Alabama's memory care license: the SCALF

What is a specialty care assisted living facility in Alabama?

A specialty care assisted living facility (SCALF) is an assisted living facility that ADPH has specially licensed and staffed under chapter 420-5-20 to care for residents whose cognitive impairment would ordinarily make them ineligible for a regular ALF.

In practice, SCALF is what Birmingham families mean by memory care. Because a regular ALF must allow residents free and unhindered exit, a community that wants to secure its doors for people who wander must hold a SCALF license for those beds. Many campuses hold both: an ALF license for one building or wing and a SCALF license for the memory care neighborhood, each with its own ADPH ID starting with D (ALF) or P (SCALF).

ADPH lists 25 specialty care assisted living licenses in the seven Birmingham-area counties, with 898 licensed beds; 13 are in Jefferson County and 7 in Shelby. See the memory care roster.

What staffing does Alabama require in memory care?

Table A of rule 420-5-20-.04 sets minimum staff on duty in a SCALF: two staff for 1 to 16 residents on every shift, three staff up to 24 residents on days, 36 on evenings and 48 overnight, then one more for each additional 8, 12 or 16 residents on those shifts, plus extra staff whenever residents' needs require it.

Wings separated from the rest of the building by a lockable door need their own dedicated staff. Each SCALF must also have at least one registered nurse, who assesses every resident monthly and writes the care plans, and a physician medical director; a nurse practitioner or physician assistant cannot be the medical director.

What dementia training do Alabama memory care staff need?

Before giving any resident care, every SCALF employee must finish the Dementia Education and Training Act (DETA) Care Series developed by the Alabama Department of Mental Health or an equivalent approved by the State Health Officer, and licensed staff also complete the DETA Brain Series, Pharmacological Management of Dementia and Dementia Assessment Series.

Ask to see training records on a tour; the rule requires attendance records and any post-tests to be kept. Training is renewed annually with refresher sessions identified by the facility's RN.

Who can and cannot live in an Alabama SCALF?

A SCALF screens each applicant within 30 days before admission and may not admit or keep anyone with a Physical Self-Maintenance Scale (PSMS) score above 23, a score of 5 in feeding, dressing, grooming or bathing, or a 4 or 5 in ambulation, nor anyone needing skilled nursing, wound care beyond first aid or hospice at admission.

The screening includes a clinical history, a mental status examination with aphasia screen, a geriatric depression screen, the PSMS and a behavior screen. The PSMS limit is the rule families most often run into later: when a parent becomes unable to walk or needs total help with eating, Alabama law, not the facility's preference, requires a move to a higher level of care. The RN must also reassess and notify the physician and family after significant weight loss (5% in a month, 7.5% in three months or 10% in six), two or more falls in 30 days, an elopement or unmanageable behavior.