Assisted living services agency. Connecticut General Statutes §19a-490; Connecticut Agency Regulations §19-13-D105.
Assisted living regulations were issued by the Health Department and approved by the Legislative Review Committee in December, 1994. The regulations take a unique approach by allowing "managed residential communities" (MRCs) to offer assisted living services through assisted living services agencies (ALSAs). MRCs may obtain a license to also serve as an ALSA.
Twenty two assisted living service agencies have been licensed. About 115 homes for the aged have been licensed. The supply, which declined for several years, seems to be increasing as more multi-facility, for-profit companies enter the market and small owner operated homes decline.
The ALSA regulations focus on the licensing of agencies to provide services rather than the building and services as an entity. MRCs have to notify the health department of their intention to provide assisted living services. The ALSA, either the MRC or another agency, must be licensed by the Department of Public Health and Addiction Services to provide services. The MRC is not licensed by the Department of Public Health and Addiction Services. MRCs must show evidence of compliance with local zoning ordinances and building codes.
A bill authorizing a pilot project in three cities with up to 300 units was signed that provides Medicaid reimbursement for assisted living services in elderly housing complexes. The pilot will be developed by the Department of Social Services and the Connecticut Housing Finance Agency. Another bill passed that repeals the certificate of need requirement.
Assisted living services: nursing services and assistance with ADLs provided to clients living within a managed group living environment having supportive services that encourage clients primarily age 55 or older to maintain a maximum level of independence. Routine household services may be provided as assisted living services or by the managed residential community. These services provide an alternative for elderly persons who require some help or aid with ADLs and/or nursing services.
To qualify as a managed residential community and a setting in which assisted living services may be provided, units are defined as a living environment belonging to a tenant(s) that includes a full bathroom within the unit including water closet, lavatory, tub or shower bathing unit and access to facilities and equipment for the preparation and storage of food.
Each ALSA agency will develop its own admission criteria but the regulations do not allow the ALSAs to impose unreasonable restrictions and screen out people whose needs may be met by the ALSA. Assisted living services may be provided to residents with chronic and stable health, mental health and cognitive conditions as determined by a physician or health care practitioner.
Services may only be provided by organizations licensed as an assisted living services agency. Nursing services delivered under the regulations and include client teaching, wellness counseling, health promotion and disease prevention, medication administration and delegation of supervision of self-administered medications and provision of care and services to clients whose conditions are chronic and stable.
Registered nurses may also perform quarterly assessments, coordination, orientation, training and supervision of aides.
The Health and Education Facilities Authority provides loans for the development of assisted living settings. As yet, no specific program has been developed to subsidize services for low income residents but a bill authorizing a Medicaid demonstration was passed and awaiting action by the Governor.
The regulations allow for administration of medications by licensed staff. Assisted living aides may supervise the self-administration of medications which includes reminding, verifying, and opening the package.
ALSAs must have at least one RN and an on-site supervisor 20 hours a week for every 10 or fewer RNs and aides and a full time supervisor for every 20 RNs and aides. A sufficient number of aides must be available to meet residents' needs. All aides must be certified Nurses Aides or Home Health Aides and complete 10 hours of orientation and one hour of in-service training every two months.
Twenty-four hour awake staff are not required since the needs will vary among managed residential communities. However, 24-hour staffing could be required if indicated by resident plans of care. An RN must be available on-call 24-hours a day.
Each agency must have an orientation policy and procedure for all employees which shall include but not necessarily be limited to the following:
Organizational structure of the agency and philosophy of assisted living services;
Agency client services policies and procedures;
Agency personnel policies; and
Applicable regulations governing the delivery of assisted living services.
Each agency shall have an in-service education policy that provides an annual average of at least one hour bimonthly for each assisted living aide.
The in-service training shall include but not be limited to current information regarding specific service procedures and techniques and information related to the population being served.
ALSAs are required to establish a quality assurance committee that consists of a physician, a registered nurse and social worker. The committee meets every four months and reviews the ALSA's policies on program evaluations, assessment and referral criteria, service records, evaluation of client satisfaction, standards of care and professional issues relating to the delivery of services. Program evaluations are also to be conducted by the quality assurance committee. The evaluation examines the extent to which the managed residential community's policies and resources are adequate to meet the needs of residents. The committee is also responsible for reviewing a sample of resident records to determine whether agency policies were followed, whether services are provided only to residents whose level of care needs can be meet by the ALSA, and whether care is coordinated and appropriate referrals are made when needed. The committee submits an annual report to the ALSA summarizing findings and recommendations. The report and actions taken to implement recommendations are made available to the state Department of Public Health.
Agencies are inspected biennially. Penalties include revocation, suspension or censure; letter of reprimand; probation; restrict acquisition of other entities; consent order compelling compliance; and civil monetary penalties.
Fees are not required for ALSAs.
Board and Care
Homes for the aged provide personal care and a maximum of two people to a room. One toilet is required for every six residents per floor and bathing facilities are required for every eight residents. Residents may receive temporary nursing services from a community agency.