Two contracts, one apartment: reading a Connecticut assisted living agreement

Why are there two agreements?

Most states license an assisted living building. Connecticut does not. It licenses the assisted living services agency, or ALSA, that sends aides and nurses into residents' apartments, and it requires the building, a managed residential community or MRC, to register with the Department of Public Health and provide a list of core services. The state auditors described Connecticut in 2023 as the only state that does not fully license assisted living facilities.

For a family touring a community on High Ridge Road in Stamford or Route 7 in Wilton, the practical result is paperwork. The MRC's residency agreement covers the apartment, meals, housekeeping, transportation and activities. The ALSA's service agreement covers personal care, medication administration and nursing oversight. Sometimes one company holds both roles and the documents are bundled; sometimes they are separate businesses with separate bills.

What the residency agreement must cover

Connecticut law spells out what an MRC residency agreement has to include: the services provided, every charge and fee including late fees and penalties, grievance procedures, the terms for ending residency, what happens if a resident's health declines or the resident dies, and the care provided in a dementia special care unit if the community has one.

Agreements signed on or after October 1, 2024 must also explain how recurring fees can change, including any scheduled increases, and must list every nonrefundable fee. That second rule matters in Fairfield County, where community fees and move-in fees are common. If a fee is not refundable, the agreement now has to say so.

What the service agreement should make clear

The ALSA's nurse must assess each resident at admission and at least every 120 days after, and the service agreement is where that assessment turns into a price. Ask how many care levels there are, what each includes, and how many hours of help a typical resident at your parent's level receives. Ask whether medication administration is billed separately.

Then ask what happens at the edges. Connecticut limits ALSA services to residents whose conditions are chronic and stable. A service agreement should describe, in plain words, which changes in health would lead the agency to say it can no longer meet a resident's needs.

Fee notices: 60 days, 90 days and a new hearing rule

An ALSA must give at least 60 days' notice of a fee increase, though it can adjust charges sooner when a resident's condition changes the services needed. An MRC must give 90 days' notice before raising monthly or recurring fees. From October 1, 2026, an ALSA that raises fees by more than 10% must hold an informational hearing for residents at least 30 days before the increase takes effect.

Ask every community for its last three annual increases on both sides of the bill. The new disclosure rule tells you how increases can happen; the history tells you how they have.

Questions to ask before you sign

Ask who employs the aides who will help your parent: the community, the ALSA or a staffing agency. Ask who to call at night and whether the registered nurse on call can be reached directly. Ask how the community handles a resident who needs more help than the top care level, and whether a private aide can be hired on top of ALSA services. Ask whether the agreement allows a short trial period, and what happens to prepaid fees if your parent moves out in the first months.

Ask for both documents in advance and read them at home. A community that will not release its agreements before a deposit is a community to slow down with.

When the two agreements disagree

Occasionally the residency agreement and the service agreement describe the same situation differently, for example what happens after a long hospital stay or when a resident's needs exceed the top care level. Ask the community which document controls and get the answer in writing. If the MRC and the ALSA are separate companies, ask how they coordinate when a resident's needs change, and who tells the family.

How to compare two communities fairly

Add the residency charges and the care charges at your parent's assessed level, then add every one-time fee spread over the first year. That gives a first-year cost you can compare honestly. A community with a lower base rent but higher care charges can easily cost more. Our assisted living roster lists every active ALSA license in the county, which is the place to confirm the agency named in the service agreement.