State Assisted Living Policy: 1998. Montana

06/01/1998

Citation

Personal care facilities Subchapter 9 §16.32.902

Adult foster care homes Chapter 16 Subchapter 1 §11.16

General Approach

The state's Medicaid HCBS waiver reimburses services provided in personal care facilities and adult foster care homes. Neither the licensing rules nor the waiver uses the term assisted living. About 130 participants are covered in personal care facilities and adult foster care homes in 1998.

Definition

Personal Care Facilities A facility in which personal care is provided for residents in either a category A facility or a category B facility. A facility must have a license for either category A or category B. Category A means the residents can self medicate, are mobile, continent and generally in good health. Category B means residents may be ventilator dependent, incontinent, under chemical or physical restraint, or IV dependent. A facility that does not have a category B license may obtain one if the residents in the facility decline in health. Facilities may have up to five residents who fall in this category.

There were 58 facilities and 892 beds in 1996.

Unit Requirements

No more than four residents may reside in a single bedroom. Each single bedroom must contain 100 square feet and each multi-bedroom must contain at least 80 square feet per bed, excluding toilet rooms, closets, lockers, wardrobes, alcoves or vestibules. Each resident must have access to a toilet room without entering another resident's room or the kitchen, dining, or living areas. There must be one toilet room for every four residents and one bathing facility for every 12 residents.

Tenant Policy

PCFs may provide personal care services to a resident who is 18 or older and in need of the personal care for which the facility is licensed. A resident in a facility licensed as a category A facility may obtain third party provider services for skilled nursing care for no more than 20 consecutive days at a time.

A resident of a category B facility must have a signed statement from a physician agreeing to the resident's admission to the facility if the resident:

  • Needs skilled nursing care;

  • Needs medical, physical, or chemical restraint;

  • Is non-ambulatory or bedridden;

  • Has no bowel or bladder control; or

  • Is unable to self-administer medications.

Category B facility residents must have a signed statement renewed every quarter by a physical, physician assistant, nurse practitioner, or a registered nurse who visited the facility within the calendar quarter covered by the statement and has certified that the resident's need can be met in the facility. Category B facilities may serve five or fewer residents with the needs defined above.

Standards for operating a category B facility must include the standards for a category. A facility (standards for physical, structural, environmental, sanitary, infection control, dietary, social, staffing, and record keeping components of the facility) as well as standards for assessment of residents, care planning, qualifications, and training of staff, restraint use and reduction, prevention and care of pressure sores, incontinence care, and the storage and administration of drugs.

Residents of category B facilities must be assessed upon admission for mobility, mental status, physical status, self-medication, dietary needs, personal hygiene needs, and social needs. Within three days after admission a care plan must be developed that is prepared by a licensed health care professional, and to the extent practicable, with the participation of the resident, the resident's family, or the resident's legal representative. Care plans must be updated at least quarterly.

Services

Services include residential services, such as laundry, housekeeping, food service, and either providing or making available provision for local transportation; personal assistance services with ADLs; recreational activities; and supervision of self-medication. Personal care assistance is provided while encouraging residents to maintain independence and a sense of self-direction.

Reimbursement

The room and board payment under SSI is $589 a month and residents retain a personal needs allowance of $100. The Medicaid waiver reimburses adult foster care home and personal care facilities between $520 and $1800 a month depending on the level of care needed by residents. State agency field staff complete the assessment and determine the payment rate. In addition to the room and board component, the basic service payment for residents is $520 a month.

Additional payments are calculated based on ADL and other impairments. Points are calculated for each impairment. The functions measured are: bathing, mobility, toileting, transfer, eating, grooming, medication, dressing, housekeeping, socialization, behavior management, executive cognitive functioning and other. Each function is rated:

  1. With aides/difficulty--means people who need consistent availability of mechanical assistance or expenditure of undue effort;

  2. With help--means requires consistent human assistance to complete the activity but the individual participates actively in the completion of the activity; or

  3. Unable--means the individual cannot meaningfully contribute to the completion of the task.

Each point equals $33 a month. For example, a resident consistently needing help with toileting would be scored a two and would earn $66 a month for that impairment. Residents with severe impairments, totally dependent in more than three ADLs, can receive $44 a month for each point. The total payment (services and room and board) ranges from $1084 to $2363 a month although very few participants have been approved at the highest rate. About 40 recipients are receiving this service under the HCBS program. The average payment is $42 a day

Medications

Staff may assist with self-administration of medications. Licensed health care professionals may set up daily dose containers, verify physician's orders, and set up injectable medications.

Staffing

There must be sufficient staff on duty 24-hour a day to provide proper resident care and all related services.

Training

Administrator Each PCF must employ an administrator who must at all times be responsible for the PCF and ensure 24-hour supervision of the residents and have completed high school or have a general education development (GED) certificate. Administrators must also evidence at least six hours of annual continuing education in one of the following areas: resident and provider rights and responsibilities, abuse/neglect, or confidentiality; basic principles of supervision; skills for working with residents, families, and other professional service providers; characteristics and needs of residents; community resources; accounting and budgeting; or basic and advanced emergency first aid.

Staff Direct care staff shall receive orientation as specified in the facility's policies and procedures manual and that is appropriate to the position, addresses the facility's policies in regard to performance of duties, and, in addition to the information required by ARM 16.32.903(9), includes at a minimum:

  • Basic personal care procedures, including grooming and personal hygiene, and methods to foster residents' maximum independence in activities of daily living;

  • Basic techniques in observation of resident's mental and physical health;

  • Bowel and bladder care, in a category B facility;

  • Assisting resident mobility, including transfer;

  • Techniques in lifting;

  • Food nutrition and diet planning;

  • Health-oriented record keeping, including time/employment records and resident records; and

  • Assistance with medications.

Background Check

All staff may not have convictions for a crime involving violence, fraud, deceit, theft, other deception or a violation of 52-3-825 MCA for which the person is still under state supervision.

Monitoring

Unannounced on-site surveys are conducted annually, biannually, or triennially depending on whether the facility has been granted an extended license. Individuals served under the HCBS program are reassessed every six months or more frequently if needed.

Fees

$70 per bed for category A facilities and $90 a bed for category B facilities.

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