What is an Elder Group Home?
321-29.1(231B)
Elder group home means a single-family residence that is operated by a person who is providing room, board, and personal care and may provide health-related services to three through five elders who are not related to the person providing the service, and which is staffed by an on-site manager twenty-four hours per day, seven days per week. Individuals who reside in Elder Group Homes are referred to as tenants.

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How do Elder Group Homes differ from Assisted Living Programs?
An Elder Group Home is a single-family residence that is operated by a person who is providing room, board, and personal care to three to five elders who are not related to the person providing the service. An EGH must be staffed by an on-site manager 24 hours per day, 7 days per week. Staff providing personal care are required by law to have completed, at a minimum, a recognized home care aide training program as defined by IAC 641 Chapter 80.8(2) Public Health.

In contrast, an Assisted Living Program is the provision of housing with services, which may include but are not limited to health-related care, personal care, and assistance with instrumental activities of daily living, to three or more tenants in a physical structure, which provides a homelike environment. Assisted living also includes encouragement of family involvement, tenant self-direction, and tenant participation in decisions that emphasize choice, dignity, privacy, individuality, shared risk, and independence. Assisted living includes the provision of housing and assistance with instrumental activities of daily living only if personal care or health-related care is also included. ALP are not required to have staff on-site 24 hours per day, 7 days per week. Staff providing personal care are not required by law to have completed a recognized home care aide training program.

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How do I choose an Elder Group Home in Iowa?
Request a program brochure, a price list, and a copy of the Occupancy Agreement (which providers are required by law to provide upon request) so that you can review these items BEFORE you visit. You will also want to visit as many different EGHs as you can. Take a tour, talk independently with tenants and staff and ask questions. Bring a friend or family member along to be an extra set of eyes and a source of support. If possible visit the program during the day and again in the evening to become familiar with the level of staffing and activities that take place at different times of the day.

Be aware that some agencies or providers may receive a referral fee from an Elder Group Home for referring individuals to their program. There are currently no laws preventing this practice. The Department of Elder Affairs recommends you proceed with caution if you are using an agency that accepts referral fees. You may want to ask during your visit to the EGH if they pay referral fees and to whom.

Educate yourself as much as you can on the laws that regulate Elder Group Homes in Iowa. The Iowa Code and Iowa Administrative Rules for elder group homes are both available online for your review.

Familiarize yourself with the terminology used in the Elder Group Home environment. The information provided on this website can be a good starting point for building your knowledge.
See the links to other websites with relevant consumer information in the Self Advocacy Section of this website.

Download the following checklist of things to survey when visiting different programs: Elder Group Home Consumer Checklist

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Are occupancy agreements required in EGH?
321-29.10(231B)
Yes. Before you move into an Elder Group Home, you or your legal representative and the provider must sign a contract called an Occupancy Agreement. This contract describes the rights and responsibilities of both the tenant (you) and of the program. Essentially, it determines what services you will receive and at what cost. This is the document that will determine how much you will pay to the Elder Group Home. All fees must be included in the occupancy agreement. The Occupancy Agreement must be revised anytime there is a change in content, which may include fees.

The Occupancy Agreement should be written in a size you are able to read and in clear and understandable language. If you have questions about the agreement, they need to be answered and explained in a way that is understandable to you. Copies of the agreement need to be provided to you or your legal representative.

You should not feel pressured to sign the occupancy agreement immediately. In fact, it makes good sense to take a copy of the agreement home with you to review. Iowa law requires the Elder Group Home to make a copy of their occupancy agreement available to you upon request. You can request occupancy agreements from multiple Elder Group Homes in order to provide you with the opportunity to compare programs and services. Give yourself enough time to review all of the information and if you choose to you can have it reviewed by an attorney.

If you are 60 or older, the Legal Hotline for Older Americans may be of assistance and can be reached by phone at: 1-800-992-8161. Your local Area Agency on Aging may also be able to provide information on how to access legal assistance to review an occupancy agreement.
The occupancy agreement must clearly outline the procedure for filing a complaint.

Complaints can be reported to Department of Inspections and Appeals Complaint Hot line: 1-877-686-0027.

The tenant advocate (also known as the Longterm Care Ombudsman) is also a valuable resource. Consumers may call at any time to ask specific questions at 515-725-3327 or 1-800-532-3213.

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How does an Arbitration Agreement apply to my Occupancy Agreement?
Arbitration agreements require the tenant and the EGH to resolve disputes that arise in binding arbitration, rather than in court before a judge or jury. Binding arbitration involves the submission of a dispute to a neutral party who renders a decision following a hearing. Arbitration takes the place of a trial before a judge or jury. Grounds for appealing or setting aside the arbitration decision are very limited and may frequently not be available at all because the arbitration is binding. Occupancy agreements may ask tenants to sign an arbitration agreement as part of the contract. If a tenant signs a contract containing a binding arbitration agreement, he or she gives up the right to go to court to have the claim resolved.
Some of the advantages to the tenant of binding arbitration are that it provides a private forum, is less formal and technical than court and MAY result in a quicker resolution. The disadvantages of binding arbitration are: it can be more expensive than court, it waives the tenant's right to have the claim decided in court, it can be extremely hard to find a lawyer who will represent the tenant on other than an hourly fee basis and it severely limits the right to appeal.

If you are not willing to sign a pre-dispute arbitration agreement as part of your occupancy agreement, you should request that the arbitration clause be stricken. If the EGH is not willing to remove the arbitration agreement from the contract, you may want to continue looking at other Elder Group Homes. The Department of Elder Affairs recommends consumers proceed with caution and consider seeking legal counsel before entering into an arbitration agreement with an Elder Group Home.

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Why should I care about Iowa's Tenant Landlord Law?
321-29.18(231B)
In Iowa, Tenant Landlord Law applies to tenants (you) who live in Elder Group Homes. This serves as a protection to both the tenant and the owner of the Elder Group Home. It allows either you or the EGH to terminate the contract after giving a 30 day notice.

What if I decide to terminate the Contract?
The occupancy agreement should explain the process for termination of the contract. If you wish to terminate the contract you must give the provider 30 days notice. Your agreement should also explain whether any portion of fees will be refunded and under what circumstances.

What if the EGH decides to terminate the Contract?
231B. 6
The occupancy agreement must also explain the circumstances under which the Elder Group Home may discharge you. This is referred to as an involuntary transfer. In cases of involuntary transfers, the Long-term Care Ombudsman (also known as the Tenant Advocate) is available to assist you through the process and can be reached by phone at 1-800-532-3213.
- they must provide you with 30 days notice regarding any changes in the occupancy agreement except in a health emergency or if there is a substantial risk to the health or safety of other residents or staff
- they may do so without your agreement
- they must explain the internal appeals process
- they must provide you with the number for the Tenant Advocate who can assist you in your internal appeal process. 1-800-532-3213

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How will the coordination of my care be determined?
321-29.8(231B)
At the time of admission, a service plan will be developed based on an assessment of your functional abilities. Your service plan must be updated within 30 days of admission, annually and as needed or requested. The service plan is required to be individualized and to include:
- Your identified needs including any services and care provided as identified in your agreement
- Your requests for assistance and expected outcomes
- Who will provide the services if they will be contracted outside of the program

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Can I still manage my own medications?
231B.21
You may manage your own medications or upon your request, the Elder Group Home may provide for medication setup. This should be specified in the occupancy agreement and your service plan as some EGHs may charge for this service. An Elder Group Home cannot prohibit you from self-administering medications. However, if you or your legal representative wishes, you may delegate medication setup to the Program. Medication setup means assistance with various steps of medication administration to support your autonomy, which may include but is not limited to routine prompting, cueing and reminding, opening containers or packaging at your direction, reading instructions or other label information, or transferring medications from the original container into suitable medication dispensing containers, reminder containers, or medication cups.

If administration of medications (medication setup) is delegated to the EGH by you or your legal representative, the medications must be administered by a registered nurse, licensed practical nurse, or advanced registered nurse practitioner licensed or registered in Iowa or by the individual to whom such licensed or registered individuals may properly delegate administration of medications. This process is called nurse delegation and allows for a universal worker to administer medications when trained and supervised by a licensed practical nurse or a registered nurse.

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What are the qualifications of staff?
321-29.13(231B)
The Elder Group Home is required by law to be staffed by an on-site manager 24 hours per day, seven days per week. At all times sufficiently trained staff must be available to meet your identified needs (scheduled and unscheduled). Staff providing personal care are required by law to have completed, at a minimum, a recognized home care aide training program. A background check is required by law to be completed on each employee, which includes dependent and child abuse record checks. All staff must be able to implement the EGH's accident, fire safety, and emergency response procedures.

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Why do I need to understand "level of care" requirements?
321-29.11(231B)
Elder Group Homes primarily serve individuals who have fewer healthcare needs and mainly need assistance with the essential activities of daily living. This type of care refers to personal care which could include assistance with transferring, bathing, personal hygiene, dressing, grooming, housekeeping and other daily living activities. When EGH staff determine that you will need licensed nursing activities or hospice care you are considered to be at a higher level of care than what is determined to be appropriate for EGH.

However, if you wish to continue living in the EGH and the manager believes they can continue to meet your increasing needs you may request for a waiver of level of care. You, your legal representative, or the EGH manager can request for waiver of level of care and submit the waiver to the Department of Inspections and Appeals. The DIA will make a decision to grant the waiver based on whether or not: it is the informed choice of the tenant to remain in the home, the EGH manager is able to provide appropriate care to the tenant in addition to adequate care of the other tenants, and the waiver will not jeopardize the care, health, safety or welfare of the tenant or others. There is no guarantee a waiver will be approved.

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Where do I eat?
Elder Group Homes are intended to be more of a family, homelike environment. Typically, meals are served in a family dining room and prepared in a kitchen. The kitchen is not required to be licensed and staff who prepare meals are not required to be certified in food safety or service. If you have concerns about the quality of the food that is being served you may contact the Longterm Care Ombudsman at 1-800-532-3213. If you have concerns with sanitation or food safety you should contact the Department of Inspections and Appeals at 1-877-686-0027. If you have special dietary needs you will want to find an EGH that can accommodate your needs. Be sure to ask during your visit if accommodations can be made for special dietary needs.

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