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|Senior Citizens Handbook - Supportive Living Program||
Last updated: March 2009
What It Is: Supportive Living Facilities (SLFs) provide an alternative to nursing home care for low-income frail elderly (age 65 and older) or persons with disabilities (age 22 and older). They combine apartment-style housing with personal care and other services. The aim of the Program is to preserve privacy and promote independence, personal choice and dignity, while emphasizing the health of each individual. For Medicaid-eligible seniors, Medicaid pays for all facility services except room and board, and SLF’s cannot charge more than the SSI rate (minus a personal allowance) for room and board.
Where To Apply: Contact the Department of Healthcare and Family Services (HFS) for more information or if you have questions regarding a supportive living facility. See contact information and website listed at the end of this Section. The website has a list of operating SLFs.
Who May Be Eligible: Any resident of Illinois, who meets the age requirement, who does not have tuberculosis or a primary or secondary diagnosis of a developmental disability or a serious and persistent mental illness, and who undergoes pre-admission screening and is found in need of nursing facility level of care (Medicaid-eligible residents). The resident must have income of at least the current allowable amount of SSI.
A Supportive Living Facility (“SLF”) is a residential setting that meets certain legal requirements. In order to operate, the Illinois Department of Healthcare and Family Services (HFS) (formerly, Department of Public Aid) must approve and certify the facility.
The supportive living program is designed to offer assisted living to the elderly and to persons with physical disabilities, both from the private sector and those who are Medicaid-eligible. SLFs are designed for those who do not need the full spectrum of nursing facility care, but who may find it difficult to live safely in their own home. Supportive living offers a special combination of housing, meals and activities, as well as health-related and personalized care services, supervised on a 24-hour basis.
The SLF’s must design their mission, their service programs and the physical environment to maximize residents’ dignity, privacy, personal choice and independence. They must encourage residents’ involvement with both family and community.
Residents pay for the housing component with Social Security or other personal funds. Currently, the state’s Medicaid program pays for the medical care (and other services) component for about 60% of the residents. The rest are considered “private pay.”
If an SLF has different rates for Medicaid and private pay, the SLF must reserve not less than 25% of its apartments for Medicaid residents. If the rate is the same for both private pay and Medicaid residents, the SLF is not required to reserve apartments for Medicaid residents but must accept Medicaid residents on a first come, first served basis.
The level of care provided by a supportive living facility (SLF) is very similar to the level of care provided in an assisted living facility (ALF). The primary difference between them is that there is no source of public payment available for care in an ALF.
An SLF can be for persons 65 and older, or for persons with disabilities between ages 22 and 64. No single facility can have both populations. At the time this Section was written, there were 100 operating SLFs in the State, with about 7,800 units. Of these, only three (3) operating SLFs are for the age 22-64 group. The rest are for the age 65 and older group. There were an additional 57 approved sites still under development.
An SLF may admit or retain you as a resident if you meet the following requirements:
Private pay individuals may choose to be admitted into an SLF when the screening assessment does not justify nursing facility level of care. However, HFS must use the DON to screen private pay residents who want convert to Medicaid while living in an SLF and must find them to be in need of nursing facility level of care before Medicaid payment can be authorized.
A “developmental disability” is defined as a disability which is attributable to mental retardation or a related condition.
If you are a Medicaid recipient living in an SLF, you cannot also receive services from the Department on Aging’s Community Care Program or the Department of Human Services’ Home Services Program.
SLF’s must be safe and comfortable. To be certified by HFS, they must meet acceptable standards, as discussed below.
In terms of building construction, they must conform to applicable building and fire codes. They must meet the accessibility standards of the Americans with Disabilities Act. There cannot be any apartments below grade level. Any facility with 2 or more stories must have one elevator available for your use. If there are more than 75 units in the building, there must be at least 2 elevators.
Apartments can be for single occupancy or double occupancy. Each apartment in an SLF must have:
• Individually controlled heating and air conditioning;
• Sufficient lighting (including well-lit corridors and stairwells);
• A door that locks from the inside;
• A separate private bathroom that includes a toilet with grab bars, a sink, a bathtub or shower stall with grab bars, hot and cold water;
• Private telephone lines;
• Access to cable TV or a satellite dish;
• A kitchen sink, microwave oven or stove and refrigerator with a separate freezer compartment;
• Locked mailboxes;
• Closet space of given dimensions;
• Doors that are wheelchair accessible, and entrance doors that lock from the outside, open onto a public corridor and are equipped with an Eye-viewer;
• Windows large enough to permit viewing outside and at least one with a sill height that permits viewing from a seated position; and
• An Emergency Call System, with at least two electronic devices available in each apartment to enable the resident to get help in an emergency. A device must be located in each bathroom and each bedroom.
The SLF also must have electronic devices available in each common area, each public restroom, each common bathing room and each resident laundry room to enable residents to secure help in an emergency.
A nursing home can operate an SLF, but if they do, they must use a distinct part of the existing facility, separate and apart from the rest of the nursing home, and must operate the SLF as a distinct entity. In all other SLFs, all of the apartments must be devoted to SLF residents.
For SLFs approved after October 18, 2004, facilities must offer a separate bedroom for each unrelated occupant.
Each SLF must comply with requirements for social and recreation areas, kitchen and dining areas, public restrooms, laundry rooms and housekeeping/ maintenance areas. Each SLF must have:
All of the above common areas must be handicapped accessible, including for persons in wheelchairs.
In addition to the costs for room and board, there is a separate rate for the other services that the SLF provides. This rate is based on the geographic location of the SLF and is paid by HFS.
For Medicaid residents, the SLF cannot charge more for room and board than the Supplemental Security Income (SSI) rate, minus a $90 personal allowance. This charge can be increased only when the SSI amount is increased, and in an amount no greater than the amount of the SSI increase.
The SLF must give each Medicaid resident $90 per month as a deduction from his or her income, for the resident’s personal use. The SLF may charge each Medicaid resident no more than the current SSI rate for a single individual, minus the $90.
If a Medicaid eligible resident shares an apartment, the Medicaid resident must be given $90 per month as a deduction from his or her income for personal use. The SLF may charge each Medicaid resident no more than the resident’s share of the current SSI rate for a couple, minus the $90.
The room and board rate for two Medicaid eligible individuals sharing an apartment cannot be more than the SSI rate for a married couple. This is true even if the two people sharing an apartment are unrelated.
If one or both of the people sharing an apartment is not Medicaid eligible, the SLF may negotiate its own room and board rate with any non-Medicaid individual.
All residents continue to be responsible for room and board charges during any absence from the facility, even those for hospitalizations or vacations.
The SLF can negotiate a rate for services with “private pay” residents. However, the SLFs often offer the same rate as they impose for Medicaid residents.
Medicaid will pay the SLFs for services provided to Medicaid residents. SLFs must accept the Medicaid rate as payment in full for all services provided to Medicaid residents (except meals). Meals are included in the room and board amount paid by the resident. SLFs are not allowed to accept any additional payment, except as noted below.
Whether the Medicaid resident lives in a single occupancy unit or a double occupancy unit, the SLF will apply any extra income of the resident as follows: If the Medicaid resident has any income left after deduction of the $90 personal allowance and the room and board charges, the SLF must first apply that income towards medical expenses not covered by Medicaid. If there is still any income left after that, the remaining income is retained by the SLF to offset HFS’s payment.
If a Medicaid resident is working, the resident may keep $50 per month of employment income, in addition to the $90 personal allowance. Any additional monthly employment income must be turned over to the facility.
If a Medicaid resident receives food stamps, the SLF can require that the food stamps be turned over to the facility.
If a Medicaid resident is temporarily absent from the SLF for reasons such as vacations or hospitalizations, HFS will continue to pay the SLF for services. However, HFS will pay for no more than 30 days per State fiscal year (July 1 -June 30) during a Medicaid resident’s temporary absence from the SLF. If the absence extends beyond that time, the resident must pay for services. In the discretion of the SLF, they may allow a Medicaid resident additional days before the resident must pay for services. If so, those additional days should be stated in the contract.
An SLF must combine housing with personal and health related services and both community and social activities, in response to your individual needs. Supportive services must be available 24 hours per day to meet both scheduled and unscheduled needs. SLFs must provide these services in a way that promotes resident self-direction and participation in decision-making. They must also provide services in a way that emphasize independence, individuality, privacy, dignity and autonomy.
The SLF must conduct a standardized interview to determine your service needs at or before the time you first move in.
The SLF must complete an initial assessment and service plan within 24 hours after you move in. This is done to identify potential immediate problems. A registered nurse must complete or co-sign each assessment.
The SLF must complete a Comprehensive Resident Assessment Investment (RAI) within 14 days after you move in. Thereafter, the SLF must complete a new RAI every year. A registered nurse must complete or co-sign each RAI.
Within 7 days after the SLF completes an RAI, a registered nurse must develop or co-sign a written service plan. The nurse should get input from you and your designated representative. The Plan should identify:
A registered nurse must complete or co-sign a quarterly evaluation of your health status. The nurse must use a specific HFS form.
The SLF must review and update the service plan every quarter and whenever your needs or preferences change. If the SLF staff observes any change in your mental or physical status, the SLF manager or licensed nurse must alert you, your physician, and your designated representative, within 24 hours after the observation. Serious or life-threatening situations should be reported to the physician and designated representative immediately.
A licensed nurse must provide the following services when needed:
Example: placing a dose in a container and placing the container to your mouth.
Other nursing services can be done by other staff under the supervision of a registered nurse. Those services include:
Certified nursing assistants can deliver certain personal care services without supervision. These services include bathing, eating, ambulation, transfer, as well as personal hygiene, grooming and toileting.
An SLF must also do the following:
Only a licensed nurse can actually help you take or apply the medication. Certified nursing assistants are not permitted to do so under the law.
An SLF must provide the following to you:
If you want to store and prepare food in your own apartment, you have the right to do so, as long as that does not represent a health or safety hazard to others. If you have a documented period of illness, the SLF must provide you with a meal service in your apartment for a limited time.
If you so request, the SLF must provide laundry services to Medicaid-eligible at no charge. The SLF must provide for the appropriate handling, cleaning and storage of not just of routine personal laundry, but also laundry soiled with body secretions and all other laundry. Laundry service does not include dry cleaning services.
If you want to do your own laundry, the SLF must provide on-site laundry equipment for your use that meets the requirements noted above. Laundry detergent and fabric softener must also be supplied by the SLF at no cost to the resident.
Each SLF must provide the following services:
The SLF must have response/security staff, as follows:
Each SLF must provide other services, as well, including:
Each SLF must provide general housekeeping services at least weekly (house cleaning, bed making, changing of linens, dusting and vacuuming). It must also maintain all public areas and common bath rooms in a clean and orderly condition.
Each SLF must keep all apartments in good repair, and the building and grounds clean and free of hazards, with all systems kept in good working order.
The SLF must provide transportation for scheduled group shopping. If you are temporarily unable to shop, the SLF must provide shopping help. At your request, they must also help you to get any needed services offered outside the SLF, to make medical appointments and to arrange for transportation to and from the doctor’s office.
The SLF must offer and encourage the use of health and exercise programs for its residents. The SLF must develop programs to be held at least 3 times per week geared toward promoting better health and fitness of the residents. These programs are in addition to the social and recreational programming described above.
Each SLF must have a system to check on the welfare of each resident daily.
If you are moving into an SLF, you or your legal representative must sign a contract that specifies the terms of your agreement. The contract must be for a term not greater than one year and may be renewable if both parties agree. The contract must include (but need not be limited to) the following:
The contract may include the agreement of the SLF to provide (for a fee), additional services such as barber or beauty services, or sundries for personal use and other amenities.
The contract must permit arrangements where two people want to share an apartment. This is true even if one of the two individuals is not eligible for SLF services, or even if the individuals are not married or related. If one of the individuals is not eligible for SLF services, the contract must provide that in the event of the eligible person’s death or discharge, the SLF must offer the ineligible resident the option to be released from the contract immediately or to remain in the SLF until the expiration of the term of the contract.
As a resident, you have all rights guaranteed under the Constitutions of the United States and the State of Illinois, as well as under all federal, State and local statutes and the HFS administrative rules. Each SLF must inform every resident of all of the following rights.
Although some of these rights depend on your not disturbing or endangering others, you otherwise have the right to:
If you refuse services that the SLF deems necessary, the SLF may request that you or your designated representative sign a “negotiated risk agreement.” If so, you may request that others be present, such as the Ombudsman or an attorney, during the negotiated risk agreement discussion.
If you refuse to use recommended or needed services, you can stay in the SLF as long as you acknowledge that the decision to forgo those services was made against the advice of the SLF, family or health care professional and you must indemnify the SLF from any liability resulting from your decision.
The SLF must have an experienced manager or a qualified designee present at the SLF during normal business hours. He or she must also be there whenever necessary to manage or administer any resident contracts. Also, the manager must designate a qualified person capable of acting in an emergency during his or her absence from the SLF. All staff must have access to the manager or the designee at all times.
There must be licensed and certified staff sufficient in number to meet the needs of all the residents. Any nurses on staff (employed or subcontracted) must be licensed by the State of Illinois.
The SLF must employ certified nursing assistants who are at least age 18 and have successfully completed no later than 120 days after employment a nursing assistant training course or a Department of Public Health approved equivalent training and competency evaluation.
The SLF must either employ or contract with a licensed dietitian who must be on-site at least twice per quarter. The SLF must consult the dietician with respect to all menu planning, food preparation and storage procedures, safety and sanitation and management of therapeutic diets.
The SLF must employ a minimum of one cook who shall have at least one year of experience in commercial food preparation. Twenty-four hour security staff must be at least 18 years old and have at least a high school diploma or a GED. Finally, the SLF must designate a trained staff person to be responsible for planning and directing social and recreational activities. This person must be at least 18 years old and have at least a high school diploma or a GED.
If you are discharged from the SLF, you are no longer bound by the contract. You can discharge yourself voluntarily or under certain circumstances, either the SLF or the HFS can discharge you.
If you want to discharge on a voluntary basis, you must give the SLF a written notice of your intent to discharge. You must give this notice at least 30 days before you leave, except where a delay would jeopardize your health, safety, and well-being or that of others.
If the SLF decides to discharge you because you do not meet the terms for occupancy as stated in the contract, the SLF must have a meeting with you and your designated representative to discuss the reasons for the discharge. This meeting must take place before the SLF begins to discharge you. The SLF must document this discussion in your record.
The SLF must also give you a written notice of any proposed involuntary discharge. This notice must be given to you at least 30 days before the discharge goes into effect, unless such a delay might jeopardize your health, safety, and wellbeing or that of others. The SLF must place a copy of this notice in your record and must provide a copy of it to you and to your designated representative.
The notice must be on a specific HFS form and must contain all of the following:
The SLF is not required to send a 30 day notice to you if:
Once an SLF decides to discharge you, they must make plans to assure that it is done in a safe and orderly manner and in a way that protects your health, safety, welfare and rights.
An SLF can discharge you only if one or more of the following occurs:
If failure to pay is the reason for discharge, you have the right to stay in the SLF if you make full payment any time up to the date of discharge.
You have the right to appeal the SLF’s decision to discharge you. You make this appeal to HFS on a form that the SLF must give you at the same time they give you the discharge notice. You must file your request for a hearing within ten (10) days after receiving the discharge notice. If you appeal, you have the right to stay in the SLF until HFS holds a hearing and makes a decision on your appeal (unless an emergency discharge situation arises).
HFS will schedule a hearing. An HFS hearing officer will have to determine whether an involuntary discharge is justified. The SLF has the burden of proving it.
If HFS decides the discharge is not justified, you may stay at the SLF. If HFS decides that an involuntary discharge is justified, then you must leave. However, the SLF cannot make you leave before the tenth day after they get the HFS decision (unless an emergency discharge situation arises).
If you want assistance or representation in any appeal at HFS, you should contact the Ombudsman’s Office and your local legal services office, such as Prairie State Legal Services.
Under certain circumstances, HFS can discharge you from an SLF, even if the SLF takes no action themselves to discharge you. HFS may discharge you from an SLF only when:
When HFS acts to discharge you for any of these reasons, you do not have the right to further appeals to HFS.
If HFS makes a decision that a discharge from an SLF is justified, and you want to further appeal that decision, you can file a lawsuit in Circuit Court. You should file that lawsuit within 35 days from the date of the HFS decision. By appropriate motion, you can ask the Court to allow you to stay in the SLF while the case is pending.
If you get involuntarily discharged, the SLF must offer you relocation assistance. This includes information on available alternative placements. You or your designated representative have the right to be involved in planning the discharge and to choose among the available alternative placements. Where an emergency makes such involvement impossible, the SLF may arrange for a temporary placement until a final placement can be arranged. The SLF may offer assistance in relocating from a temporary to a final placement.
At the time of this publication, several proposed amendments to the SLF program rules have been planned, although it is unknown when the proposed rules will be filed. The proposed amendments would impact several sections of the rule including, but not limited to, the following:
The Illinois Public Aid Code calls for the establishment of supportive living facilities (SLFs). 305 ILCS 5/5-5.01a. HFS has been approved for a federal waiver from the U.S. Centers for Medicare & Medicaid Services to allow for Medicaid to pay for home and community-based services. 305 ILCS 5/5-5a.
The SLF Rules can be found at 89 Illinois Administrative Code, Chapter 1, Sections 146.200 et. seq.
If you want more information, or have questions regarding a particular SLF, you can contact the:
Department of Healthcare and Family Services, Bureau of Long Term Care:
To find more detailed information, you may visit the Illinois Supportive Living Program website. There, you will find a listing of approved and operational SLFs, as well as an SLF locator, by county. You may also find Fact Sheets about the Supportive Living Program, and various other information.
If you have a complaint about a specific SLF, your complaint will be investigated by HFS. You can call their Complaint Hotline at: 1-800-226-0768.
The Illinois Department on Aging has a Long Term Care Ombudsman Program that protects and promotes the rights and quality of life for people who reside in long term care facilities. This is done through regional ombudsmen who have a hands-on working relationship with the residents and staff of the facilities within their program areas. You can contact the Ombudsman Program whenever you need to:
To find the regional Ombudsman’s office near you, consult the Long Term Care Ombudsman Directory for names, addresses and phone numbers.
Legal information and forms are available.
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