Basic Care Facilities. The Department of Public Health, Facility Licensing and Investigations Section, licenses assisted living services agencies that provide assistance to residents of managed residential communities, state-funded congregate housing facilities, and apartments subsidized by the U.S. Department of Housing and Urban Development. Negotiated service agreements are based on the results of the uniform assessment. The facility must have a licensed social worker or licensed professional counselor available to provide specified social services. Texas Department of Aging and Disability Services, Assisted Living Disclosure Statement. States generally require that assessments and service plans be updated periodically. In 2014, the federal SSI payment was $721, the average OSS payment was $682, and the PNA was $65, providing an average room and board payment of $1,338 per month. Although the new laws supersede existing regulations, the state has not yet amended existing regulations or issued new regulations to reflect the statutory changes. If the assessment indicates that the individual requires health care services, a health care assessment must be completed within 14 days of admission by an RN using a Department-provided or approved assessment instrument. Facilities may provide respite services, but provision of this service is not a condition for licensure. Take your time and you will be fine. Promote a sense of security and self-worth. A designated staff person who is responsible for managing or coordinating the structured activities program must be on site at least 20 hours a week. All facility staff must receive in-service training regarding the facility's resident elopement response policies and procedures within 30 days of employment. A commonly described provision is for external exit door controls that prevent residents who are at risk of wandering from exiting the building while still allowing occupants to safely evacuate the building in an emergency. Facilities must meet daily dietary requirements and requests, with consideration of food allergies, reasonable religious, ethnic, and personal preferences, and the temporary need for meals to be delivered to the resident's room. Alabama Department of Public Health. The health and safety of persons with dementia may be enhanced by environments with features designed to accommodate cognitive and physical impairments.hh Thirty-five states have provisions for the physical features of dementia care units, including the residents' living units, access to bathrooms, and external locking doors or controlled methods of egress to prevent unsafe exits.26. Utah Department of Health, Assisted Living Residence, Residential Care Home. Dementia Staff Training. An ISP is developed based on the assessment and reviewed by a licensed nurse at least every 6 months, or following a significant change in health status. Type I ARCHs are licensed for five or fewer residents and Type II for six or more residents. It is the licensee's responsibility to require and submit fingerprint background check authorization forms on all individuals associated with the ALF who have unsupervised access to residents, including, but not limited to, employees, managers, volunteers who are not residents, contractors, and students. Healthcare Surveillance Branch Every ALF must have a director of nursing who is an RN. Experienced staff may take the competency exam without undergoing training. Head back towards Double O Arch, following the Primitive Trail to the left when you are almost back at Double O Arch. Care of persons specific to the physical/mental condition being cared for in the facility (e.g., Alzheimer's disease and other dementias, cognitive disability) to include communication techniques (cueing and mirroring), understanding and coping with behaviors, safety, and activities. Continuing education must be completed on or before the first anniversary date of employment. [October 25, 2006]http://www.dhhs.nh.gov/oos/bhfa/documents/he-p805.pdf, New Hampshire Code of Administrative Rules, Chapter He-P 800, Part He-P 813: Adult Family Care Residence. Assistance with self-administration of medication is limited to the following: The resident may be reminded to take his/her medication. Director of Licensure Wisconsin Department of Health Services. Assisted care living facilities must provide personal services such as protective care; responsibility for the safety of the resident when in the facility; the ability and readiness to intervene if crises arise; assistance with activities of daily living (ADLs); laundry services; and dietary services. The state provides a monthly Supplemental Security Income (SSI) exceptional expense (SSI-E) payment of $95.99 to an SSI recipient who needs at least 40 hours of primary long-term support services each month, whose expenses are greater than the SSI-E payment level, and who lives in a licensed or certified adult family/foster home, a CBRF of 20 beds or less, or a certified RCAC.134. Health-related services mean less than daily skilled nursing services and professional therapies for temporary but not indefinite periods of time of up to 21 days a month. Facilities must be capable of providing three meals a day and snacks. Assisted living communities may not provide health care services. Level 4. The resident may be physically assisted in pouring or otherwise taking medications, so long as the resident understands what the medication is and why they are taking the medication. The state does not use Medicaid to cover services in assisted living communities or personal care homes. The ALF statute requires careful monitoring to detect and report unlicensed facilities. The facility must provide orientation to medication policies and procedures for staff responsible for medication administration prior to their administering or supervising the administration of medications. Montana permits families to set up medications, including insulin administered by injection. Social Security Administration. The state has a Medicaid State Plan program--Basic Care Assistance Program--that supplements the income of Medicaid-eligible residents in participating licensed basic care facilities who, after applying all available income to the cost of care at a basic care facility, requires further assistance. Assisted Living Facilities. Each facility must have a full-time administrator who is responsible for daily operations and may designate a house manager to be responsible when the administrator is absent. Utah is an anomaly in that it requires facilities to document, before admitting a resident into a dementia care unit, that a wandering risk management agreement has been negotiated with the resident or that the resident's responsible person has signed the agreement as a proxy. Facilities must complete screening prior to admission to determine whether an applicant is eligible to be admitted. (2009). Family supplementation is permitted. Adult Foster Care. The facility must review the plan at least annually, and whenever the resident's condition or circumstances warrant a review, including whenever a resident's decision, behavior, or action places the resident or others at risk of harm or the resident is incapable of engaging in a negotiated risk agreement. Twelve states specify admission criteria that designate who may be admitted to a dementia care unit (Exhibit 7). Unlicensed staff may administer medications after completing a 16-hour medication course from an approved medication training provider. Facilities with secured units must report to the Department the following information during each annual survey: resident assessments by multidisciplinary teams and reviews; number of deaths, hospitalizations, and incidents; staffing patterns and ratios; staff training; and daily group activities. Other services include personal care, housekeeping, and laundry. Residences may not admit or retain persons needing medical or skilled nursing care, including daily professional observation and evaluation, and/or persons who are bedbound or in need of the assistance of more than one person for ambulation. Residential homes for the aged must provide the same personal services listed above. Annually, all employees must receive in-service training in at least the following: (1) fire and accident prevention and safety; (2) residents' mental and physical health needs, including behavior problems; (3) prevention and control of infections, including universal precautions; and (4) residents' rights. Assisted Living Residences-Residential Care. A maximum of two residents is allowed per resident unit, unless a facility was licensed prior to July 1, 1991, in which case four residents can be housed per room. Sheltered Care Facilities. Within 30 days after admission to an assisted living facility (ALF)--or 15 days with certain exceptions--the administrator, administrator-designee, a registered nurse (RN), or a licensed practical nurse (LPN) under the supervision of RN must complete an initial assessment, using a Department-provided form or an approved facility-developed form. Type of Staff. Staff Ratios. Eight hours of annual continuing education are required. When ALFs first became popular, starting in the early 1990s, one of their defining features was respect for resident privacy, and thus facilities were expected to offer residents a private room or apartment with a private bathroom, often with cooking appliances in a small kitchen area. New §1915(c) waiver programs and §1915(i) and (k) State Plan programs must meet the new requirements to be approved. ALFs are not required to provide assistance with ADLs, health support services, and intermittent nursing services. Within 30 days of admission to the SCU and quarterly thereafter, the facility must develop a written resident profile containing assessment data that describes the resident's behavioral patterns, self-help abilities, level of daily living skills, special management needs, physical abilities and disabilities, and degree of cognitive impairment. All newly constructed ALRs must provide a private bathroom for each unit, which must be equipped with one sink, one toilet, and one bathtub or shower stall. The state has no licensure category for adult foster care. Ten states require that the residency agreement include information about medication services and policies.6 For example, Georgia requires that facilities describe medication management provisions, including the staff responsibility for refilling prescriptions, and Oregon requires facilities to describe their system for packaging medications and the resident's right to choose a pharmacy. Prior to working independently, each employee must be given an orientation to the facility by the supervisor, which includes: Instructions on the needs of the specialized populations served in the facility. The resident agreement includes the costs of services and terms of payment, as well as refunds and third-party provider agreements; occupancy and transfer criteria; grievance policies; emergency response policy; staffing policies, including whether or not staff are available 24 hours a day; staff delegation policies; and how staffing will be adjusted to meet changing needs. Administer medications via a metered dose inhaler. ...assessing resident health and well-being; delegating and teaching staff to perform tasks in accordance with Board of Nursing rules; participating on the service planning team, as needed; providing health care teaching and counseling based on service plans; and providing intermittent direct nursing services, as needed. The two most commonly mentioned third-party providers are home health agencies (24 states) and hospice agencies (32 states). Residents who are capable of self-administration may purchase and self-administer over-the-counter medications. Staff Ratios. The term "may make medications available" is not defined. Residents who are combative, violent, suicidal, or homicidal may not be admitted or retained. A supervisor must be available 20 hours a week for every ten or fewer licensed nurses or assisted living aides and a full-time supervisor must be available for every 20 licensed nurses or aides. At least 8 of the 16 hours of the annual training requirement for administrators must pertain to caring for persons with severe cognitive impairments. In 2015, Medicaid limits room and board rates for eligible residents to the federal Supplemental Security Income (SSI) benefit--$733--minus a $90 personal needs allowance. The state has separate regulations for Alzheimer's disease/dementia care units, which are permitted to accept persons with up to Stage II Alzheimer's disease. Facilities must provide protective oversight and a physically safe and sanitary environment; personal services (i.e., assistance with activities of daily living, instrumental activities of daily living, individualized social supervision, and transportation); and social and recreational services, both within the facility and in the local community, based on residents' interests. Ohio is unique in allowing RCFs to choose whether to serve no meals--or one, two, or three meals. This program consolidated all prior 1915(c) waiver programs. Georgia Health Care Association, Assisted Living Facilities, Adult Residential Care Homes. A minimum of one bathtub or shower is required for every four residents in facilities with 1-8 residents and one for every eight residents in larger facilities. How California's assisted living system falls short in addressing residents' health care needs. Adult foster care providers that serve two or more adults are licensed as a type of personal care home. The orientation must include job descriptions; ethics, confidentiality, and residents' rights; fire and disaster plans; policies and procedures; and reporting responsibility for abuse, neglect, and exploitation. However, the online sources do not yet reflect some changes that have been made to the regulatory provisions--either through rule-making or statutory change. The latter two programs are specifically for Medicaid clients who have transitioned to the community from nursing facilities under the Living Choice/Money Follows the Person demonstration program. This person must possess the health and judgment determined necessary by the Department to carry out assigned duties; to determine this, the Department may require an examination and submission of a written report from a duly authorized licensed practitioner or licensed psychologist. Residents have the right to arrange directly with an outside agency for the provision of medical and personal care. The employee responsible for administering medications prepares the dose, observes the swallowing of oral medications, and records the medication. No minimum ratios are specified for other staff. Maine permits payment by a relative to cover the cost of a private room, a telephone, television, and any non-Medicaid-covered services. Non-financial components include: basic and optional services; optional services provided by third parties; residents' rights and obligations; grievance procedures; occupancy provisions, such as policies concerning modifications to the resident's living area; procedures for changing the resident's accommodations (relocation, roommate, number of occupants in the room); transfer procedures; security; temporary absence policy; interim service arrangement during an emergency; staff members' right to enter a resident's room; discharge policies and procedures; and facility obligations. Within 30 days prior to admission, facilities must obtain assessments from individuals' health care practitioner stating that they are appropriate for the level of care the facility provides. Providers serving residents who receive auxiliary grants may not charge more than the total SSI payment. In 2014, the average OSS payment was $361 and the PNA was $131. The assessment must be updated as required in accordance with professional standards of practice. The training must include, but is not limited to, the following topics: General supervision and care of residents. In addition to appropriately licensed and qualified facility staff, medical services may be provided by licensed or qualified contractors, a licensed home care organization, licensed staff of a nursing home, or another appropriately licensed entity. All health reasons for discharge must be documented by a physician, physician's assistant, or nurse practitioner. Nursing home eligibility is not required for beneficiaries using State Plan services. Assisted living centers and/or residents may contract with licensed home health agencies as defined in the facility's description of services. Family supplementation is permitted up to the maximum allowable charges for room and board. An appliance must be designed so it can be disconnected and removed for resident safety or if the resident chooses not to have the appliance within the living unit. Each unit must have a kitchen area equipped with a sink, refrigerator, a cooking appliance that can be removed or disconnected, space for food preparation, and storage space. Third-party providers are defined as any party, other than the facility, that furnishes services/supplies to a resident. The 37 states that do not already cover personal care through their State Plan have been reluctant to add it because it is an entitlement and services must be provided statewide. Monthly evaluation by a licensed health care professional is required for residents who take psychotropic medications, and a physician must review the resident's record every 6 months and assess the need for continued use of the prescribed medication and the potential to decrease the dose. The state's Medicaid 1915(c) waiver program covers services in assisted living centers. All units must have an escape window that opens directly onto a public street, public alley, yard, or exit court. The program serves adults over the age of 21 with disabilities and adults age 65 or older who have been covered by Medicaid in a nursing home for at least 90 days and want to relocate to the community; or who receive services in another waiver program and are at immediate or near immediate need of admission to a nursing home; or who have been residing in a licensed ALF on an extended stay basis of 180 days or more. If an AFCH provides room, board, and personal services for only 1-2 adults who do not receive an OSS, it does not have to be licensed. Additional toilet facilities must be provided in areas other than the residential units to meet the needs of residents, staff, and visitors to the facility. The facility must provide health services and have systems in place to respond to residents' 24-hour care needs. Male and female residents may not be housed in the same or adjoining rooms that lack a full floor-to-ceiling partition and lockable door (exceptions for immediate family). Adult family care providers who serve only private pay residents are not regulated by the state. As shown in Exhibit 4, 36 states permit unlicensed staff to administer medications and 18 permit unlicensed staff to assist with medications. No provisions identified. Staffing must be appropriate to meet residents' needs. The training must address ECC concepts and requirements, including statutory and rule requirements, and delivery of personal care and supportive services in an ECC facility. One option for doing so is to specify admission, retention, and discharge criteria, thereby setting the parameters for whom can be served in these settings. Supportive Living Facilities. Basic Care Facilities. Getting to see all the arches after all the hard work was rewarding! Residential Homes for the Aged. If direct care workers supervise residents or administer medications, the home must train them in the proper handling and administration of medications.