DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
BUREAU OF COMMUNITY AND HEALTH SYSTEMS  
HOMES FOR THE AGED  
(By authority conferred on the department of licensing and regulatory affairs by section  
427 of the Executive organization act of 1965, 1965 PA 380, MCL 16.527, section 2233  
of the public health code, 1978 PA 368, MCL 333.2233, and Executive Reorganization  
Order Nos. 1996-1, 1996-2, 2003-1, and 2015-1, MCL 330.3101, 445.2001, 445.2011,  
and 400.227)  
PART 1. GENERAL PROVISIONS  
R 325.1901 Definitions.  
Rule 1. As used in these rules:  
(a)"Act" means the public health code, 1978 PA 368, MCL 333.1101 to 333.25211.  
(b) "Activities of daily living" means activities associated with eating, toileting,  
bathing, grooming, dressing, transferring, mobility, and medication management.  
(c) "Admission policy" means a home's program statement of its purpose, eligibility  
requirements, and application procedures for admission.  
(d) "Assistance" means help provided by a home or an agent or employee of a home  
to a resident who requires help with activities of daily living.  
(e) "Authorized representative" means that person or agency that has been granted  
written legal authority by a resident to act on behalf of the resident or is the legal  
guardian of a resident.  
(f) "Department" means the department of licensing and regulatory affairs.  
(g) "Director" means the director of the department.  
(h) "Discharge policy" means a home's written statement of the criteria and  
procedures by which a resident is discharged from the home.  
(i) "Elopement" means a resident who has a service plan that requires notice or  
arranged supervision to leave the facility and is absent without notice or supervision.  
(j) "Home" means a home for the aged as defined in section 20106(3) of the act,  
MCL 333.20106.  
(k) "Incident" means an intentional or unintentional event including, but not limited  
to, elopements and medication errors, where a resident suffers physical or emotional  
harm.  
(l) "Licensed health care professional" means an individual who is licensed under  
article 15 of the act, MCL 333.16101 to 333.18838, and who is operating within the  
scope of his or her license.  
(m) "Major building modification" means an alteration of walls that creates a new  
architectural configuration or revision to the mechanical or electrical systems that  
significantly revise the design of the system or systems. Normal building maintenance,  
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repair, or replacement with equivalent components are not considered major building  
modifications. A change in room function shall not cause a conflict with these rules.  
(n) "Medication management" means assistance with the acquisition and  
administration of a resident’s prescribed medication.  
(o) "Program statement" means a written description of the home's overall  
philosophy and mission reflecting the needs of residents and services provided to  
residents. A home that represents to the public that it provides residential care or  
services, or both, to individuals with Alzheimer's disease or a related condition shall  
include in its program statement the information required by section 20178 of the act,  
MCL 333.20178.  
(p) "Protection" means the continual responsibility of the home to take reasonable  
action to ensure the health, safety, and well-being of a resident as indicated in the  
resident's service plan, including protection from physical harm, humiliation,  
intimidation, and social, moral, financial, and personal exploitation while on the  
premises, while under the supervision of the home or an agent or employee of the home,  
or when the resident's service plan states that the resident needs continuous supervision.  
(q) "Resident" means an individual who is 55 years of age or older, or an individual  
under the age of 55 who has been admitted through a waiver of the director pursuant to  
section 21311(3) of the act, MCL 333.21311.  
(r) "Resident admission contract" means a written agreement between the home and  
the resident or the resident's authorized representative that specifies the services to be  
provided, the fees to be charged, including all fees related to admission such as deposits,  
admission fees, advance care payments, application fees and all other additional fees, and  
the home's policies related to the admission and retention of a resident.  
(s) "Room and board" means the provision of housing and meals to meet the needs  
of the resident.  
(t) "Service plan" means a written statement prepared by the home in cooperation  
with a resident, the resident's authorized representative, or the agency responsible for a  
resident's placement, if any, that identifies the specific care and maintenance, services,  
and resident activities appropriate for the individual resident's physical, social, and  
behavioral needs and well-being, and the methods of providing the care and services  
while taking into account the preferences and competency of the resident.  
(u) "Supervision" means guidance of a resident in the activities of daily living, and  
includes all of the following:  
(i) Reminding a resident to maintain his or her medication schedule in accordance  
with the instructions of the resident's licensed health care professional as authorized by  
section 17708(2) of the act, MCL 333.17708.  
(ii) Reminding a resident of important activities to be carried out.  
(iii) Assisting a resident in keeping appointments.  
(iv) Being aware of a resident's general whereabouts as indicated in the resident's  
service plan, even though the resident may travel independently about the community.  
(v) Supporting a resident's personal and social skills.  
History: 2004 AACS; 2018 AACS; 2023 MR 6, Eff. March 21, 2023.  
PART 2. STATE ADMINISTRATION  
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R 325.1911 License applications; authorized representatives; notices.  
Rule 11. (1) An application for a license for a home shall be made on forms  
authorized and provided by the director and shall be completed in full.  
(2) An application for a license for a home shall be made and signed by the  
individual desiring to establish, conduct, or maintain a licensed home, or by the  
authorized representative of any individual, copartnership, corporation, or association  
including any receiver, trustee, assignee, or similar representative desiring to establish,  
conduct, or maintain a licensed home.  
(3) An authorized representative shall be authorized by the applicant to do all of  
the following:  
(a) Make application and amendments to the application  
(b) Provide the director with all information necessary  
determination in connection with the issuance of a license.  
to  
make a  
(c) Enter into agreements with the director in connection with the issuance of a  
license.  
(4) A certificate of appointment or other written evidence of the authority  
vested in the authorized representative shall be attached to the application.  
(5) In matters relating to the licensing of the home, the director may continue to  
deal with the authorized representative until the director is notified in writing that a  
new authorized representative has been appointed with equal power and the former  
authorized representative is no longer authorized to act.  
(6) The director may use any appropriate means of notice and may direct notices  
of any administrative action pursuant to licensing of the home to the applicant or the  
authorized representative, either personally or by certified mail at the address of the  
establishment or institution.  
History: 2004 AACS.  
R 325.1912 Licenses and permits; issuance.  
Rule 12. (1) Upon determination that the home complies with the act and these  
rules, the department shall issue a license.  
(2) The department may issue a nonrenewable temporary permit for not more than  
6 months in accordance with MCL 333.20162(2).  
(3) The department may issue a provisional license for not more than  
consecutive years in accordance with MCL 333.20162(3).  
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(4) The maximum number of resident beds authorized for occupancy shall be  
endorsed on the license, provisional license, or nonrenewable temporary permit.  
History: 2004 AACS.  
R 325.1913 Licenses and permits; general provisions.  
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Rule 13. (1) A license, provisional license, or temporary nonrenewable permit is  
not transferable between owners, or from one location to another, or from one part of an  
institution to another.  
(2) The applicant or the authorized representative shall give written notice to the  
department within 5 business days of any changes in information as submitted in the  
application pursuant to which  
nonrenewable permit has been issued.  
a
license, provisional license, or temporary  
(3) The number of residents cared for in a home and the complement of resident  
beds shall not exceed the number authorized by the license, provisional license, or  
temporary nonrenewable permit.  
(4) The current license, provisional license, or temporary nonrenewable permit  
shall be posted in a conspicuous public area of the home.  
History: 2004 AACS.  
R 325.1914 Administrative actions.  
Rule 14. (1) Orders and notices of intended action regarding licensure that are  
issued by the department against a home or applicant shall be in writing, and shall  
include all of the following:  
(a) The nature of the action or intended action by the department.  
(b) A brief statement of the facts on which the department action or intended  
action is based.  
(c) The legal authority and jurisdiction for the action or intended action.  
(d) A reference to the applicable sections of the act and rules.  
(e) A statement regarding any rights to a hearing that are provided by the act or R  
325.1915.  
(f) Any written requirement and deadline for response from the home or applicant  
to the administrative action.  
(2) Orders and notices of intended action shall be served on the home or applicant  
personally or by certified mail.  
(3) Failure of the home or applicant to respond to an order or a notice within 30  
days shall constitute a default.  
History: 2004 AACS.  
R 325.1915 Hearing procedures.  
Rule 15. (1) This rule applies to hearings that are required by MCL 333.20162,  
333.20165, 333.20166, and 333.20168.  
(2) Unless otherwise provided by the act, the procedures for hearing shall  
comply with sections 71 to 92 of 1969 PA 306, MCL 24.271 to 24.292.  
(3) If a hearing is required, then the home or applicant shall be notified in  
writing of the date, hour, place, and nature of the hearing. Unless otherwise specified in  
the notice, the hearing shall be held at the offices of the department in Lansing,  
Michigan.  
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(4) A hearing date shall be scheduled in accordance with the timeframes set out in  
MCL 333.20162, 333.20165, 333.20166, and 333.20168 as follows:  
(a) Under MCL 333.20162 and 333.20168, an opportunity for a hearing on  
a
compliance order or on an emergency order limiting, suspending, or revoking the  
license of the home shall be provided to the home within 5 working days of issuance of  
the department's order.  
(b) Under MCL 333.20165 and 333.20166, the date set for an opportunity for a  
hearing on a notice of intent to deny, limit, suspend, or revoke a license shall be at  
least 30 days from the date of service of the action on the home or applicant.  
(c) The date set for an opportunity for a hearing on a department order imposing  
an administrative fine on a home under MCL 333.20165(1) shall be at least 30 days from  
the date of service of the order on the home.  
(5) The presiding officer may grant a request for an adjournment of a hearing for  
good cause. Unless provided otherwise by the act or these rules, an adjournment  
does not suspend the effective date of the department's order, including the effective  
date of a compliance order issued under MCL 333.20162 or an emergency order  
issued under MCL 333.20168 to limit, suspend, or revoke a home's license.  
(6) Absent an adjournment, a home or applicant that fails to appear at a contested  
case hearing after proper service of notice waives the right to an administrative hearing  
on the department's order and any other review to which the home or applicant may be  
entitled. In such case, a default shall be entered, and the department's order or notice of  
intended action shall become final.  
History: 2004 AACS.  
Editor's Note: An obvious error in R 325.1915 was corrected at the request of the promulgating  
agency, pursuant to Section 56 of 1969 PA 306, as amended by 2000 PA 262, MCL 24.256. The rule  
containing the error was published in Michigan Register, 2004 MR 12. The memorandum requesting the  
correction was published in Michigan Register, 2006 MR 14.  
R 325.1916 Prohibited use of "state approved" and "hospital."  
Rule 16. (1) The home shall not use "state approved" or words having a similar  
meaning unless the home is operating under a current license.  
(2) The home shall not use "hospital" or words having a similar meaning.  
(3) The home shall not use "nursing home" or words having a similar meaning.  
History: 2004 AACS.  
R 325.1917 Compliance with other laws, codes, and ordinances.  
Rule 17. (1) A home shall comply with all applicable laws and shall furnish  
such evidence as the director shall require to show compliance with all local laws,  
codes, and ordinances.  
(2) A home shall comply with the department's health care facility fire safety rules  
being R 29.1801 to R 29.1861 of the Michigan Administrative Code.  
History: 2004 AACS.  
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PART 3. ADMINISTRATIVE MANAGEMENT OF HOMES  
R 325.1921 Governing bodies, administrators, and supervisors.  
Rule 21. (1) The owner, operator, and governing body of a home shall do all of the  
following:  
(a) Assume full legal responsibility for the overall conduct and oporation of  
the home.  
(b) Assure that the home maintains an organized program to provide room and  
board, protection, supervision, assistance, and supervised personal care for its residents.  
(c) Assure the availability of emergency medical care required by a resident.  
(d) Appoint a competent administrator who is responsible for operating the home  
in accordance with the established policies of the home.  
(2) An administrator shall meet all of the following requirements:  
(a) Be at least 18 years old.  
(b) Have education, training, and/or experience related to the population served by  
the home.  
(c) Be capable of assuring program planning, development,  
and  
implementation of services to residents consistent with the home's program statement  
and in accordance with the residents' service plan and agreements.  
(3) A licensee who meets the qualifications of an administrator may serve as an  
administrator.  
History: 2004 AACS.  
R 325.1922 Admission and retention of residents.  
Rule 22. (1) A home shall have a written resident admission contract, program  
statement, admission and discharge policy, and a resident's service plan for each resident.  
(2) The admission policy shall specify all of the following:  
(a) That at the time of admission, the home shall document the needs of each  
individual seeking admission. The documented needs shall be used to develop the  
resident's service plan.  
(b) That a home shall not accept an individual seeking admission unless the  
individual's needs can be adequately and appropriately met within the scope of the home's  
program statement.  
(c) That the individual seeking admission and his or her authorized representative,  
if any, shall participate in the development of the individual's service plan.  
(d) That the home has developed and implemented a communicable disease policy  
governing the assessment and baseline screening of residents.  
(3) At the time of an individual's admission, a home or the home's designee shall  
complete a written resident admission contract between the resident, the resident's  
authorized representative, or both, and the home. The resident admission contract shall,  
at a minimum, specify all of the following:  
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(a) That the home shall provide room, board, protection, supervision, assistance,  
and supervised personal care consistent with the resident's service plan.  
(b) The services to be provided and the fees for the services.  
(c) The notice to be provided by the home to the resident, the resident's authorized  
representative, or both, upon any change in fees.  
(d) The transportation services that are provided, if any, and the fees for those  
services.  
(e) The home's admission and discharge policy.  
(f) The home's refund policy.  
(g) The resident's rights and responsibilities, which shall include those rights and  
responsibilities specified in section 20201(2) and (3), MCL 333.20201(2) and (3) of the  
public health code and section 20202, MCL 333.20202, of the code.  
(4) If there is a change in a term or condition in the written resident admission  
contract, then the home or home's designee shall review the change with the resident and  
the resident's authorized representative, if any.  
(5) A home shall update each resident's service plan at least annually or if there is a  
significant change in the resident's care needs. Changes shall be communicated to the  
resident and his or her authorized representative, if any.  
(6) A home shall require an individual who, at the time of admission, is under the  
care of a licensed health care professional for ongoing treatments or prescription  
medications that require the home's intervention or oversight, to provide a written  
statement from that licensed health care professional completed within the 90-day period  
before the individual's admission to the home. The statement shall list those treatments  
or medications for the purpose of developing and implementing the resident's service  
plan. If this statement is not available at the time of an emergency admission, then the  
home shall require that the statement be obtained not later than 30 days after admission.  
(7) An individual admitted to residence in the home shall have evidence of initial  
tuberculosis screening on record in the home that was performed within 12 months before  
admission. Initial screening may consist of an intradermal skin test, a blood test, a chest  
x-ray, or other methods recommended by the public health authority. The screening type  
and frequency of routine tuberculosis (TB) testing shall be determined by a risk  
assessment as described in the 2005 MMWR “Guidelines for Preventing the  
Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005”  
(http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf), Appendices B and C, and any subsequent  
guidelines as published by the centers for disease control and prevention. A home, and  
each location or venue of care, if a home provides care at multiple locations, shall  
complete a risk assessment annually. Homes that are low risk do not have to conduct  
annual TB testing for residents.  
(8) A home shall not retain a resident if the resident has harmed himself or herself  
or others, or has demonstrated behaviors that pose a risk of serious harm to himself or  
herself or others, unless the home has the capacity to manage the resident's behavior.  
(9) A home shall not admit a resident who requires continuous nursing care  
services of the kind normally provided in a nursing home as specified in section 21711(3)  
of the code, MCL 333.21711(3), and section 21715(2), MCL 333.21715(2), of the code.  
(10) A home shall not retain a resident who requires continuous nursing care  
services of any kind normally provided in a nursing home as specified in section  
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21711(3), MCL 333.21711(3), and section 21715(2), MCL 333.21715(2), of the code  
unless the home meets the provisions of section 21325, MCL 333.21325, of the code or  
the individual is enrolled in and receiving services from a licensed hospice program or a  
home health agency.  
(11) In accordance with section 20201(3) of the code, MCL 333.20201(3) (e), a  
home’s discharge policy shall specify that a home for the aged resident may be  
transferred or discharged for any of the following reasons:  
(a) Medical reasons.  
(b) His or her welfare or that of other residents.  
(c) For nonpayment of his or her stay.  
(d) Transfer or discharge sought by resident or authorized representative.  
(12) The reason for transfer or discharge shall be documented in the resident  
record.  
(13) A home shall provide a resident and his or her  
authorized  
representative, if any, and the agency responsible for the resident's placement, if  
any, with a 30-day written notice before discharge from the home. The written notice  
shall consist of all of the following:  
(a) The reasons for discharge.  
(b) The effective date of the discharge.  
(c) A statement notifying the resident of the right to file a complaint with the  
department. The provisions of this subrule do not preclude a home from providing other  
legal notice as required by law.  
(14) If the department finds that the resident was discharged in violation of these  
rules or the home's discharge policy, then the resident may return to the first available  
bed in the home that can meet the resident's needs as identified in the resident's service  
plan.  
(15) A home may discharge a resident before the 30-day notice if the home has  
determined and documented that either, or both, of the following exist:  
(a) Substantial risk to the resident due to the inability of the home to meet the  
resident's needs or due to the inability of the home to assure the safety and well-being of  
the resident, other residents, visitors, or staff of the home.  
(b) A substantial risk or an occurrence of the destruction of property.  
(16) A home that proposes to discharge a resident for any of the reasons listed in  
subrule (15) of this rule shall take all of the following steps before discharging the  
resident:  
(a) The home shall notify the resident, the resident's authorized representative, if  
any, and the agency responsible for the resident's placement, if any, not less than 24  
hours before discharge. The notice shall be verbal and issued in writing. The notice of  
discharge shall include all of the following information:  
(i) The reason for the proposed discharge, including the specific nature of the  
substantial risk.  
(ii) The alternatives to discharge that have been attempted by the home, if any.  
(iii) The location to which the resident will be discharged.  
(iv) The right of the resident to file a complaint with the department.  
(b) The department and adult protective services shall be notified not less than 24  
hours before discharge in the event of either of the following:  
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(i) A resident does not have an authorized representative or an agency responsible  
for the resident’s placement.  
(ii) The resident does not have a subsequent placement.  
(c) The notice to the department and adult protective services shall include all of  
the following information:  
(i) The reason for the proposed discharge, including the specific nature of the  
substantial risk.  
(ii) The alternatives to discharge that have been attempted by the home, if any.  
(iii) The location to which the resident will be discharged, if known.  
(d) If the department finds that the resident was improperly discharged, then the  
resident may return to the first available bed in the home that can meet the resident's  
needs as identified in the resident's service plan.  
(e) The resident shall not be discharged until a subsequent setting that meets the  
resident's immediate needs is located.  
History: 2004 AACS; 2017 AACS.  
R 325.1923 Employee's health.  
Rule 23. (1) A person on duty in the home shall be in good health. The home shall  
develop and implement a communicable disease policy governing the assessment and  
baseline screening of employees. A record shall be maintained for each employee, which  
shall include results of baseline screening for communicable disease. Records of  
accidents or illnesses occurring while on duty that place others at risk shall be maintained  
in the employee's file.  
(2) A home shall provide initial tuberculosis screening at no cost for its employees.  
New employees shall be screened within 10 days of hire and before occupational  
exposure. The screening type and frequency of routine tuberculosis (TB) testing shall be  
determined by a risk assessment as described in the 2005 MMWR “Guidelines for  
Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings,  
2005” (http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf), Appendices B and C, and any  
subsequent guidelines as published by the centers for disease control and prevention.  
Each home, and each location or venue of care, if a home provides care at multiple  
locations, shall complete a risk assessment annually. Homes that are low risk do not need  
to conduct annual TB testing for employees.  
(3) Employees with past documented positive TB skin test results or who have  
received treatment for tuberculosis infection in the past are exempt from the TB skin test.  
Employees with past documented positive TB skin result, who have never been treated  
for TB infection, shall be screened for active symptoms of TB disease and the need for  
evaluation by a qualified health care professional to determine if treatment for TB  
infection is indicated.  
(4) TB skin tests, as well as post-exposure follow-up and treatment evaluations,  
shall be offered at no cost to the employees at times and locations convenient to the  
employees. A qualified health care professional shall perform the reading and  
interpretation of the TB testing.  
History: 2004 AACS; 2017 AACS.  
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R 325.1924 Reporting of incidents, quality review program.  
Rule 24. (1) A home for the aged must implement and maintain a quality review  
program consistent with section 20175(8) of the act, MCL 333.20175, and the  
professional review function. The program is responsible for all of the following:  
(a) Reviewing and evaluating incidents.  
(b) Identifying effective means to correct any deficient practice.  
(c) Ensuring resident safety and quality of care.  
(d) Improving procedures.  
(2) The program must be reviewed annually by the administrator and governing  
body.  
(3) The program must be staffed by a multi-disciplinary team. The multi-disciplinary  
team shall consist of not less than 2 personnel that have training or experience with the  
type of the incident being evaluated.  
(4) The multi-disciplinary team shall meet not less than twice each calendar year or  
more frequently as needed to review an incident or incidents.  
(5) Records must be maintained that demonstrate incident reporting to the team,  
analyses, outcomes, corrective action taken, and evaluation to ensure that the expected  
outcome is achieved. These records must be maintained for 2 years.  
(6) The facility must have a policy and procedure to report an incident using a  
department approved form to the multi-disciplinary team responsible for the quality  
review program required under subrule (1) of this rule.  
(7) The facility must have a policy and procedure to ensure that an incident, once  
known by facility staff, is reported as soon as possible, but not later than 48 hours after  
the incident, to a resident’s authorized representative or designated health care  
professional, as appropriate. Verbal or written notification must be documented in the  
resident’s record to reflect the date, time, name of staff who made the notification, and  
name of the representative or professional who was notified.  
(8) If an elopement occurs, staff shall conduct a search to locate the resident. If the  
resident is not located within 30 minutes after the elopement occurred, staff shall comply  
with subrule (7) of this rule and contact the local police authority.  
(9) The department may review a quality review program during a renewal survey to  
confirm that a program is in place. During a complaint investigation, the licensee shall  
confirm if an incident was reviewed and if any corrective actions were taken, but the  
department shall not request any other case-specific information that was part of the  
quality review program. The department shall rely on other documents outside this  
professional review function as part of its investigation. The department shall maintain  
and protect these documents in accordance with state and federal laws, including privacy  
laws.  
History: 2004 AACS; 2023 MR 6, Eff. March 21, 2023.  
PART 4. RESIDENT CARE  
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R 325.1931 Employees; general provisions.  
Rule 31. (1) Personal care and services that are provided to a resident by the home  
shall be designed to encourage residents to function physically and intellectually with  
independence at the highest practical level.  
(2) A home shall treat a resident with dignity and his or her personal needs,  
including protection and safety, shall be attended to consistent with the resident's service  
plan.  
(3) The home shall designate 1 person on each shift to be supervisor of resident  
care during that shift. The supervisor of resident care shall be fully dressed, awake, and  
on the premises when on duty.  
(4) The supervisor of resident care on each shift shall do all of the following:  
(a) Assure that residents are treated with kindness and respect.  
(b) Protect residents from accidents and injuries.  
(c) Be responsible for safety of residents in case of emergency.  
(5) The home shall have adequate and sufficient staff on duty at all times who  
are awake, fully dressed, and capable of providing for resident needs consistent with  
the resident service plans.  
(6) The home shall establish and implement a staff training program based on the  
home's program statement, the residents service plans, and the needs of employees, such  
as any of the following:  
(a) Reporting requirements and documentation.  
(b) First aid and/or medication, if any.  
(c) Personal care.  
(d) Resident rights and responsibilities.  
(e) Safety and fire prevention.  
(f) Containment of infectious disease and standard precautions.  
(g) Medication administration, if applicable.  
(7) The home's administrator or its designees are responsible for evaluating  
employee competencies.  
History: 2004 AACS.  
R 325.1932 Resident’s medications.  
Rule 32. (1)A service plan must identify prescribed medication to be self-  
administered or managed by the home.  
(2) Prescribed medication managed by the home shall be given, taken, or applied  
pursuant to labeling instructions, orders and by the prescribing licensed health care  
professional.  
(3) Staff who supervise the administration of medication for residents who do not  
self-administer shall comply with all of the following:  
(a) Be trained in the proper handling and administration of the prescribed  
medication.  
(b) Complete an individual medication log that contains all of the following  
information:  
(i) The name of the prescribed medication.  
(ii) The prescribed required dosage and the dosage that was administered.  
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(iii) Label instructions for use of the prescribed medication or any intervening  
(iv) The time when the prescribed medication is to be administered and when the  
order.  
medication was administered.  
(v) The initials of the individual who administered the prescribed medication.  
(vi) A record if the resident refuses to accept prescribed medication and  
notification as required in subdivision (c) of this subrule.  
(vii) A record of the reason for administration of a prescribed medication that is on  
an as-needed basis.  
(c) Contact the appropriate licensed health care professional when the prescribed  
medication has not been administered in accordance with the label instruction, an order  
from a health care professional, medication log, or a service plan.  
(4) If a resident requires prescription or over-the-counter medication or medications  
while out of the home, and medication or medications are not identified as self-  
administered, staff responsible for the medication management shall ensure that the  
resident, or the person that assumes responsibility for the resident, has all appropriate  
information, medication, and instructions.  
(5) Prescribed medication that is no longer required by a resident must be properly  
disposed of consistent with the policy established by the home and manufacturer  
guidelines.  
(6) For a resident who is identified as self-administered in his or her service plan, the  
home must have a policy to offer a secured method of storage for medications if desired  
by the resident and to notify the applicable health care professional or legal representative  
if there is a change in a resident’s capacity to self-medicate.  
History: 2004 AACS; 2013 AACS; 2023 MR 6, Eff. March 21, 2023.  
R 325.1933 Personal care of residents.  
Rule 33. (1) A home shall provide a resident with necessary assistance with  
personal care such as, but not limited to, care of the skin, mouth and teeth, hands and  
feet, and the shampooing and grooming of the hair as specified in the resident's  
service plan.  
(2) A home shall afford a resident the opportunity and instructions when necessary  
for daily bathing, oral and personal hygiene, daily shaving, and hand washing before  
meals. A home shall ensure that a resident bathes at least weekly and more often if  
necessary.  
History: 2004 AACS.  
R 325.1934 Furniture.  
Rule 34. (1) A home shall provide an individual bed at least 36 inches wide, with  
comfortable springs in good condition and a clean protected mattress not less than 5  
inches thick, or 4 inches thick if of synthetic construction.  
(2) A cot or rollaway cot shall not be used as a resident bed.  
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(3) A bedside stand or its equivalent shall be available for a resident for the  
storage of small personal articles.  
(4) A resident may use his or her own personal bed, mattress, and bedside stand or  
its equivalent, and may bring in personal furniture and possessions as space permits.  
Furniture and other possessions shall fit comfortably within the resident's own or  
shared living quarters, be safe and in reasonable condition, and be in compliance with  
R 29.1801 to R 29.1861 of the health facility fire safety rules.  
History: 2004 AACS.  
R 325.1935 Bedding, linens, and clothing.  
Rule 35. (1) Bedding shall be washable, in good condition, and clean, and shall be  
changed at least weekly or more often as required.  
(2) The home shall assure the availability of clean linens, towels, and washcloths.  
The supply shall be sufficient to meet the needs of the residents in the home.  
Individually designated space for individual towels and washcloths shall be provided.  
(3) The home shall make adequate provision for the laundering of a resident's  
personal laundry.  
(4) Rooms and all items in them shall be completely cleaned following the  
discharge of each resident.  
History: 2004 AACS.  
PART 5. RECORDS  
R 325.1941 Records; general.  
Rule 41. A resident register, resident records, accident records and incident  
reports, and employee records and work schedules shall be kept in the home and shall  
be available to the director or the director's authorized representative.  
History: 2004 AACS.  
R 325.1942 Resident records.  
Rule 42. (1) A home shall provide a resident record for each resident.  
(2) A home shall assure that a current resident record is maintained and that all  
entries are dated and signed.  
(3) The resident record shall include at least all of the following:  
(a) Identifying information, including name, marital status, date of birth, and  
gender.  
(b) Name, address, and telephone number of next of kin or authorized  
representative, if any.  
(c) Name, address, and telephone number of person or agency responsible for the  
resident's maintenance and care in the home.  
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(d) Date of admission.  
(e) Date of discharge, reason for discharge, and place to which resident was  
discharged, if known.  
(f) Health information, as required by MCL 333.20175(1), and other health  
information needed to meet the resident's service plan.  
(g) Name, address, and telephone number of resident's licensed health care  
professional.  
(h) The resident's service plan.  
(4) A home shall keep a resident's record in the home for at least 2 years after  
the date of a resident's discharge from the home.  
History: 2004 AACS.  
R 325.1943 Resident registers.  
Rule 43. (1) A home shall maintain a current register of residents which shall  
include all of the following information for each resident:  
(a) Name, date of birth, gender, and room.  
(b) Name, address, and telephone number of next of kin or authorized  
representative, if any.  
(c) Name, address, and telephone number of person or agency responsible for  
resident's maintenance and care in the home.  
(d) Date of admission, date of discharge, reason for discharge, and place to which  
resident was discharged, if known.  
(e) Name, address, and telephone number of resident's licensed health care  
professional, if known.  
(2) A register of all residents shall be maintained at all times for the previous 2  
years.  
History: 2004 AACS.  
R 325.1944 Employee records and work schedules.  
Rule 44. (1) A home shall maintain a record for each employee, which shall  
include all of the following:  
(a) Name, address, telephone number, and social security number.  
(b) License or registration number, if applicable.  
(c) Date of birth.  
(d) Summary of experience, education, and training.  
(e) Beginning date of employment and position for which employed.  
(f) References, if provided.  
(g) Results of initial TB screening as required by R 325.1923(2).  
(h) Date employment ceases and reason or reasons for leaving, if known.  
(i) Criminal background information, consistent with section 20173a, MCL  
333.20173a, of the code.  
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(2) The home shall prepare a work schedule showing the number and type of  
personnel scheduled to be on duty on a daily basis. The home shall make changes to the  
planned work schedule to show the staff who actually worked.  
(3) The home shall retain the work schedules for the preceding 3 months.  
History: 2004 AACS; 2017 AACS.  
PART 6. FOOD SERVICE  
R 325.1951 Nutritional need of residents.  
Rule 51. A home shall meet the food and nutritional needs of a resident in  
accordance with the recommended daily dietary allowances of the food and nutrition  
board of the national research council of the national academy of sciences, adjusted for  
age, gender, and activity, or other national authority acceptable to the department, except  
as ordered by a licensed health care professional.  
History: 2004 AACS.  
R 325.1952 Meals and special diets.  
Rule 52. (1) A home shall offer 3 meals daily to be served to a resident at regular  
meal times. A home shall make snacks and beverages available to residents.  
(2) A home shall work with residents when feasible to accommodate  
individual preferences.  
(3) A home shall assure that the temporary needs for meals delivered to a resident's  
room are met.  
(4) Medical nutrition therapy, as prescribed by a licensed health care professional  
and which may include therapeutic diets or special diets, supplemental nourishments  
or fluids to meet the resident's nutritional and hydration needs, shall be provided in  
accordance with the resident's service plan unless waived in writing by a resident or a  
resident's authorized representative.  
(5) A home shall prepare and serve meals in an appetizing manner.  
(6) A home shall provide a table or individual freestanding tray of table height for a  
resident who does not go to a dining room.  
History: 2004 AACS.  
R 325.1953 Menus.  
Rule 53. (1) A home shall prepare and post the menu for regular and  
therapeutic or special diets for the current week. Changes shall be written on the  
planned menu to show the menu as actually served.  
(2) A home shall maintain a copy of all menus as actually served to residents  
for the preceding 3 months.  
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History: 2004 AACS.  
R 325.1954 Meal and food records.  
Rule 54. The home shall maintain a record of the meal census, to include residents,  
personnel, and visitors, and a record of the kind and amount of food used for the  
preceding 3-month period.  
History: 2004 AACS.  
PART 7. BUILDINGS AND GROUNDS  
R 325.1961 Plans and specifications.  
Rule 61. (1) A floor plan of the home, with a description of rooms showing  
size, use, door locations, window area, and number of beds, shall be on file in the home.  
(2) Complete plans, specifications, and an operational narrative for new buildings,  
additions, major building changes, and conversion of existing facilities to use as a  
home shall be submitted to the department for review to assure compliance with the law  
and these rules.  
(3) An operational narrative shall describe the operational characteristics  
and special needs of the home that dictate the design of renovation, construction, or  
conversion needed to support the home's program statement as defined by R  
325.1901(15). An operational narrative may include any of the following:  
(a) Each function to be performed in the home.  
(b) Functional space requirements.  
(c) Number of staff or other occupants anticipated for the various functional  
units.  
(d) Type of equipment to be required and utilized.  
(e) Interrelationship of functional spaces.  
(f) Services and equipment to be brought into the home from outside the home  
and not requiring duplication in the home.  
(4) Plans and specifications meeting the requirements of the law and these rules  
shall be approved by the department.  
(5) Construction of new buildings, additions, major building changes, and  
conversion of existing facilities to use as a home shall not begin until the plans and  
specifications are approved by the department and written approval to begin construction  
is issued.  
History: 2004 AACS.  
R 325.1962 Exteriors.  
Rule 62. (1) The home shall be located in an area free from hazards to the health  
and safety of residents, personnel, and visitors.  
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(2) The premises shall be maintained in a safe and sanitary condition and in a  
manner consistent with the public health and welfare.  
(3) Sufficient light for an exterior ramp, step, and porch shall be provided for  
the safety of persons using the facilities.  
(4) Exterior steps shall have a handrail on both sides. An above grade porch shall  
have a railing on open sides.  
History: 2004 AACS.  
R 325.1963 Accessibility.  
Rule 63. (1) A new construction or a home undergoing addition, major building  
modification, or conversion shall comply with all of the following:  
(a) Applicable statutory accessibility requirements.  
(b) Applicable accessibility requirements for common and shared facilities.  
(c) Accessibility requirements for 10% of all resident sleeping rooms and the  
connecting bathing or toilet rooms.  
History: 2004 AACS.  
R 325.1964 Interiors.  
Rule 64. (1) A building shall be of safe construction and shall be free from  
hazards to residents, personnel, and visitors.  
(2) A part of a building in use as a home shall not be used for any purpose  
which interferes with the care, well-being, and safety of residents, personnel, and  
visitors.  
(3) An occupied room shall have a minimum ceiling height of 7 feet, 6 inches,  
except as otherwise provided in R 325.1964(4) and (5).  
(4) Floor area under a part of a drop or slant ceiling which is less than 6 1/2 feet  
from the floor shall not be used in computing the usable floor space or maximum  
number of beds allowed in any sleeping room.  
(5) A bed and the working space around a bed shall not be directly under a part of  
a drop or slant ceiling that is less than 6 1/2 feet from the floor.  
(6) Each area of the home shall be provided with lighting commensurate with the  
use made of each area and in accordance with generally recognized standards.  
(7) A stairway or ramp shall have a handrail on both sides.  
(8) A room used for living or sleeping purposes shall have a minimum total  
window glass area on outside walls equal to 10% of the required floor area of the room.  
Forty-five percent of the window glass area shall be openable unless the room is  
artificially ventilated.  
(9) Ventilation shall be provided throughout the facility in the following  
manner:  
(a) A room shall be provided with a type and amount of ventilation that will  
control odors and contribute to the comfort of occupants.  
(b) Bathing rooms, beauty shops, toilet rooms, soiled linen rooms, janitor  
closets, and trash holding rooms shall be provided with a minimum of 10 air changes per  
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hour of continuously operated exhaust ventilation that provide discernable air flow into  
each of these rooms.  
(10) A resident room shall open to a corridor, lobby, or day room.Traffic to and  
from any room shall not be through a sleeping room, kitchen, bathroom, toilet room, or  
storage room, except where a toilet room, bathroom, or storage room opens directly off  
the room or rooms which it serves.  
(11) A doorway, passageway, corridor, hallway, or stairwell shall be kept free from  
obstructions at all times.  
(12) A floor, wall, or ceiling shall be covered and finished in a manner that will  
permit maintenance of a sanitary environment.  
(13) A basement shall be of such construction that it can be maintained in a dry and  
sanitary condition.  
(14) A minimum of 15 square feet of floor space per licensed bed shall be provided  
for day room, dining, recreation, and activity purposes.  
(15) A basement or cellar shall not be used for sleeping or living quarters,  
except that recreation and activity space may be provided in a basement in addition to  
the 15 square feet per licensed bed required in subrule (14) of this rule.  
(16) A room or compartment housing a water closet shall have a minimum width  
of 3 feet.  
(17) Emergency electrical service shall provide, at  
operated lighting units sufficient to light corridors and exits.  
a
minimum, battery-  
(18) A home shall provide functionally separate living, sleeping, dining,  
handwashing, toilet, and bathing facilities for employees and members of their  
families who live on the premises.  
History: 2004 AACS.  
R 325.1965 Elevators and space requirements for certain homes.  
Rule 65. (1) A new construction, addition, major building change, or conversion  
after November 14, 1969 shall provide all of the following:  
(a) An elevator if resident bedrooms are situated upon more than 1 floor level. An  
elevator shall have a minimum cab size of 5 feet by 7 feet, 6 inches.  
(b) A sleeping, day, dining, recreation, and activity room with a minimum ceiling  
height of 8 feet.  
(c) In a room requiring windows, a clear unobstructed horizontal view of 20 feet  
from the windows. One additional foot shall be added to the minimum distance of 20  
feet for each 2-foot rise above the first story up to a maximum of 40 feet of required  
unobstructed view.  
(d) A minimum of 30 square feet of floor space per licensed bed for day room,  
dining, recreation, and activity purposes.  
History: 2004 AACS.  
R 325.1966 Public and employee areas.  
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Rule 66. (1) A lobby or waiting area for visitors shall be separate from resident  
rooms.  
(2) Employees shall have adequate toilet facilities that are separate from resident  
living quarters.  
History: 2004 AACS.  
R 325.1967 Resident rooms.  
Rule 67. (1) A resident bedroom shall have the floor surface at or above grade  
level along exterior walls with windows.  
(2) A single resident room shall have at least 80 square feet of usable floor space.  
(3) A multi-bed resident room shall have at least 70 square feet of usable floor  
space per licensed bed.  
(4) A toilet room or closet shall not be included in usable floor space.  
(5) A multi-bed resident room shall be designed to allow for a 3-foot clearance  
between beds.  
(6) Residents may have their own rooms arranged in a manner that is  
comfortable and reflects their preferences, provided that the arrangement does not  
create an unreasonable fire safety risk or unsanitary conditions.  
(7) A resident room shall have at least 2 duplex electrical receptacles.  
(8) Each resident occupied floor shall have a janitor's closet.  
History: 2004 AACS.  
R 325.1968 Toilet and bathing facilities.  
Rule 68. (1) Resident toilet facilities shall be located in separate rooms or stalls  
and shall be provided in the ratio of 1 handwashing facility and water closet for every 8  
resident beds per floor.  
(2) A bathing facility shall be provided for every 15 resident beds.  
(3) All water closets and bathing facilities shall have substantially secured grab  
bars at least 1 foot long.  
(4) A resident toilet room or bathroom shall not be used for storage  
housekeeping functions.  
or  
History: 2004 AACS.  
R 325.1969 Additional resident area requirements in certain homes.  
Rule 69. (1) A new construction, addition, major building change, or conversion  
after November 14, 1969 shall provide all of the following:  
(a) A resident room with not more than 4 beds.  
(b) A minimum of 100 square feet of usable floor space in single resident rooms.  
(c) A minimum of 80 square feet of usable floor space per licensed bed in multi-  
bed resident rooms.  
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(d) A resident room with a minimum of 5 square feet of floor space per licensed  
bed for wardrobe and closet in addition to other requirements for usable floor space per  
licensed bed. A bathing or toilet room or vestibule shall not be included in usable floor  
space.  
History: 2004 AACS.  
R 325.1970 Water supply systems.  
Rule 70. (1) A home located in an area served by a public water system shall  
connect to and use that system.  
(2) If a public water system is not available, then the location and construction  
of a well and the operation of the private water system shall comply with the Safe  
Drinking Water Act, 1976 PA 399, MCL 325.1001 et seq.  
(3) A physical cross-connection shall not exist between water systems that are  
safe for human consumption and those that are, or may at any time, become unsafe for  
human consumption.  
(4) Minimum water pressure available to each plumbing fixture shall exceed 20  
pounds per square inch.  
(5) The plumbing system shall be designed and maintained so that the  
possibility of back flow or back siphonage is eliminated.  
(6) The plumbing system shall supply an adequate amount of hot water at all  
times to meet the needs of each resident and the functioning of the various service  
areas.  
(7) The temperature of hot water at plumbing fixtures used by residents shall be  
regulated to provide tempered water at a range of 105 to 120 degrees Fahrenheit.  
History: 2004 AACS.  
R 325.1971 Liquid wastes.  
Rule 71. (1) Liquid wastes shall be discharged into a public sanitary sewage  
system if such a system is available.  
(2) Homes that use a private wastewater disposal system shall be approved by the  
department.  
(3) A private wastewater disposal system shall consist of a stabilization lagoon or  
approved "package" treatment plant. Subsurface disposal systems such as septic tanks  
with tile fields are not allowed.  
(4) The licensee shall obtain a discharge permit issued by the  
department of environmental quality pursuant to MCL 324.3101 et seq.  
Michigan  
History: 2004 AACS.  
R 325.1972 Solid wastes.  
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Rule 72. All garbage and rubbish shall be kept in leakproof, nonabsorbent  
containers. The containers shall be kept covered with tight-fitting lids and shall be  
removed from the home daily and from the premises at least weekly.  
History: 2004 AACS.  
R 325.1973 Heating.  
Rule 73. (1) A home shall provide a safe heating system that is designed and  
maintained to provide a temperature of at least 72 degrees Fahrenheit measured at a  
level of 3 feet above the floor in rooms used by residents.  
(2) A resident's own room or rooms in the home shall be maintained at  
comfortable temperature.  
a
History: 2004 AACS.  
R 325.1974 Laundry and linen.  
Rule 74. (1) A home that processes its own linen shall provide a well ventilated  
laundry of sufficient size which shall be equipped to meet the needs of the home.  
(2) A home that uses a commercial or other outside laundry facility shall have a  
soiled linen storage room and a separate clean linen storage room.  
History: 2004 AACS.  
R 325.1975 Laundry and linen requirements.  
Rule 75. (1) A new construction, addition, major building change, or conversion  
after November 14, 1969 shall provide all of the following:  
(a) A separate soiled linen storage room.  
(b) A separate clean linen storage room.  
(c) A separate laundry processing room with handwashing facilities in a home that  
processes its own linen.  
(d) Commercial laundry equipment with a capacity to meet the needs of  
residents in a home that processes its own linen.  
History: 2004 AACS.  
R 325.1976 Kitchen and dietary.  
Rule 76. (1) A home shall have a kitchen and dietary area of adequate size to  
meet food service needs of residents.  
It shall be arranged and equipped for the  
refrigeration, storage, preparation, and serving of food, as well as for dish and utensil  
cleaning and refuse storage and removal.  
(2) The kitchen and dietary area shall be equipped with  
a
lavatory for  
handwashing. Each lavatory shall have a goose neck inlet and wrist, knee, or foot  
control. Soap and single service towels shall be available for use at each lavatory.  
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(3) The kitchen and dietary area shall be restricted to kitchen and dietary activities.  
(4) Separate personnel dining space shall be provided.  
(5) The kitchen and dietary area, as well as all food being stored, prepared,  
served, or transported, shall be protected against potential contamination from dust,  
flies, insects, vermin, overhead sewer lines, and other sources.  
(6) Food and drink used in the home shall be clean and wholesome and shall be  
manufactured, handled, stored, prepared, transported, and served so as to be safe for  
human consumption.  
(7) Perishable foods shall be stored at temperatures which will protect against  
spoilage.  
(8) A reliable thermometer shall be provided for each refrigerator and freezer.  
(9) An individual portion of food which is served and not eaten shall be destroyed.  
(10) A separate storage area for poisonous material shall be provided away from  
food service and food storage areas. Poisonous material shall be identified as such  
and shall be used only in a manner and under such conditions that it will not  
contaminate food or constitute a hazard to residents, personnel, or visitors.  
(11) Food service equipment and multi-use utensils shall be of such design and  
material as to be smooth, easily cleanable, and durable.  
(12) Food service equipment and work surfaces shall be installed in such a manner  
as to facilitate cleaning and be maintained in a clean and sanitary condition, and in  
good repair.  
(13) A multi-use utensil used in food storage, preparation, transport, or serving  
shall be thoroughly cleaned and sanitized after each use and shall be handled and stored  
in a manner which will protect it from contamination.  
(14) A single service eating or drinking article shall be stored, handled, and  
dispensed in a sanitary manner and shall be used only once.  
(15) Ice used in the home for any purpose shall be manufactured, stored,  
transported, and handled in a sanitary manner.  
(16) A storage area for housekeeping items and a janitor's closet shall be provided  
convenient to the kitchen and dietary area.  
(17) If food service is provided from an outside service, then that service shall  
be licensed under the requirements of the citation.  
History: 2004 AACS.  
R 325.1977 New construction, addition, major building modification, or  
conversion after effective date of these rules.  
Rule 77. (1) Exhaust ventilation shall be designed as central systems with the fan  
at the building exterior and at least 10 feet from all doors, operable windows, and  
domestic outside air intakes.  
(2) Facilities for dispensing of medications shall be designed to be under the  
control of responsible residents or designated staff. Central dispensing locations  
shall keep medications locked and equipped with handwashing, work counter, and  
storage facilities.  
(3) Bathing facilities shall have access to handwashing, toilet, and bathing  
supply storage facilities without entering a common corridor.  
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History: 2004 AACS.  
R 325.1978 Insect and vermin control.  
Rule 78. (1) A home shall be kept free from insects and vermin.  
(2) Pest control procedures shall comply with MCL 324.8301 et seq.  
History: 2004 AACS.  
R 325.1979 General maintenance and storage.  
Rule 79. (1) The building, equipment, and furniture shall be kept clean and in  
good repair.  
(2) A room shall be provided in the home or on the premises for equipment and  
furniture maintenance and repair and storage of maintenance equipment and supplies.  
(3) Hazardous and toxic materials shall be stored in a safe manner.  
History: 2004 AACS.  
R 325.1980 Soap and towels.  
Rule 80. Soap and single use towels shall be available for the use of employees  
and visitors. Use of the common towel is prohibited.  
History: 2004 AACS.  
PART 8. EMERGENCY PROCEDURES  
R 325.1981 Disaster plans.  
Rule 81. (1) A home shall have a written plan and procedure to be followed in  
case of fire, explosion, loss of heat, loss of power, loss of water, or other emergency.  
(2) A disaster plan shall be available to all employees working in the home.  
(3) Personnel shall be trained to perform assigned tasks in accordance with the  
disaster plan.  
History: 2004 AACS.  
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;