Residential Facilities for Groups: Nevada Revised Statutes § 449.017 et seq.; Nevada administrative code § 449.156
Revised regulations went into effect in 1997 which replace rules for small facilities (<7 beds) and larger facilities (7 or more). A small Medicaid waiver reimburses homes for personal care in residential facilities for groups.
An adult group home for the elderly or disabled means a residential facility which provides care to three or more elderly or disabled persons requiring assistance and protective supervision due to infirmity or disability.
An Alzheimer's group home means a residential facility which provides care and protective supervision for three or more persons with Alzheimer's disease or related diseases to include: senile dementia, organic brain syndrome or other cognitive impairments.
Single occupant rooms must have 80 square feet of floor space and multiple resident rooms must have 60 square feet of floor space per resident. No more than three residents may share a room. One toilet and lavatory is required for every four residents. A tub or shower is required for every six residents. Doors of bedrooms may be equipped with locks for use by residents if the doors may be unlocked from the corridor and keys are readily available. Provisions must be made for privacy in all bathrooms and for all toilets located in bedrooms for use by more than one resident.
Facilities serving people with Alzheimer's disease must be sprinklered, and have 24-hour awake staff. Exit doors must have alarms or time-delay locks. Local audible alarming units must be installed. Facilities serving people with Alzheimer's disease must have a secure yard, completely fenced and gated with locking devices.
Residents are considered "care category 1," ambulatory, and "care category 2," non-ambulatory. Ambulatory residents are physically and mentally capable of moving from an unsafe area to an area of safety within four minutes unassisted. Non-ambulatory residents require the assistance of at least one other person to move to a safe area within four minutes. Facilities licensed prior to January 1, 1997 are not required to meet requirements for installing automatic sprinkler systems unless they seek to serve category 2 residents. Sprinklers must be installed prior to a change of ownership, an increase in licensed beds or admission of non-ambulatory residents. Requirements for hard wired smoke detectors with battery back up are also waived for small homes unless the above changes are proposed.
People who are bedfast, require 24-hour killed nursing or medical supervision, require restraints, or confinement in locked quarters may not be admitted. The rules do not allow facilities to admit or retain residents with a lengthy list of health conditions with some exceptions. Residents with (or needing) catheters, colostomies, contractures, pressure ulcers, diabetes, incontinence, enemas/suppositories, incontinence, oxygen, injections or wound care may not be admitted or retained unless the resident is physically and mentally capable of performing the required care or if the care is provided or supervised by an appropriately skilled medical professional. Residents needing gastronomy care, naso-gastric tubes, or have staph or other serious infections or tracheotomies cannot be admitted or retained unless a written request is submitted by the administrator documenting the resident's condition and how care can be provided and the request is approved by the licensing agency.
Services provided include personal care, at least 10 hours of activities a week, three meals a day, protective supervision, laundry, assisting with access to dental, optical, social and related services as needed by residents. Assistance with medical needs described in the tenant policy section may be provided through a contract with a community agency or directly by staff hired by the facility.
Facilities serving people with Alzheimer's disease must offer activities related to gross motor activities, social activities, sensory enhancement activities and outdoor activities.
Facilities may assist with self-administration of medications when the resident's condition is stable and following a predictable course, the amount of medication is at a maintenance level and does not require daily assessment, and a written plan of care has been prepared by a physician or registered nurse. The staff assisting with self-administration must complete a training program in medications.
Personal care services are reimbursed through a Medicaid HCBS in group residential settings if they meet the SSI eligibility criteria. Facilities receive a total payment of approximately $1000 a month which includes $781 from SSI for room and board and $9.09 a day ($277.20 a month) for personal care. Fifty four facilities currently contract with Medicaid and serve 52 beneficiaries. Participation has been lower than expected. Because the residential care program was designed to serve people needing an hour of personal care a day, participants have preferred to remain in their homes and participate in a similar waiver. As needs increase, facilities have not felt prepared to provide a higher level of care.
Facilities must maintain staffing patterns that are sufficient to meet the care needs of residents and to enable residents to achieve and maintain their functioning, self care and independence. Facilities with more than 20 residents must have at least one awake staff member and an additional person available within 10 minutes. Staff of all facilities must receive 8 hours of training annually directed toward meeting the needs of group care residents. Facilities licensed for 20-49 residents must have one staff member designated to organize, conduct and evaluate activities. Facilities with 50 or more beds must have a full time person for activities.
Facilities serving people with Alzheimer's disease must have a licensed administrator with no less than three years of experience in licensed facilities caring for people with Alzheimer's disease or education and training comparable to the three year requirement. Staff in these facilities shall successfully complete eight hours of training in rendering care, emergency procedures and family support services. Facilities must plan to maintain interaction groups with a ratio of no more than six residents to one staff member during times when residents are awake.
Administrators must have the necessary skills to meet or direct staff to meet the needs of residents unless such skills are met by appropriately skilled medical professionals who are employed by or contract with the facility. Administrators must receive eight hours of training annually directed toward meeting the needs of group care residents.
Staff All staff must possess the necessary skills to meet the needs of the residents in the residential facility with the exception of those needs/skills which are to be met in a contract with other service providers. Staff must receive 8 hours of training annually directed toward meeting the needs of group care residents.
Caregivers must have no prior convictions or history of previous findings of abuse, neglect or exploitation or other serious convictions relating to the ability to care for dependent persons. All other staff must not have any convictions or history of abuse, neglect or exploitation. Reference checks may be used for documentation.
Facilities are subject to on-site inspections and complaint investigation.
Initial license, $500 and $50 per bed. Renewal, $300 and $35 per bed.