State Assisted Living Policy: 1998. Illinois

06/01/1998

Citation

Shelter care facility 77 IAC 330 et seq.

Supported residential living Title 89, Chapter I, Subchapter d, Part 146

Community based residential facilities Public Act 89-530. 89 IAC Chapter II, §280

General Approach

The legislature has approved two assisted living projects. A "supportive living" facility model has been developed by the Department of Public Aid for Medicaid beneficiaries who are frail elderly or have disabilities and need assistance with activities of daily living. It targets lighter need nursing facility residents who are unable to remain in their homes. A supportive living facility (SLF) may be converted nursing home units or free standing buildings that integrate housing, health, personal care and supportive services in home-like residential settings. The program is consistent with the definition of assisted living used by the federal 1915 c Medicaid Home and Community Based Services Waiver program.

The SLF program was developed with the assistance of advisory groups composed of members of the nursing home industry, advocates, consumers, long term care experts and the aging network. A request for proposals was issued in October 1997. Bids were received for a total of 1486 units. Two bids were received from nursing homes seeking to create 46 units. The approved waiver can serve up to 750 Medicaid residents the first year, 1,750 Medicaid residents in the second year and 2,750 Medicaid residents in the third year.

The Department on Aging is testing a Community Based Residential Facilities service model. Services will be reimbursed as home care services through the Medicaid Home and Community Based Services Waiver or state funds. The pilot may include three facilities and serve no more than 360 people. The authorizing statute allows the programs to serve people with short or long term needs as a means of relieving family caregivers. Projects may offer, directly or through contract, services that preclude admission to a nursing home. Sites that continue to be in compliance with the demonstration project rules will be eligible for annual renewals "until an assisted living or similar licensure model is established by legislation." Two facilities have been selected, including an Alzheimer's care facility. The Department may contract with a third program involving a nursing home seeking to convert its facility. If no applicant is forthcoming, another housing setting can be chosen.

Definition

Shelter care facility means a facility licensed under the nursing home care act that provide maintenance and personal care but does not provide routine nursing care.

Supportive living facility (SLF) means a residential setting that provides or coordinates flexible personal care services, 24-hour supervision and assistance (scheduled and unscheduled), activities and health related services with a service program and physical environment designed to minimize the need for residents to move within or from the setting to accommodate changing needs and preferences; has an organized mission, service programs and a physical environment designed to maximize residents' dignity, autonomy, privacy and independence; and encourages family and community involvement.

Community Based Residential Facilities (CBRFs) provide care that combines housing, personal and health-related services in response to the individual needs of those who need help in ADLs and IADLs. Supportive and intermittent health-related services are available 24 hours per day, if needed, to meet scheduled and unscheduled needs, in a way that promotes self-direction and participation in decisions that emphasize independence, individuality, privacy and dignity in a residential surrounding. A CBRF provides sleeping accommodations to three or more unrelated adults.

Units

Shelter care facility No more than four persons may share a room. Single rooms must be 70 square feet and multiple occupancy rooms, 60 square feet per person. One lavatory is required for every 10 residents and one shower/bath is required for every 15 residents. A lavatory and shower/bath is required on each floor.

SLF To participate in the DPA program, facilities must have not less than 10 and no more than 150 apartments. Freestanding sites must provide apartments with 350 square feet of living space, including closets and bathroom. Apartments for individuals wishing to share the unit must have 500 square feet of living space, including closets and bathroom. Units must have a full bathroom, lockable doors, emergency call system, heating and cooling controls, wiring for private telephone, access to cable television or satellite dish, a sink, microwave oven or stove, refrigerator. Fifty percent of all apartments in a facility must have showers only (no bath tub) with non-skid surfaces and hand held shower heads. Nursing homes converting a portion of a facility must offer apartments with 160 square feet for single occupancy and 320 square feet if two people want to share a unit. Free standing sites must provide apartments with at least 350 square feet of living space for single occupancy. Participants willing to share an apartment must have no less 500 square feet.

CBRFs The Department on Aging's pilot does not include specifications for the living unit, and rather, expect that market forces will determine what is developed.

Tenant Policy

Shelter care facility No resident needing nursing care may be admitted or retained. Persons who have a communicable disease or are mentally ill, need treatment for mental illness, are likely to harm others, or is destructive of property or himself may not be admitted or retained.

CBRFs must execute a written contract with the tenant.

SLFs may serve frail elderly or disabled residents over age 22 who have been screened and determined to meet the nursing facility level of care criteria. Residents may be discharged if they are a danger to self or others or have needs that cannot be met by the SLF. The SLF must develop a service plan and execute a written contract with each resident that includes services the resident will receive and other terms of the agreement.

Services

Shelter care facility may provide personal care, group and individual activities, assistance with self administration of medications or administration by a physician or licensed nurse.

CBRFs must provide meals, routine housekeeping, security, emergency response system, and laundry services. One or more of the following services must be provided directly or through contract: personal care, medication management, money management and intermittent health services (medication administration, dressing changes, catheter care, therapies, and other medical, nursing or rehabilitative care provided by licensed personnel). They may, but are not required to, provide transportation, health assessment, counseling or social/educational activities.

SLFs must provide a combination of housing, personal care, health and supportive services that promote autonomy, dignity and quality of life and respond to the individual needs of residents. Room and board includes three meals per day. Services include nursing services, personal care, medication oversight and assistance in self-administration, housekeeping services, laundry service, social and recreational programs, 24-hour response/security staff, emergency call systems, health promotion and referral, exercise, transportation and maintenance services. Nursing services include completion of a resident assessment and service plan, a quarterly health status evaluation, administration of medication when residents are temporarily unable to self-administer, medication set up, health counseling and teaching self care in meeting routine and special health needs, and disease prevention. Facilities are expected, when possible, to involve family members in service planning. Residents must be assessed within 24-hours of admission and updated at least annually.

Reimbursement

SLF For Medicaid residents, participating facilities must be willing to accept the SSI rate, which is currently $494 a month less a $90 personal needs allowance, as payment for room and board. For Medicaid covered services, bidders will submit a proposed rate that may not exceed 75% of average nursing facility rate less the average amount contributed by residents. Residents may be eligible to receive food stamps and facilities may be certified as eligible vendors.

CBRFs are reimbursed based on an assessment score called a "determination of need." There are categories ranging from $236 to $1598 a month. Participants pay a share of the service costs based on their DON score and income.

Staffing

Shelter care facility Facilities must have staffing patterns that are sufficient to meet the needs of residents. At least one awake staff member is required.

SLFs must provide licensed and certified staff that are sufficient to meet the needs of residents in conjunction with contractual agreements. Personal care services and assistance with self-administration of medications must be provided by certified nurse assistants. SLFs must contract with a dietician.

CBRFs must provide sufficient staff, and maintain appropriate back up staff, to provide services.

Training

Shelter care facility
Administrators
The administrator shall arrange for facility supervisory personnel to annually attend appropriate education programs on supervision, nutrition and other pertinent subjects.

Staff There shall be an ongoing planned in-service program embracing orientation to the facility and its policies, skill training and ongoing education carried out to enable all personnel to perform their duties effectively. Written records of program content and personnel attending shall be kept.

SLF
Administrators
must have at least five years experience in providing health care services in assisted living settings, inpatient hospital, long term care setting, adult day care or in a related field. The manager also must have at least two years of progressive management experience.

Staff shall receive documented training by qualified individuals in their area(s) of responsibility prior to employment and semi-annual training thereafter. Nurses assistants must be certified or are enrolled in and pursuing certification. A trained staff person must be responsible for planning and directing social and recreation activities. Nurses must be licensed. Twenty-four hour response staff must be certified in emergency resuscitation.

CBRFs must provide 15 hours of initial training and three hours in-service training per calendar quarter for homemakers.

Monitoring

SLF Participating facilities will be Medicaid certified and monitored, at least annually, by DPA. Monitoring includes contract requirements, resident autonomy, resident rights, adequacy of service provision, quality assurance process, safety of the environment, program policies and procedures, information provided to low income residents, review of resident assessment and service plans, resident satisfaction surveys, check in system and food service.

Facilities must have a grievance process and a quality assurance process. Complaints may be heard informally. If not resolved or if the resident prefers, grievances may be submitted through the facility's formal process. Residents may use the Medicaid appeals process for denial or delay of service.

Internal quality assurance procedures must encompass resident satisfaction, oversight and monitoring, peer review, utilization review, procedures for preventing, detecting and reporting resident neglect and abuse and ongoing quality improvement. The committee must establish review schedules, objectives for improving service quality, including quality indicators and measures, and a mechanism for tracking improvements based on care outcomes. A system with outcome indicators must be developed that measures: quality of services; residents' rating of services; cleanliness and furnishing in common areas; service availability and adequacy of service provision and coordination; provision of a safe environment; socialization activities; and resident autonomy.

Background Check

State legislation passed during the spring of 1998 prohibits SLFs from knowingly hiring, employing or retaining any individual in a position with duties involving direct care for residents who has been convicted or committing or attempting to commit designated criminal offenses, unless a waiver as been granted by the Illinois Department of Public Health. Further, the legislation requires SLFs to check the Certified Nurse Aid Registry in the state and ensure that appropriate background criminal history record checks are initiated or have been conducted.

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