State Assisted Living Policy: 1998. New Hampshire

06/01/1998

Citation

Supported Residential Care Facilities Chapter He-P 805

Residential Care Home Facilities Chapter He--804

General Approach

State policy does not use the term assisted living, however, state contacts indicated that their approach supports assisted living in a number of settings. Home health agencies provide assisted living services in apartments and a number of apartment complexes advertize themselves as assisted living. In addition to home care services, two residential levels of care are licensed. Residential Care Home Facilities and Supported Residential Care Facilities. Supported Residential Care Facilities provide a higher level of care than Residential Care Home Facilities. The latter are not allowed to provide nursing services and provide guidance for assistance with ADLs rather than hands on assistance. There are 84 residential care facilities with 1,071 beds and 49 supported residential care facilities with 1,390 beds.

Regulations will be revised in 1998.

Definition

"Residential care facilities, whether or not they are private homes or other structures built or adapted for the purpose of providing residential care, offering services beyond room and board to two or more individuals who may or may not be elderly or suffering from illness, injury, deformity, infirmity or other permanent or temporary physical or mental disability. Such facilities include those:

  1. Offering residents home-like living arrangements and social or health services including, but not limited to, providing supervision, medical monitoring, assistance in daily living, protective care or monitoring and supervision of medications; or

  2. Offering residents social, health, or medical services including, but not limited to, medical or nursing supervision, medical care or treatment, in addition to any services included under subparagraph (1). Such homes or facilities shall include, but not be limited to, nursing homes, sheltered care facilities, rest homes, residential care facilities, board and care homes, or any other location, however, named, whether owned publicly or privately or operated for profit or not.

The statute indicates that residential care requires a minimum of regulation and reflects the availability of assistance in personal and social activities with a minimum of supervision or health care, which can be provided in a home or home-like setting. Supported residential health care reflects the availability of social or health services, as needed, from appropriately trained or licensed individuals, who need not be employees of the facility, but residents shall not require nursing services complex enough to require 24-hour nursing supervision. Such facilities may also include short-term medical care for residents of the facility who may be convalescing from an illness and these residents shall be capable of self-evacuation. Supportive residential care serves residents who do not need 24-hour nursing care except on a short term basis. Residents need help with ADLs but must be able to evacuate with assistance. Residential care homes are a step below supported residential care facilities and provide supervision and some ADL assistance.

Unit Requirements

Units must have at least 80 square feet per one bed room and 140 square feet per room with two beds, exclusive of space required for closets, wardrobe, dressers and toilet room. Rooms may be shared by two people. Sinks, toilets, tubs and showers shall be available for every six residents.

Tenant Policy

Residential care homes can accept only those persons who are (1) mobile and can self evacuate; (2) able to initiate and accomplish most activities of daily living but may require supervision or physical assistance; (3) not in need of licensed or professional nursing or monitoring except for temporary episodic illness.

Persons admitted for short stays must have a health examination conducted within 30 days prior to admission and include any orders and medications required by the resident; an assessment focused on the services needed by the resident; and an admission agreement which lists the services to be provided during the residence.

Persons admitted for more than a short term stay must have a health exam conducted within 30 days prior to admission which addresses medical requirements; functional activities and limitations; medication needs and orders; and dietary needs; the administrator or designee in conjunction with the resident's provider and family/guardian must complete an initial assessment prior to admission; the administrator must ensure that assessments are completed at least every six months; and the resident must receive a written list of services that will be provided; a list of services for which additional payment is required; rules of the home; information on, and procedures for, reserving a place in the home when the resident is hospitalized or out of the home for a period of time; grounds for termination of agreement; and notification required for involuntary transfer for reasons other than emergency situations.

Residential care homes may not accept any resident whose assessment indicates services are required which the facility cannot provide.

Supported residential care facilities may accept only residents who are mobile and can self-evacuate; are able to initiate and accomplish some ADLs with help but require physical assistance and prompting with others; require intermittent, short term 24-hour nursing care or less than 24-hour nursing care on an ongoing basis; require consultation or direct care for therapeutic services (physical, occupational, recreational therapy and mental health services); or require administration of medications.

Services

Residential care homes Services include protective services including supervision, arrangement of appointments, crisis intervention, supervision in activities of daily living, nutrition and medications, and provision of or arrangement for transient medical care with licensed home health care providers; access to community services; and room and board.

If a resident's health status changes permanently to non-mobile or the resident requires medical or nursing care on an ongoing basis, the home must either provide medical or nursing care from a licensed home health care provider on a contract basis; seek licensure to provide a higher level of care; or transfer the resident to another facility where medical and nursing care are available.

The home is responsible for arranging the provision of additional services to residents requiring care during a temporary episodic illness or convalescence following acute hospital care.

Supported residential care facilities provide housekeeping, verbal and physical assistance with ADLs, nutrition monitoring, meals, personal supervision when required to offset cognitive deficits that pose a risk to self or others, assistance with medications (verbal prompting, reminding and some physical assistance) and provision for administration of medications by appropriately licensed persons directly or by contract with a licensed home health agency and for treatments ordered by a physician. Facilities shall provide or arrange with a licensed home health agency for short term intermittent nursing care and less than 24-hour nursing or other medical monitoring care on an ongoing basis.

Medication

Administration of medications by licensed staff is allowed.

Financing

A Medicaid waiver is expected to be submitted in 1998.

Staffing

Administrators must be at least 21 and never convicted of a misdemeanor or felony. Administrators of facilities licensed for 4 to 16 beds must have a high school diploma or GED plus one year of work experience in a health field; or an associates degree from an accredited college or university in a health field.

Administrators of residential care homes licensed for 17 or more residents must have a high school diploma plus five years of direct care experience; an associate's degree from an accredited college or university plus three years of experience in a health or human services field; or a bachelor's degree in a health field.

Residential care homes do not require medical directors or directors of nursing. Other staff must be at least 18 years old if they provide direct care.

Training

Administrators must have 12 hours of continuing education each year.

Staff Personnel shall have orientation and training in the performance of their duties and responsibilities which includes job description requirements, fire safety and evacuation, medical emergency protocol, resident rights and facility tour and familiarization.

Ongoing in-service training or continuing education must be provided to address areas of weakness identified during annual performance review. In-service training shall also address new or special needs of residents and shall include training in: medication supervision or administration; first aid; behavior management; personal care; fire safety and evacuation; socialization and resident rights.

Background Check

Staff may not have been convicted of a felony and never have been convicted of abuse, assault, neglect, or exploitation of any person. A signed statement by the employee is acceptable documentation for conviction of abuse, assault, neglect or exploitation.

Monitoring

The licensing agency conducts annual inspections of facilities.

Fees

$2.50 per bed.

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