State Assisted Living Policy: 1998. New Jersey

06/01/1998

Citation

Assisted living Chapter NJAC 8:36

General Approach

Regulations took effect in December 1993 governing the provision of assisted living services in assisted living residences and comprehensive personal care homes. The regulations promote aging in place in homelike, apartment style settings for frail elders. The purpose section of the regulations describes the goals of assisted living to "maintain independence, individuality, privacy, dignity" in an environment that "promotes resident self direction and personal decision making while protecting health and safety." The NJ Board of Nursing approved applying a medication administration rule for all three categories of assisted living, which allow unlicensed staff, who are certified and under the supervision of a licensed registered nurse, to administer medications, in specific circumstances, to assisted living residents.

Regulations creating assisted living programs in subsidized housing sites were effective in August 1996. ALP regulations permit licensing of a service agency to deliver services in subsidized elderly housing projects.

Licenses have been issued for 57 facilities containing 3,919 beds. Of these 33 are ALRs with 2,772 beds, 20 are CPCHs with 1,147 beds and 4 are ALPs. One nursing facility with 51 beds has converted to assisted living. Another 233 have been approved but not yet licensed and 43 applications are under review.

Eighteen ALRs/CPCHs and three ALPs currently contract with Medicaid and serve 120 beneficiaries.

All new construction is purpose built, apartment style units. Only facilities licensed by the Department of Health and Senior Services prior to December 1993, the effective date of the assisted living regulations, can convert to comprehensive personal care homes and offer bedrooms rather than apartment style units with a kitchenette. The state has adopted an expedited certificate of need review for assisted living residences.

Definition

Assisted living "means a coordinated array of supportive personal and health services, available 24-hours per day to residents who have been assessed to need these services, including residents who require formal long term care. Assisted living promotes resident self direction and participation in decisions that emphasize independence, individuality, privacy, dignity and homelike surroundings."

Assisted living residence means a facility which is licensed by the Department of Health and Senior Services to provide apartment-style housing and congregate dining and to assure that assisted living services are available when needed, for four or more adult persons unrelated to the proprietor. Apartment units offer, at a minimum, one unfurnished room, a private bathroom, a kitchenette and a lockable door on the unit entrance.

Comprehensive personal care home means "a facility which is licensed by the Department of Health and Senior Services to provide room and board and to assure that assisted living services are available when needed, to four or more adults unrelated to the proprietor. Residential units may house no more than two residents and have a lockable door on the unit entrance."

Assisted living program (ALP) "means the provision of or arrangement of meals and assisted living services, when needed, to the tenants of publicly subsidized housing which because of federal, state or local housing laws, regulations or requirements cannot become licensed as an assisted living residence. An assisted living program may also provide staff resources and other services to a licensed assisted living residence and a licensed comprehensive personal care home." In these instances, ALPs must comply with the licensing standards that are appropriate to the setting.

Unit Requirements

Each assisted living residence unit must offer a minimum 150 square feet (single occupancy) of clear and useable floor area (excluding closets, bath and kitchen), private bathroom, a kitchenette and a lockable door on the unit entrance. The kitchenette must include a small refrigerator, cabinet for food storage, sink, and space with outlets suitable for cooking appliances such as a microwave, cook top or toaster oven." An additional 80 square feet of floor space must be provided for a second person occupying a unit. No more than two people may occupy a unit.

Comprehensive personal care home units must provide 80 square feet for single occupancy units and 130 square feet if the unit is occupied by two people. While a locked door is required, private baths and kitchenettes are not required.

Assisted living programs are licensed as a service. Requirements for the apartments in subsidized housing projects are specified by the source of financing and the building code.

Tenant Policy

Assisted living is not appropriate for people who are not capable of responding to their environment, expressing volition, interacting or demonstrating independent activity. Each resident receives an assessment and a care plan by a registered nurse. The residence may, but is not required to, care for people who require 24-hours, seven day a week nursing supervision, are bedridden longer than 14 days, consistently and totally dependent in four or more ADLs, have cognitive decline that interferes with simple decisions, require treatment of stage three or four pressure sores or multiple stage two sores, are a danger to self or others or have a medically unstable condition and/or special health problems. The admission agreement has to specify if the facility will retain residents with one or more of these characteristics and the additional costs which may be charged. The facility must also describe the assessment process and the manner in which the resident and/or their family will be involved. Managed risk agreements are negotiated, when appropriate, based on resident actions, choice or preferences. Within 36 months of licensing, at least 20 percent of the residents in each licensed facility must have nursing home level of care needs.

Services

The residence must provide personal care and provide or arrange for other services. The minimum service capacity must include personal care, nursing, pharmacy, dining, activities, recreation, and social work services to meet the individual needs of residents. Supervision, assistance with and administration of medications by trained and supervised personnel is also required. Facilities must also be capable of providing or arranging for the provision of nursing services to maintain residents.

Rules ALPs require contracts between service providers and the housing entity. The contracts provide that tenants will not be barred from participation because of the location of a unit, tenants cannot be moved because of their participation. Housing owners/managers must agree to the provision of services. ALPs shall be capable of providing or arranging for assistance with personal care, nursing, pharmaceutical, dietary and social work services, transportation and recreational activities.

Financing

A Medicaid home and community based services waiver effective in 1996 allows the state to serve 1500 residents. In April 1998, 120 residents were being served. Rates have been developed for each of the three settings. Assisted living residences receive $571.55 for room and board from SSI and $1800 a month for Medicaid services. Assisted living programs receive $1200 a month for services. Residents are charged a percentage of their income for room and board. Comprehensive personal care homes receive $571.55 for room and board and $1500 a month for services. Medicaid officials plan to review their methodology.

NEW JERSEY RATE SCHEDULE

 

  Assisted Living  
Residences

  Assisted Living  
Programs

Comprehensive
  Personal Care  
Homes

Room and board

$571.55

NA*

$571.55

Medicaid waiver services  

$1800.00

$1200.00

$1500.00

Total

$2371.55

$1200.00

$2071.55

NOTE: Assisted living program residents live in subsidized housing and are charged a percentage of their income for rent. Residents in ALRs and ALPs retain a personal needs allowance of $72.50 a month.

Medications

Residences are allowed to provide supervision of and assistance with self-administration of medications and administration by trained and supervised personnel. Registered nurses may delegate medication administration to personal care assistants who have completed required training and passed a written test.

Staffing

The regulations require at least one awake personal care assistant and one additional staff at all times and sufficient staffing to provide the services indicated by the assessments of resident needs. A registered nurse must be available on staff or on call 24-hours a day. ALPs must have policies which assure that at least one staff member of the ALP or the housing program is on-site 24-hours a day.

Training

Administrators in all three licensed settings must be licensed as a nursing home administrator or complete an assisted living training course, or other equivalent training, as approved by the department and shall pass a state examination. The course includes 40 hours of classroom training and a 16 hour curricula. The administrator must also participate in at least 10 hours of continuing education annually regarding assisted living concepts and related topics, as specified and approved by the Department of Health and Senior Services or the NJ Nursing Home Administrators Licensing Board.

Staff Each personal care assistant shall have completed:

  • A nurse aide training course approved by the Department and shall have passed the Nurse Aide Certification exam; or

  • A homemaker-home health aide training program approved by the Board of Nursing and shall be so certified; or

  • Other equivalent training program approved by the Department.

Each PCA shall receive orientation prior to or upon employment and ongoing in-service education regarding the concepts of assisted living, emergency plans and procedures and the infection and prevention program.

Background

Administrators must be of a good moral character. Facilities shall exercise good faith and reasonable efforts to ensure that staff have not been convicted of a crime relating adversely to the person's ability to provide resident care such as homicide, assault, kidnapping, sexual offenses, robbery, and crimes against family, children or incompetents, except where the applicant has demonstrated rehabilitation.

Fees

Licensure fees are $500 plus $10 per bed. Assisted living programs pay a fee of $750.

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