State Assisted Living Policy: 1998. Idaho

06/01/1998

Citation

Residential Care Facilities. Idaho code § 39-3301 et seq., Idaho Administrative Rules Title 3, Chapter 22., § 70 et seq.

General Approach

The Governor's long term care policy statement includes the following:

"amending the current federal waiver and make changes to state law and rules necessary to create a system of long-term care for elderly or disabled adults. Such a system will allow for the provision of client- or family-directed services whenever possible and for the provision of services in the least restrictive, most cost-effective setting (including assisted living, personal care, and other community-based services).

In 1996, the legislature passed HB 742 which made changes in the state's residential care facility rules. Regulations implementing the law are being developed. Medicaid is considering adding assisted living as a covered service under the HCBS waiver, however legislation has not passed to authorize coverage.

A task force has been to make further recommendations and a report is expected to be issued in 1999.

The supply of RCFS has increased from 175 facilities and 3,500 beds in 1996 to 227 and 4,902 in 1998.

Definition

Residential care facility means one or more buildings constituting a facility or residence, however named, operated on either a profit or nonprofit basis, for the purpose of providing 24hour non-medical care for three or more persons, not related to the owner, eighteen years of age or older, who need personal care or assistance and supervision essential for sustaining activities of daily living or for the protection of the individual.

Specialized care units/facilities for Alzheimer's/dementia residents "are specifically designed, dedicated, and operated to provide the elderly individual with chronic confusion, or dementing illness, or both, with the maximum potential to reside in an unrestrictive environment through the provision of a supervised life-style which is safe, secure, structured but flexible, stress free and encourages physical activity through a well developed activity and recreational program. The program constantly strives to enable residents to maintain the highest practicable physical, mental or psychosocial well-being."

Facilities operating without a license may be subject to six months in jail and fines up to $5,000.

Unit Requirements

Facilities licensed before July 1, 1991 must not have more than four residents per bedroom, and new facilities or conversions licensed after July 1, 1992 must not have more than two residents in each bedroom. Facilities that have been continuously licensed since before May 9, 1977 must have 75 square feet of floor space per single bed rooms and 60 square feet per resident in multi-bed rooms. Facilities licensed after May 9, 1977 must have 100 square feet of floor space per single bed rooms and 80 square feet per resident in multi-bed rooms. There must be at least one toilet for every six persons, residents or employees, and at least one tub or shower for every eight persons, residents or employees.

Tenant Policy

There are three levels of care to which a resident may be assigned: minimal assistance, moderate assistance, and maximum assistance. See table.

LEVELS OF CARE

Level I
Minimum Assistance

Level II
Moderate Assistance

Level III
Maximum Assistance

Resident requires room, board, and supervision, and requires only verbal prompting to function independently in ADLs, is independently mobile, is capable of self preservation, and does not require medication management or supervision.

Resident requires room, board, and supervision, and requires both verbal prompting and some physical assistance with ADLs, mobility (such as transferring, climbing stairs and walking), self preservation, medication management, and behavior management.

Resident requires room, board, and supervision, and requires staff up and awake on a 24-hour basis and may require extensive hands on assistance with ADLs, non-medical personal assistance needs, mobility such that the person may be immobile without assistance, self preservation, medications such that the person needs extensive assistance with the self-administration of medications, or extensive behavior management for antisocial and aggressive behavior.

Residents may not be admitted or retained if they require ongoing skilled nursing, intermediate care or care not within the legally licensed authority of the facility for the elderly. Residents may not be admitted or retained who are unable to feed themselves; are bedfast; need nursing judgment for an ongoing unstable health condition; have decubitus ulcers or open wounds; need the ongoing technical or professional personnel to appropriately evaluate, plan and deliver resident care; are beyond the level of fire safety provided by the facility; have physical, emotional, or social needs that are not homogenous with other residents in the home; or who are violent or a danger to themselves or others. Residents who need ongoing 24-hour nursing care must be discharged. Residents who need 24-hour care for a short time for an acute condition may be retained.

Residents of specialized care units for Alzheimer's disease must be evaluated by their primary care physician for the appropriateness of placement into the unlocked specialized care unit/facility prior to admission. No resident shall be admitted to these units without a diagnosis of Alzheimer's disease or related disorder. Residents must be at a stage in their disease such that only periodic professional observation and evaluation is required. Residents in these units must be re-evaluated quarterly. No resident shall be admitted who requires physical or chemical restraints.

Services

Services include assistance with activities of daily living, arrangements for medical and dental services, provisions for trips to social functions, recreational activities, maintenance of self-help skills, special diets, arrangement for payments and medication management. A licensed nurse must visit the facility at least once a month to conduct a nursing assessment of each resident's response to medications and to assure that the medication orders are current. The nurse also assesses the health status of each resident and makes recommendations to the administrator regarding any needs.

Services in specialized care units for Alzheimer's disease include habilitation services, activity program and behavior management according to the individualized plan of care.

A uniform assessment and a negotiated service agreement must be used with residents. New rules will address qualifications of assessors, state responsibilities for public clients, time frames for completing assessments and the information to be included. The negotiated service agreement is based on the assessment and provides for coordination of services and guidance of staff. Residents shall be given the choice and control of how and what services the facility, or external vendor, will provide to the extent the resident can make choices.

Financing

Currently, residential care homes are reimbursed privately and through a state fund. The highest reimbursement rate from the state fund is $800, and the private pay rate is generally $900 to $1200. The SSI rate in Idaho in about $500.

Staffing

Facilities must have sufficient staff to serve residents in keeping with negotiated service plans. At least one staff member must be immediately available to residents at all times. Facilities admitting level III residents must have a minimum of one awake staff during sleeping hours. Waivers may be sought by small facilities.

Training

Administrators must have a valid residential care administrator's license. Personnel must be given an orientation to the facility and participate in a continuing training program developed by the facility.

Staff Orientation training. Each facility shall develop an orientation program including, but not be limited to: job responsibilities; resident rights; operational procedures; disaster preparedness; fire safety, fire extinguisher and smoke alarms; assisting residents with medications; first aid and CPR; policies and procedures; complaint investigations and survey procedures; emergency procedures; employee dress code; house keeping and proper sanitation procedures; infection control; grievance procedures; work schedules, holidays and paydays; recognizing indications of illness, change in condition, and the need for professional help including facility documentation procedures; living skills training; death, dying and the grieving process; risk management; behavior management techniques and documentation; the aging process for facilities admitting elderly residents; mental illness, facilities admitting residents with mental illness; developmental disabilities, for facilities admitting residents with a developmental disability; and other topics as outlined by the administrator.

A minimum of eight hours of job-related pre-service orientation training shall be provided to all new employees, upon being hired, who are to provide personal assistance to the resident upon being hired

Continuing training. An ongoing, planned, and written continuing training program which maintains and upgrades the knowledge, skills and abilities of the staff in relation to services provided and employee responsibilities shall be provided to employees at least every six month, to include, but not be limited to, the orientation training program as required above.

Each employee, providing personal assistance to residents, shall receive a minimum of 16 hours of job related continuing training per year.

Alzheimer's/Dementia Facilities

Staff in specialized care units for Alzheimer's/dementia residents must complete an orientation/continuing training program that includes information on Alzheimer's and dementia, symptoms and behaviors of memory impaired people, communication with memory impaired people, resident's adjustment, inappropriate and problem behavior of residents and appropriate staff response, activities of daily living for special care unit residents, and stress reduction for special care unit staff and residents. Staff must have at least six additional hours of orientation training, and four hours of the required twelve hours per year of continuing education must be in the provision of services to persons with Alzheimer's disease.

Background Check

Applicants for licensure must submit a criminal history clearance as described in IDHW rules title 05, Chapter 06 and a notarized set of fingerprints.

Monitoring

With the exception of the initial surveys for licensure, all inspections and investigations shall be made unannounced and without prior notice. Inspections are conducted at least annually.

Inspections entail reviews of the quality of care and service delivery, resident records, and other items relating to the running of the facility. If deficiencies are found, then plans of correction are made and follow-up surveys are conducted to determine if corrections have been made. Complaints against the facility are investigated by the licensing agency. A complainant's name or identifying characteristics may not be made public unless "the complainant consents in writing to the disclosure; the investigation results in a judicial proceeding and disclosure is ordered by the court; or the disclosure is essential to the investigation. The complainant shall be given the opportunity to withdraw the complaint before disclosure."

Inspections of specialized care units for Alzheimer's disease are conducted by the licensing agency with participation from the Regional Department staff who have program knowledge of and experience with the type of residents to be served and the proposed program offered by the facility. Facilities that are specialized or have specialized care units must submit a synopsis of the program of care to be offered by the unit/facility.

Enforcement options include ban on admissions, civil monetary penalties, appointment of temporary management, suspension or revocation of the license, transfer of residents, and other remedies.

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