SB 1560 (1997). Adult residential care facility, Louisiana Revised Statutes Annotated § 2151 et seq.; LA administrative code title 48, § 8901 et seq.
A public hearing on draft rules was scheduled for May 29, 1998. The proposed rules would create core requirements for adult residential care facilities plus three modules for assisted living facilities, personal care homes and shelter care facilities. The modules contain separate requirements for administrators, staff training and living units. The draft states that the purpose of the regulations is to promote the availability of appropriate services for elderly and disabled persons in a residential environment, enhance the dignity, independence, privacy, choice and decision-making ability to the residents; and promote the concept of aging-in-place.
SB 1560, passed in 1997, creates a pilot program to test the feasibility of covering assisted living under Medicaid. The project will be implemented by the Department of Health and Hospitals. A task force was appointed to draft guidelines for the project. The project will include two assisted living facilities. Medicaid funds are approved for the pilot. The project "shall maximize the independence of the elderly while providing the assistance that the special needs of this population require." The bill defines assisted living as "a residential congregate housing environment combined with the capacity by in-house staff or others to provide supportive personal services, twenty four hour supervision and assistance, whether or not such assistance is scheduled, social and health related services to maximize residents' dignity, autonomy, privacy, and independence and to encourage facility and community involvement."
One rural and one urban site will be selected through an RFP. Each facility may serve up to 30 Medicaid beneficiaries. Residents must be offered a chance to live in private quarters with a lockable door, bedroom, kitchenette and bathroom.
The Louisiana Advisory Committee on Assisted Living was created which includes five state agency representatives, the state fire Marshall, two legislators, and 10 public members representing associations, consumers, providers and architects. An interim report is to be filed with the legislature by October 1, 1998 and a final report in January 2001.
The summary below is based on the draft rules.
Adult residential care home means a publicly or privately operated residence that provides personal assistance, lodging and meals for compensation to two or more adults who are unrelated to the residence licensee, owner or director.
Assisted living home/facility means an adult residential care facility that provides room, board and personal services, for compensation, to two or more residents that reside in individual living units which contain, at a minimum, one room with a kitchenette and a private bathroom.
Personal care home means an adult residential care facility that provides room, board and personal services, for compensation, to two but not more than eight residents in a congregate living setting and is in a home that is designed as any other private dwelling in the neighborhood.
Shelter care home means an adult residential care facility that provides room, board and personal services, for compensation, to nine or more residents in a congregate living and dining setting.
Assisted living facilities Efficiency/studio units must provide 250 square feet excluding bathrooms and closets and may be shared by no more than two people by choice. Units with separate bedrooms shall have a living area of at least 190 square feet, excluding bathroom and closets. Each separate bedroom must have 120 square feet.
Shelter care facilities must have 100 square feet in single occupancy rooms and 160 square feet for double occupancy rooms. No more than two residents may share a room and they must agree in writing to share a room. Facilities must have adequate toilet, bathing and hand washing facilities in conformance with the state sanitary code.
Residents may include those who need or wish to have available room, board, personal care and supervision due to age, infirmity, physical disability or social dependency. Residents with advanced or higher care needs may be accepted or retained if the resident can provide or arrange for care through appropriate private duty personnel, residents do not need continuous nursing care for more than 90 days and the provider can meet the resident's needs. Facilities may not enter into contracts with outside providers to deliver health related services. These services must be arranged by the resident, family members or the resident's representative. Residents must be discharged if a physician certifies that more than 90 days of continuous care is needed or the resident is a danger to themself or others.
Basic services provided include assistance with ADLs and IADLs, three meals a day, personal and other laundry, opportunities for individual and group socialization, housekeeping, services for residents who have behavior problems and recreation services and assistance with self-administration of medications. Providers must plan or arrange for health assessments, health care monitoring and assistance with health tasks as needed or requested. Facilities must have the capacity to provide transportation for medical services, personal services (barber/beauty), personal errands and social/recreational activities.
(SB 1560) The pilot project was designed to serve elderly Medicaid beneficiaries who can no longer live at home because they need additional care with ADLs but do not require continuous nursing care and have no alternative under the traditional model except institutional care.
Facilities may provide assistance with self-administration of medications, however, residents may be assisted with pouring or otherwise taking medications only if they are cognitive of what the medication is, what it is for and the need for the medication. Residents may contract witih an outside source for medication administration. Staff assisting with medications must have training on the policies and procedures for assistance.
Providers must demonstrate that sufficient staff are scheduled and available to meet the 24-hour scheduled and unscheduled needs of residents and show adequate coverage for each day and night. Assisted living facilities and shelter care facilities must have at least one awake staff on duty at night.
Administrators must be 21 years of age. Assisted living administrators must have a bachelor's degree plus two years of experience in the field of health, social, management administration or in lieu of a degree, six years of experience and education or a master's degree in geriatrics, health care administration or a human service related field.
Shelter care home administrators must have two years of college and two years experience or four years experience in lieu of college or a bachelor's degree. Personal care home administrators must have two years of college training plus one year experience or three years of experience in lieu of college or a bachelor's degree.
Staff An orientation program shall include but not be limited to thorough coverage of the following areas: facility policies and procedures, emergency and evacuation procedures, resident's rights, procedures for and legal requirements concerning the reporting of abuse and critical incidents, and instruction in the specific responsibilities of each employee's job. Direct care staff orientation must cover training in resident care services (personal care), infection control and any specialized training to meet resident needs. All direct care staff must receive certification in first aide.
An annual training plan must be developed that includes the topics covered by the orientation.
Licenses may be denied based on a criminal conviction of any board member, owner or staff if the act that caused the conviction would cause harm to a resident if repeated. Providers must include the results of a criminal history check in each employee's personnel file.
The Department of Health shall make at least annual inspections. Complaints are to be reviewed and investigated by the appropriate state agency.
The proposed licensing fee would be $75 plus an initial fee of $25.