State Assisted Living Policy: 1998. North Dakota

06/01/1998

Citation

Basic Care Facility Chapter 23-09.3

Assisted living Chapter 50-24.5

General Approach

A task force has been created to study and make recommendations on creating an assisted living category. The task force is approaching assisted living as an opportunity to provide more choices and options for consumers. A two year moratorium was established in 1997 to halt new construction of nursing homes and basic care facilities. Recommendations will be submitted to the legislature in 1999.

The state reimburses assisted living primarily through two state funded service programs. Assisted living is viewed as a service in an apartment setting. Licensing is not required, however, the public welfare statute contains a definition of assisted living. The state funded assisted living program operates in two buildings. The program assists fifteen of the eighteen residents in one building which is funded by HUD for people with mobility impairments. Another 24-hour unit building also plans to participate in the program.

Definition

Assisted living means an "environment where a person lives in an apartment like unit and receives services on a twenty-four hour basis to accommodate the person's needs and abilities and maintain as much independence as possible."

Basic care facility means "a facility licensed by the department ... whose focus is to provide room and board and health, social and personal care to assist the residents to attain or maintain their highest level of functioning, consistent with the resident assessment and care plan, to five or more residents not related by blood or marriage to the owner or manager. These services shall be provided on a 24-hour basis within the facility, either directly or through contract, and shall include assistance with ADLs and IADLs; provision of leisure, recreational and therapeutic activities; and supervision of nutritional needs and medication administration.

Unit Requirements

Assisted living The state funded assisted living program guidelines require an apartment setting.

Basic care facility single rooms provide 100 square feet, double rooms at least 80 square feet per bed and rooms for three or more, 70 square feet per bed. At least one toilet is required for every four residents and one bath for every 15 residents.

Tenant Policy

Assisted living Participants in the Service Payments for Elderly and Disabled (SPED) program must have needs that can be met through the program. To qualify for services, residents must have impairments in four ADLs, or impairments in five IADLs totaling eight points or six points if the person lives alone, and is not eligible for the Medicaid HCBS waiver.

Basic care facility While an admission policy was not outlined in the regulations, a "resident" was defined as "an individual admitted and retained in a facility in order to receive room and board and health, social, and personal care who is capable of self-preservation, and whose condition does not require continuous, twenty-four-hour a day on site availability of nursing or medical care."

Services

Basic care facilities provide personal care (ADLs, IADLs, and observation and documentation of changes in physical, mental, and emotional functioning, as needed); arrangements to seek health care when needed; arrangement for transfer and transportation as needed; assistance with functional aids, clothing, and personal effects as well as maintenance of personal living quarters; assistance with medication administration; and social services. Nursing services must be available to meet the needs of residents either by the facility directly or arranged by the facility through an appropriate individual or agency.

Basic care facilities may also provide adult day care and respite care services under the Medicaid waiver.

Financing

Basic care facilities The state has two state funded programs covering services to resident in basic care facilities - SPED and the expanded SPED. The state funded programs pay providers a rate based on the care needs of the resident. The maximum rate is $56.66 a day. A point system is used to convert unmet service functional needs to a rate (see table). The total points are multiplied by a factor of eight and divided by 30 to obtain a monthly payment rate. These facilities may receive funding under the Medicaid HCBS waiver for adult day care and respite care.

Assisted living apartments Residents in these buildings may receive Medicaid HCBS waiver services if they meet the nursing home eligibility requirements.

The state also pays for services in two buildings that are called assisted living.

Medications

Medicaid waiver. The state's nurse practice act allows assistance with self-administration but not the direct administration except by licensed staff. No separate requirements outside the nurse practice act are included.

Basic Care Facilities must make available medication administration services.

Staffing

Assisted living Staff must be able to deliver the necessary services required by plans of care.

Basic care facilities There must be awake staff on duty 24-hours a day.

Training

Basic care facilities

Administrators must attend at least 12 hours of continuing education annually. No other requirements are stated.

Staff The facility shall design, implement and document educational programs to orient new employees and develop and improve employees' skills to carry out their job responsibilities. On an annual basis, all employees shall receive in-service training in at least the following: fire and accident prevention and safety; mental and physical health needs of the residents, including behavior problems; prevention and control of infections, including universal precautions; and. resident rights. The staff responsible for food preparation shall attend a minimum of two dietary educational programs per year. Staff responsible for activities shall attend a minimum of two activity-related educational programs per year.

Background Checks

Basic care facilities Each facility's personnel policies must include checking state registries and licensure boards prior to employment for findings of inappropriate conduct, employment, disciplinary actions and termination.

Monitoring

Basic care facilities On site, unannounced surveys are conducted by the department to determine compliance with regulations. Plans of correction must be developed by the facility if deficiencies are found. Corrections must be completed within 60 days of the survey completion date unless the department has approved an alternative schedule. The department will follow up on all plans of correction. Enforcement actions include a ban or limitation on admissions, suspension or revocation of license, or denial of license.

NORTH DAKOTA POINT SYSTEM

Activity

  Value  

Activity

  Value  

Taking medication

1

Foot care

10

Temp\Pulse\Resp\BP  

1

Nail care

10

Managing money

1

Change dressings

10

Communication

1

Apply elastic bandage  

10

Shopping

15

Care of prosthetic

10

Housework

10

Medical gases

10

Laundry

10

Meal preparation

20

Mobility

6

Exercise

20

Transportation

6

Water bath/heat

20

Bathing

10

Ostomy care

20

Teeth/mouth care

20

Bowel program

20

Dress/undress

15

Indwelling catheter

20

Toileting

15

Bronchial drainage

20

Transfer

10

Feeding/eating

20

Continence

15

Supervision Level I

15

Eye care

10

Supervision Level II

30

Skin care

10

 

 

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