridors and stairwells. Outdoor areas must be lit for emergencies. Common areas must be lighted to assure the safety of residents,
• A telephone must be accessible to residents. It must allow for private conversations, and
• Facilities must have a way of unlocking all doors. This is for emergency situations, or as provided in your contract.

Requirements for individual apartments

Each apartment must have:

• A lockable door,
• A telephone jack,
• An emergency communication response system. This must be in place 24 hours each day. You need to be able to someone for need of assistance. This includes building management or an emergency response vendor, and
• A window to the outside or a door made of glass to the outside.

Facilities do not have to furnish the apartments. If they do, they must provide at a minimum:

• A clean bed in good repair,
• Adequate general and task lighting,
• Adjustable, private window covers, and
• A dresser or other storage space for clothing and personal effects.

If you live in an ALF, your apartment must also have:

• A bathroom that provides privacy when in use. It must have a working toilet, sink, and mirror. It must have ventilation or a window. There must be assistive devices. This includes grab bars if identified in your service plan;
• Private bathing facilities. They can be in the apartment or a readily accessible common room. It must be lockable from the inside. There must be slip-resistant surfaces in tubs/showers. There must be assistive devices if indicated in your service plan; and
• Space to accommodate small kitchen appliances.

If you live in an SHE, the facility must satisfy these requirements: 

• At least one tub and shower for every six residents,
• One operational toilet and one sink for every four residents,
• Bathrooms with privacy, and
• Bathrooms must have a mirror, ventilation or window. They must have slip-resistant surfaces for tubs/showers. they must have grab bars if required in your service plan.

Environmental requirements

The facility must: 

• Be kept in a clean, safe and orderly condition and good repair,
• Be free of odors, insects, and rodents,
• Store garbage and refuse in covered containers. Containers must be lined with plastic bags. They must be removed from the premises at least once a week,
• Maintain hot water temperatures. Maintain the supply of hot and cold water to meet personal hygiene needs,
• Require pets (if allowed) to be controlled by their owners. Pets must be licensed and vaccinated consistent with local ordinances,
• Provide common bathrooms. Bathrooms must have toilet paper, soap, and towels. Towels can be cloth or paper towels. There could also be a mechanical air hand dryer, and
• Keep a first aid kit available.

Foodservice

Facilities can provide its food service or have a service provider. Either way they must meet the following requirements: 

• Meet applicable state sanitation codes and local requirements,
• Employ a dietition for therapeutic diets as ordered by a doctor. The dietitian must approve written menus and diet extensions. The dietitian must assess the resident’s special diet needs. They must plan individual diets and guide dietary staff. Staff will be guided in preparation, service and monitoring the resident’s acceptance of the diet,
• Meals must be nutritionally balanced. The facility must work with residents to accommodate preferences,
• Menus must be planned and made available at least 48 hours in advance,
• Facilities must have policies for delivery of meals to resident’s rooms to fill a temporary need, and
• Facilities must make snacks, fruits, and beverages available.

Where to go for more information or assistance

Statutes and regulations

The Assisted Living and Shared Housing Act can be found at 210 ILCS 9/1 et. seq.

The Illinois Department of Public Health regulations govern assisted living and shared housing. They can be found at 77 Illinois Administrative Code Part 295.

Additional sources of information

To see a list of ALFs and SHEs in Illinois, go to the following website:

Assisted Living/Shared Housing Licensed Establishments

For more information regarding ALFs and SHEs, call the Illinois Department of Public Health’s Bureau of Assisted Living and Information Support: (217) 782-2448.

You can also call the Illinois Department on Aging’s Senior Helpline at (800) 252-8966 (Voice and TTY).

The Illinois Department on Aging has a Long-Term Care Ombudsman Program. This protects and promotes the rights and quality of life for those in long-term care facilities. This is done through regional ombudsmen. They have a hands-on working relationship with the residents and staff in their area. You can contact the Ombudsman Program whenever you need to:

• Report a problem or concern,
• Seek information about long-term care facilities, or
• Get answers to questions about facility services or standards, resident rights, or transfer and discharge.

Find the regional Ombudsman’s office near you. See the following directory for names, addresses, and phone numbers:

Long-Term Care Ombudsman Program Public Contact List 

Legal information and forms are available.