Assisted Living Regulations for Resident Evacuation

Reviewed by Mike Barker · Updated 13 October 2026

Every state licenses assisted living differently, but on one point they agree: if you house people who cannot get themselves out of a building, you need a written plan for getting them out, and you need to have practised it. What differs is how often you drill, how long you must be able to run without power, who approves the plan, and what happens when you cannot show one.

This page summarizes the rules in the five states we are asked about most: Florida, California, Texas, New York and North Carolina. It then covers the part most plans leave out, which is who pays for the buses, the hotel rooms and the nurses when an evacuation actually happens.

Assisted living residents being evacuated by bus

What Every State Asks For

The wording changes from state to state, but the same five things turn up in every set of rules we have read:

  • A written plan that covers the hazards your area actually faces, reviewed and updated at least once a year.
  • Resident-by-resident information: who can walk out, who needs a wheelchair, who is on oxygen, who takes what medication, and who to call for each of them.
  • Transport and a destination, arranged in advance rather than on the morning of the storm.
  • Staff training and drills, with a record that they happened.
  • A link to the local emergency management office, which in several states has to see or approve the plan.

Surveyors check the paperwork, not the intention. A facility that evacuated safely but cannot produce the plan, the training log and the drill record is still out of compliance.

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State by State

Florida

Florida's rules were rewritten after Hurricane Irma in 2017, when residents of a Hollywood nursing home died in the heat after the power failed. Every assisted living facility now needs an approved Comprehensive Emergency Management Plan, and on top of it an emergency power plan: enough generator and fuel capacity to keep the building at or below 80°F for at least 96 hours after a power loss. The power plan goes to the county emergency management agency for approval, and a facility that fails to comply can be fined $1,000 a day and lose its license. Transport arrangements for evacuation are part of the emergency management plan. Regulator: the Agency for Health Care Administration.

California

Since January 1, 2019, every residential care facility for the elderly has to have an emergency and disaster plan under AB 3098. The plan must name at least two shelter locations, one of them outside the immediate area, and the facility must be able to look after itself for at least 72 hours after a disaster, including a long power failure. Staff are trained on the plan when hired and once a year after that. Drills run at least once a quarter on each shift, covering a different kind of emergency each time; residents do not have to be physically moved during a drill. The plan is reviewed every year and has to be shown on request to a resident's responsible party or the long-term care ombudsman. Regulator: the Department of Social Services, Community Care Licensing.

Texas

Texas takes an all-hazards approach. The licensing standard for assisted living facilities, 26 TAC §553.275, requires an emergency preparedness and response plan written for the building you actually have: the needs of the residents living in it, the risks of its part of the state, and the rules of the local jurisdiction. Hurricanes on the coast, ice storms and grid failures inland, and wildfire in the Hill Country are not the same plan. Regulator: Texas Health and Human Services.

New York

New York's adult care facility rules (18 NYCRR Parts 487, 488 and 490) are specific about practice: monthly fire drills for staff, quarterly fire drills for staff and residents together, written procedures for every resident who needs help to get out, evacuation procedures posted on every floor and in every wing, training for every new and current employee and volunteer, and a review of how the staff performed after each drill. The Department of Health also issues evacuation planning letters to operators ahead of hurricane season. Regulator: the New York State Department of Health.

North Carolina

Adult care homes in North Carolina must keep a written disaster plan that has been approved by, or documented as submitted to, both the local emergency management agency and the local agency that runs special-needs sheltering, and update it at least once a year (10A NCAC 13F .0309). The plan has to deal with weather, fire, utility failures and equipment failures, not just the hazard everyone expects. Hurricane Helene in September 2024 made that point in the mountains, where flooding of that scale was not on most plans and facilities leaned on charities and neighbours for transport, supplies and beds. Regulator: the Division of Health Service Regulation.

Those are summaries. Before you rely on any of them, read the current rule on the regulator's own site, because the drill frequencies and submission deadlines are the details surveyors cite.

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A Plan That Works on the Day

A plan that satisfies the surveyor and a plan that works at 3 a.m. with the water rising are usually the same document, if it was written for your building rather than copied from a template. The parts that matter when the order comes:

  • The resident list, current today. Mobility, medical equipment, medications, dietary needs, dementia, and who goes in which vehicle. If it was accurate at the last annual review and three residents have arrived since, it is wrong.
  • Transport you can actually get. A bus company's contract is worth more than its phone number. In a county-wide evacuation every facility calls the same three companies at once.
  • A destination that has agreed to take you. Reciprocal agreements with another facility, a hotel block, or the county's special-needs shelter, confirmed in writing and checked each season.
  • Continuity of care in transit and on arrival. Medication administration records travel with the residents, oxygen and chargers go on the same vehicle as the people who need them, and a nurse goes with each group.
  • Someone whose only job is communication. Families, the regulator, the ombudsman and the receiving site all need to hear from you, and the administrator loading residents cannot be the one making the calls.
  • Staff who have done it before. A drill with the real vehicles and the real route finds the problems a tabletop exercise cannot.

The legal exposure runs the other way too. If a resident is injured during an evacuation, or during a failure to evacuate, the question in the lawsuit is whether the facility did what its own plan and the state's rules said it would do.

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Who Pays for an Evacuation

An evacuation is expensive before anyone is hurt: buses, ambulances for the residents who cannot sit in a bus, hotel rooms or a receiving facility's charges, agency nurses, meals, and the cost of moving everyone back. None of that is covered by a standard general liability policy, which responds to injury claims, not to the cost of avoiding them.

Senior living carriers deal with this through an evacuation expense endorsement on the general liability or professional liability policy. In the policies we place it typically pays:

  • Transportation, including buses, ambulances and in some policies air transport.
  • Temporary housing for residents at a hotel, another facility or a shelter.
  • Medical support during the move and at the temporary location.

Limits, triggers and waiting periods vary by carrier. Some forms respond only to a mandatory evacuation order; others pay for a voluntary evacuation the facility decides on. Ask which yours is before the season starts, not during it. Our assisted living insurance page covers the full program for these facilities, and the general liability page explains the underlying policy the endorsement sits on.

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Common Questions

How often do we have to run evacuation drills?

It depends on the state. California requires a drill at least once a quarter on each shift, with the type of emergency changing from one quarter to the next. New York requires monthly fire drills for staff and quarterly drills that include residents. Florida, Texas and North Carolina tie the frequency to the plan the facility files with its regulator or local emergency management office, so the answer is whatever your approved plan says, and the surveyor will ask for the log.

Who decides when residents should be evacuated?

In a declared emergency the county or state emergency management office issues the evacuation order for your zone, and your plan should say what you do when that order comes. Short of an order, the decision is the administrator's, based on the triggers written into the plan: a forecast, a power loss expected to outlast your generator fuel, a fire or flood threat, or a failure of water or sewer. The states' rules expect those triggers to be written down in advance, which is what stops the decision being made under pressure.

In what order do you evacuate residents?

Anyone in immediate danger first, whatever their condition. After that, most plans move residents in the order the resident assessment sets: the people who can walk out with a staff member go first because they need the least help, residents who need wheelchairs or lifting go with the equipment and the staff trained to use it, and residents on oxygen, ventilators or other life-sustaining equipment travel with a nurse and their supplies. The order is written per resident in the plan, which is why that list has to be current.

What is a resident evacuation assessment?

The record, kept for each resident, of what it takes to move that person safely: how they get around, what equipment and medication goes with them, any cognitive condition that affects how they respond to instructions, dietary needs, and the family or responsible party to contact. California and North Carolina require it in so many words; every state's surveyors expect to see it.

Does our insurance cover the cost of an evacuation?

Only if the policy carries an evacuation expense endorsement or a similar extension. Plain general liability does not. If you are not sure, send us your declarations page and we will tell you what you have.

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  • AIG Insurance
  • Applied Underwriters
  • Beazley Insurance
  • CFC Insurance
  • CNA Insurance
  • Core Specialty Insurance
  • Crum Forster Insurance
  • Travelers Insurance
  • Empro Insurance
  • Genstar Insurance
  • Great American Insurance
  • Hudson Insurance
  • Huntersure Insurance
  • Ironshore Insurance
  • Kinsale Insurance
  • LIO Insurance
  • Magmutual Insurance
  • Medpro Insurance
  • MIG Insurance
  • Skyward Insurance
  • Strategic Insurance
  • Tokio Marine Insurance

Speak with an Insurance Professional

If you run an assisted living or senior living facility and want to know whether your policy would pay for an evacuation, or you need cover that will, we can read your current program and tell you where it stands.

Call 239-251-3703 or Fill Out the Form

Ralph Schiller, Licensed Insurance Specialist

Ralph Schiller

Ralph places insurance for assisted living and senior living facilities across the country. Call him or use the form. Either way it reaches him, not a queue.

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