Residential care facilities: Ohio Revised Code Annotated § 3721 et seq.; Ohio administrative code § 3701-17-50 et seq.
Adult care facilities: Ohio Revised Code Annotated 3722 et seq.; Ohio Administrative Code Chapter 3701-20-01 et seq.
The majority of assisted living facilities in Ohio are licensed as residential care facilities, however some are licensed as adult care facilities. Earlier legislation creating an assisted living licensing category was repealed by the 1995 budget bill before regulations were ever finalized. The budget bill, in an effort to accommodate some of the assisted living philosophies, amended the existing rest home licensing law to change the licensing nomenclature to residential care facility and to expand the scope of services that the RCFs may provide. The adult care facility licensing law, which became effective in 1990, requires licensing of what is commonly known as board and care homes.
Residential care facilities provide supervision, personal care services, and may administer medications, supervise special diets and perform dressing changes. Residential care facility residents may also receive up to 120 days of nursing services on a part-time intermittent basis.
Adult care facilities provide supervision and personal care services. Unlike residential care facilities, ACFs are prohibited from administering medications, supervising special diets or performing dressing changes. However, ACF residents with short-term illnesses may receive up to 100 days of these and other needed nursing services.
Legislation (SB 60) requiring criminal background checks for staff working with elders was passed by the legislature in 1996.
Residential care facility means a home that provides either of the following:
Accommodations for seventeen or more unrelated individuals and supervision of personal care services for three or more of those individuals who are dependent on the services of others by reason of age or physical or mental impairment.
Accommodations for three or more unrelated individuals, supervision and personal care services for at least three of those individuals who are dependent on the services of others by reason of age or physical or mental impairment and to at least one of those individuals, any of the skilled nursing care authorized by section 3721.011 of the revised code.
Adult care facility means an adult family home or an adult group home. An adult family home is a residence or facility that provides accommodations to three to five unrelated adults and supervision and personal care services to at least three of those adults. Adult group homes provide accommodations to six to sixteen unrelated adults and supervision and personal care to at least three of the unrelated adults.
If a residence, facility, institution, hotel, congregate housing project or similar facility provides services that meet the definition of a residential care facility or an adult care facility then it must be licensed accordingly, regardless of how the facility holds itself out to the public.
RCFs must offer 100 square feet for single occupancy rooms and 80 square feet per person in multiple occupancy rooms. No more than four people may share a room. A toilet, sink, tub/shower is required for every eight residents except if there are more than four persons of one sex to be accommodated in one bathroom on a floor, a bathroom must be provided on that floor for each sex residing on that floor.
ACFs must offer 80 square feet for single occupancy rooms and 60 square feet per person in multiple occupancy rooms. No more than three people may share a room. A toilet, sink, tub/shower is required for every eight residents.
The statute allows residential care facilities to admit and retain residents requiring part time, intermittent nursing care for up to 120 days. RCFs may also admit and retain residents who require dressing changes, special diets and medication administration beyond the 120 day limit if the facility provides those services itself.
ACFs may not provide but may admit and retain individuals who need part time, intermittent nursing care to treat a short-term illness.
RCFs may provide supervision and personal care, and nursing services that include supervision of special diets, application of dressings and administration of medication, and may also provide other nursing services on a part time, intermittent basis for a total of not more than 120 days in any twelve month period. Part time, intermittent is defined as less than eight hours a day or less than 40 hours a week. The skilled nursing services may be provided by the RCF, a licensed hospice agency or a certified home health agency. In ACFs, part time, intermittent nursing services may be provided by either a licensed hospice or a certified home health agency to residents with short-term illnesses.
Medicaid payments are not available. An earlier budget proposal included $4.4 million for the Department of Aging to develop an assisted living program through a Medicaid Home and Community Based Services waiver and to subsidize room and board payments. In 1995, the Department of Aging developed a five tiered system for determining the level of reimbursement with rates ranging from $200 to $1400 a month for services. A Residential State Supplement (SSI) of $700 a month would have covered room and board costs. A decision on submission of the waiver was postponed pending an overall review of the entire Medicaid program.
Trained non-licensed staff of both RCFs and ACFs may assist with self-administration. Assisting with self-administration requires the resident to be mentally alert and able to participate in the medication process and includes reminders, observing, handing medications to the resident, verifying the resident's name on the label and, for physically impaired residents, removing oral or topical medications from containers, applying medication upon request, and placing containers with medication to the mouth of the resident. Medications may be administered by a licensed hospice agency, certified home health agency or a member of the RCF's staff who is qualified to do so. Adult care facility staff may not administer medications.
For RCFs, at least one staff member must be on-site at all times. An RN, LPN or physician must be on duty when medications are being administered. Staff may be shared with other licensed facilities in the same building or in the same lot as long as staffing requirements for all facilities are met. A dietitian's services are required if the facility elects to supervise special diets or perform enteral tube feedings, and sufficient nursing staff are required if the RCF elects to perform dressing changes or part time intermittent nursing care.
ACFs, which include some semi-independent living homes, must have one staff member on site whenever a resident who requires ongoing supervision, assistance with walking, moving, bathing, toileting dressing, eating, evacuation, or PRN medications is present.
In addition, for both RCFs and ACFS, sufficient additional staff must be available to meet, in a timely manner, the residents' care, supervisory and emotional needs and reasonable requests for service, including ongoing supervision of residents with increased emotional needs or presenting behaviors that cause problems for the resident or other residents and to properly provide dietary, housekeeping, laundry and facility maintenance services and recreational activities.
RCF administrators must be a licensed nursing home administrator or have 2000 hours of operational responsibility in related facilities, successfully complete 100 credit hours of post high school education in gerontology, be a licensed health professional or hold a baccalaureate degree. RCF administrators also must receive nine hours annually continuing education in gerontology, health care, business administration or residential care facility operation. ACF managers are required to have basic orientation and training applicable to job duties including emergency response training.
Staff Both ACFs and RCF must provide orientation and training for all staff in job responsibilities, facility procedures, securing emergency assistance and resident rights. ACF and RCF staff who provide personal care must have currently valid documentation of a successfully completed first aid course. In addition, RCF staff providing personal care must have met one of the following:
Successfully completed training or continuing education covering the correct techniques of providing personal care services, observational skills such as recognizing changes in residents' normal status and the facility's procedures for reporting changes and communication and interpersonal skills provided by an RN or LPN;
Successfully completed the training and competency evaluation program approved or conducted by the Director under §3721.31 of the revised code; or
Successfully completed the training or testing requirements in accordance with the Medicare Conditions of Participation of home health aide services.
If an RCF serves people with emotional and behavior needs, training or continuing education in the appropriate interventions for meeting these needs and for handling and minimizing such problems must be completed.
ACF staff that provide personal care must also have successfully completed training or continuing education cover the correct techniques of personal care services.
Criminal background checks are required for any individual used by an ACF or RCF in a position that provides direct care to older adults.
RCFs must be inspected once every 15 months by the Department of Health and the fire marshal (state or local). ACFs must be inspected annually by the Department. Adult group homes must also undergo an annual fire inspection.
RCF licensing and renewal fee of $100 for every 50 persons, or part thereof of licensed capacity. AGH license fee is $50, and AFH is $25. AGHs and AFHs must also pay an inspection fee of $10 for each licensed bed.