State Assisted Living Policy: 1998. New Mexico

06/01/1998

Citation

Adult residential care NMAC Title 7 Chapter 8 Part 2

Assisted living (Medicaid)

General Approach

The state has added assisted living as a Medicaid waiver service. Providers may be licensed adult residential care homes or new or innovative programs. The program has signed agreements with 6 contractors although few recipients have joined the program. State contacts indicate that most facilities are part of or attached to nursing homes and residents prefer to remain in their own homes. Residential care facilities may not provide 24-hour supervision and residents who may be appropriate for admission but are able to remain in their own homes with waiver services.

Definition

Adult residential care facility means any congregate residence, maternity shelter or building for adults, which provides and primary purpose is to provide to residents, within the facility, either directly or through contract services, programmatic services, room, board, assistance with activities of daily living, in accordance with the program narrative, and/or general supervision to two or more adults who have difficulty living independently or managing their own affairs.

Medicaid Assisted living is a special combination of housing and personalized health care service designed to respond to the individual needs of waiver recipients who require assisting with activities of daily living (ADL's e.g., ability to perform tasks that are essential for self care, such as bathing, feeding oneself, dressing, toileting, and transferring) and instrumental activities of daily living (IADL's, e.g., ability to care for household and social tasks to meet individual needs within the community). Assisted living is based on the following fundamental principles of practice: individuality, independence, privacy, dignity, choice and a home-like environment. Assisted living services are packaged per individual recipient needs.

Unit Requirements

Private rooms must have at least 100 square feet of floor area, not including closets and locker areas. Semi-private rooms shared by no more than two people must have at least 80 square feet of floor area per bed, not including closets and locker areas. Dormitories or wards must have sixty feet of floor area for each bed. Toilets, sinks, tubs, and showers must be provided in ratios of one for every eight residents.

Medicaid Services must be provided in "home-like" environments which are defined as:

  1. A minimum of 220 square feet of living and kitchen space (not including bathroom) for newly constructed units (rehabilitated units must provide a minimum of 160 square feet).

  2. Adult residential shelter care homes must provide 100 square feet of floor area in a single bedroom (excluding closet/locker). Recipients must have access to a common living area, kitchen and bathroom which are handicapped accessible. 80 square feet is required for semi-private bedrooms.

Tenant Policy

Facilities may not admit anyone requiring continuous nursing care which includes ventilator dependency, stage III or IV pressure sores, intravenous therapy or injections directly to veins, airborne infectious diseases, conditions requiring physical or chemical restraints, nasogastric tubes/gastric tubes, tracheotomy care, individuals presenting an imminent physical threat or danger to self or others or individuals whose physician certifies that placement is no longer appropriate. Exceptions are allowed when a team (director, resident, agent, advocate, physician, other health professionals) jointly agree and approve a service plan identifying needs and how they will be met, ensuring maintenance of the facility's evacuation rating, and the well-being of others.

Services

Facilities must supervise and assist residents as necessary with health, hygiene and grooming needs to include but not be limited to eating, dressing, oral hygiene, bathing, grooming, mobility and toileting. Individual service plans may be prepared as needed but are required for residents who need nursing services. Three meals, laundry, and housekeeping must be provided.

Medicaid An inter-disciplinary team develops an individualized service plan which is approved by the Department of Health waiver staff. Staff from the facility participate as a member of the team and attend team meetings.

Core services provide minimum to moderate assistance and include at a minimum: bathing, dressing, eating, personal hygiene, behavior management, opportunities for individual and group interaction, housekeeping, laundry, transportation, meal preparation and dining, twenty-four hour response capability to meet routine scheduled care as well as unscheduled, unpredictable needs of the recipients, capacity to provide on-going supervision of the waiver recipient within a twentyfour hour period, service coordination capability to arrange access to services not provided directly, provider participation in the interdisciplinary team meetings for development of the individualized service plan and demonstrated capability to address the most common dementia related problems (e.g., memory loss, depression, sleep disorders).

In addition to the above core services, providers may provide personal services (specialized bowel and bladder program and catheter care); private duty nursing (medication management, nursing services such as injections, wound care, health status monitoring and assessment); skilled maintenance therapies (PT, OT, speech); emergency response services; and other support services authorized by the Department of Health designed to maintain independence.

Services may be provided by the facility or another approved waiver provider.

Reimbursement

The Department of Health has established an interim service rate of $47.50 per day (excluding room and board) for approved provider agencies. The Department of Health and Department of Human Services reviews reports filed during the first quarter to determine a final rate. The Department will consider setting a base rate with add-ons for other services (eg., therapies) as well as negotiated rates. Room and board charges must be submitted to the Department of Health prior to the provision of services. The waiver set eligibility at 200% ($988 a month) of the federal SSI payment and recipients may keep income below $988 to cover maintenance needs. The maintenance allowance was set based on recipients living in their own home/apartment and an adjustment may be made for recipients in assisted living.

Medications

Medications may be administered by licensed health care professionals.

Staffing

The waiver guidelines require staffing ratios and patterns that will meet the individual recipient's needs as identified in the ISP.

Training

Staff training, appropriate to staff responsibilities, includes, at a minimum, an orientation and an on-going, but at least annual, program which includes: fire safety, first aid, safe food handling practices, confidentiality of records and resident information, infection control, resident rights, reporting requirements on abuse, neglect and exploitation, and providing quality resident care based on current resident needs.

Subchapter: §836-1.8 Qualifications of personal care assistants.

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.

Background

No specific provisions. May be addressed in facility personnel policies.

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