Assisted living §28-39-144 et seq.
The Kansas legislature passed a law creating an assisted living licensure category in 1995. The law created an overall framework of adult care homes which includes nursing facilities, nursing facility for mental health, intermediate care facility for the mentally retarded, assisted living facility, residential health care facility, home plus, boarding care home and adult day care facility. The regulations were effective 3/1/97 and differentiate among the categories of adult care homes. By March 1998, 66 assisted living facilities with a total of 3,510 units have been licensed. Thirty eight nursing home with 952 beds have converted to assisted living facilities. The regulations are being reviewed and refinements may be issued by the end of 1998.
A 1915(c) waiver to include assisted living and residential care facilities as providers of waiver services has been approved.
"Assisted living facility" means any place or facility caring for six or more individuals not related within the third degree of relationship to the administrator, operator or owner by blood or marriage and who, by choice or due to functional impairments, may need personal care and may need supervised nursing care to compensate for activities of daily living limitations and in which the place or facility includes apartments for residents and provides or coordinates a range of services including personal care or supervised nursing care available 24-hours a day, seven days a week for the support of resident independence. The provision of skilled nursing procedures to a resident in an assisted living facility is not prohibited by this act. Generally, the skilled services provided in an assisted living facility shall be provided on an intermittent or limited term basis, or if limited in scope, on a regular basis.
The rules provide that the administrator or operator of facilities ensure that written policies and procedures are developed and implemented which incorporate the principles of individuality, autonomy, dignity, choice, privacy and a home-like environment.
Each facility must offer apartments which include areas for sleeping, living, storage, kitchen (with sink, refrigerator, stove or microwave and space for storage of utensils and supplies) and bathroom. At least 200 square feet of living space, excluding bathroom, closets, lockers wardrobes, other built-in fixed items, alcoves and vestibules. Facilities licensed prior to January 1, 1995 as an intermediate personal care facility are not required to offer kitchens and private baths.
Each facility develops admission, transfer and discharge policies which protect the rights of residents. Facilities may not admit or retain people with the following conditions unless the negotiated service agreement includes hospice or family support services which are available 24 hours a day or similar resources:
Incontinence where the resident cannot or will not participate in management of the problem;
Immobility requiring total assistance in exiting the building;
Any ongoing condition requiring two person transfer;
Any ongoing skilled nursing intervention needed 24 hours a day for an extended period of time; or
Any behavioral symptom that exceeds manageability.
Facilities must develop a negotiated service agreement with each resident in collaboration with the resident, the resident's legal representative, family, if agreed to by the resident, or case manager. The agreement describes the services to be provided, the provider of service, and the parties responsible for payment when services are provided by an outside agency. The agreement supports the dignity, privacy, choice, individuality and autonomy of the resident. The agreement is reviewed at least annually or when requested by any of the participating parties.
Services may include meals, health care services based on an assessment by a licensed nurse, housekeeping, medical, dental and social transportation, and other services necessary to support to health and safety of the resident. Health care services include personal care, supervised nursing care, and wellness and health monitoring. The service agreement contains the skilled nursing services to be provided and the licensed person or agency providing services.
The Medicaid waiver includes assisted living facilities as a provider of respite and health care attendant services. The services covered by the waiver include respite care, sleep cycle support, health care attendant (Level I and Level II), adult day care and wellness monitoring. Sleep cycle support means "non-nursing physical assistance and supervision during the consumer's normal sleeping hours in the consumer's place of residence, excluding nursing facilities" and includes "physical assistance or supervision with toileting, transferring and mobility, prompting and reminding of medication."
Health care attendant "provides physical assistance with activities of daily living and instrumental activities of daily living for individuals who are unable to perform one or more activities independently. IADLs, excluding medication management or medication administration, may be performed without nurse supervision. These services are limited to 12 hours a day.
Level I activities include assistance with ADLs and IADLs (bathing, grooming, toileting, transferring, feeding, mobility, accompanying to obtain necessary medical services, shopping, house cleaning, meal preparation, laundry and life management).
Level II activities are health maintenance activities and include monitoring vital signs, supervision and/or training of nursing procedures, ostomy care, catheter care, enteral nutrition, medication administration/assistance, wound care, range of motion and reporting changes in function or condition. These services must be authorized by a physician or a nurse.
Medicaid waiver services are available to elderly recipients who meet the nursing home level of care criteria and have income below 300% of the federal SSI payment. Rather than a flat per diem, payments are made to assisted living facilities as a provider of home and community based services. The amount of payment is based on the development of an individual care plan by a case manager. Services based on the care plan are billed fee for service. The maximum rate for health care attendant services is $12.00 per hour for Level I tasks and $13.25 per hour for Level II tasks. Care plans requiring a mix of both levels are reimbursed at the Level II rate.
Appropriate facility staff may assist with self-administration and administer medications.
Sufficient numbers of qualified personnel must be available to ensure that residents receive services in accordance with negotiated service agreements.
Administrator The licensee shall appoint an administrator or operator who holds a Kansas license as an adult care home administrator or has successfully completed an operator training program as designated by the secretary.
Staff Facilities shall provide orientation to new employees and regular in-service training for all employees to ensure that services provided assist residents to attain and maintain their individuality, autonomy, dignity, independence and ability to make choices in a home-like environment.
In-service education must include: principles of assisted living; fire prevention and safety; disaster procedures; accident prevention; resident rights; infection control; and prevention of abuse, neglect or exploitation of residents
In-service education on treatment of behavioral symptoms shall be provided to all employees of facilities which admit residents with dementia.
$50 plus $15 for each resident.