Residential care homes: 63 Oklahoma statute § 1-819 et. seq.; Oklahoma rules, § 310:680:1:1 et seq.
Continuum of care and assisted living rules Chapter 663
Legislation, HB 1540, was passed during the 1997 session creating an assisted living category. The nine member State Board of Health appointed a 27 member Continuum of Care and Assisted Living Standards Council to develop recommendations to implement the law. Each member of the Board of Health appointed three members which included a nursing home owner/operator, a residential care facility owner/operator and a member representing the public. The regulations were expected to be effective July 1, 1998.
Assisted living center means any home or establishment offering, coordinating or providing services to two or more persons who:
Are domiciled therein;
Are unrelated to the operator;
By choice or functional impairments, need assistance with personal care or nursing supervision;
May need intermittent or unscheduled nursing care;
May need medication assistance; and
May need assistance with transfer and/or ambulation.
No facilities may call themselves an assisted living center or a continuum of care facility unless they are licensed. The bill allows assisted living centers to be licensed as a component of a nursing facility.
A continuum of care facility means a home, establishment or institution providing nursing facility services and assisted living center services or adult day care center services.
Residential care home means any establishment or institution other than a hotel, motel, fraternity or sorority house, or college or university dormitory which offers or provides residential accommodations, food services and supportive assistance to any of its residents or houses any resident requiring supportive assistance who are not related to the owner or administrator of the home by blood or marriage. Said residents shall be ambulatory and essentially capable of managing their own affairs, but do not routinely require skilled nursing care or intermediate care.
Assisted living centers No more than two residents may share a bedroom. Each Center shall ensure privacy and independence and no more than 4 residents may share bathing and toilet facilities. The assisted living portion of continuum of care facilities must be physically separate from the nursing home.
Residential care home Single rooms must have 80 square feet and multiple occupancy rooms 60 square feet per bed. The regulations do not limit the number of resident who may share a bedroom. Toilet facilities must be provided for every six residents and a tub/shower for every 10 residents.
Assisted living centers must describe the population to be served based on their need for personal care, nursing supervision, intermittent or unscheduled nursing care, medication administration, assistance with cognitive orientation and care or service for Alzheimer's disease and assistance with transfer or ambulation. Each Center's admission criteria must be included in the application for licensing.
Centers may not serve anyone whose needs are inconsistent with the services provided by the facility, the resident's physician determines that restraints are needed, the resident is a threat or danger to self or others, or the facility is unable to meet the resident's need for privacy and dignity.
Residential care home
The regulations do not contain a section on admission/retention criteria. The definition states that residents may not need services provided in a skilled or intermediate care facility. Residents must be ambulatory and essentially capable of managing their own affairs.
Assisted living centers may provide personal care, meals, housekeeping, laundry, intermittent or unscheduled nursing care, nursing supervision, medication administration, assistance with cognitive orientation, specialized services for people with Alzheimer's disease, assistance with transfer or ambulation, planned programs for socialization, and activities and exercise. Nurses are allowed to delegate tasks that are within the scope of their license to perform.
Nurses remain responsible for all nursing care that a person receives under their direction. Nurses may use their professional judgement in determining which tasks may be delegated. Tasks which may not be delegated include those which require nursing assessment, judgement, evaluation and teaching during implementation such as physical, psychological and social assessment which require nursing judgement, intervention, referral or follow up; formulation of a plan of nursing care and evaluation of responses to the care; administration of medications except as authorized by regulations.
An admission assessment must be implemented 30 days before or at admission and a comprehensive assessment must be completed within 30 days after admission and updated at least annually thereafter or whenever a significant change occurs. The rules describe the content of the assessment. Assessments must be conducted or coordinated by a registered nurse and signed by the resident's physician.
A managed risk process is required when resident preferences or decisions create risk or are likely to lead to adverse consequences. The Center identifies the cause for concern, attempts to negotiate an agreement that minimizes risk and offers alternatives. Any lack of agreement must be documented.
Residential care homes provide assistance with personal care, medications, three meals a day and supportive assistance which includes housekeeping, assistance in the preparation of meals, and storage, distribution and assistance with medications.
Medicaid coverage may be considered at a later date.
Assisted living centers
Each center must develop a policy for administering medications that are at least equivalent as those for nursing homes. Unlicensed personnel administering medications must complete a training program approved by the Department.
Residential care homes may provide administer medications and assist with self-administration of medications. Medications must be reviewed monthly by a registered nurse.
Assisted living centers Staffing shall be available based on the needs of residents. Nursing staff shall be provided or arranged supervise skilled interventions, document the resident's physician of choice, and document the resident's living will or DNR order. Centers must have a dietary consultant, pharmacy consultant and nurse consultant if their is no nurse on staff.
Residential care homes must have a minimum of 3/4 hour of personnel per day per resident based on the average daily census.
Assisted living centers Administrators must either hold a state license, a residential care home administrators license from an institution of higher learning approved by the Department or a national recognized assisted living certificate of training and competency reviewed and approved by the Department.
Staff providing socialization, activity and exercise services must be qualified by training. Centers offering specialized units must ensure that staff are trained to meet the specialized needs of residents and all direct care staff must be trained in first aid and CPR.
Residential care homes Administrators must be 21 and obtain a certificate of training which includes 50 hours of which at least 15 cover administration of medications, administration, supervision, reporting, record keeping, independent or daily living skills, leisure skills and recreations and public relations. Administrators shall have 16 hours of job related training annually, not counting first aid and CPR training.
Staff All employees must be currently certified in first aid. All direct care staff must receive eight hours of in-service training within 90 days of employment and eight hours annually. Staff responsible for administering or monitoring medications must receive 8 hours of training annually in: patient reporting and observation; record keeping; independent or daily living skills; leisure skills and recreation; human relations; and such other training that is relevant to residential care program and operations. Direct care staff shall begin eight hours of in-service by the administrator within 90 days of employment. Eight hours of in-service shall be required annually thereafter.
New employee orientation programs must include: policies and procedures on abuse and neglect; resident rights, confidentiality, handling emergencies and job descriptions.
Assisted living All employees are subject to requirements for criminal arrest checks applicable to nurses aides under 63 O.S. Supp. 1997, Section 1-1950.1. Employers must pay a fee of $10 to the Bureau of Investigation for checks. Reports are provided for felonies and misdemeanors for crimes against a person, public indecency or morality, domestic abuse, controlled substances, and crimes against property. Employees may not be hired if they have been convicted of crimes listed in the statute.
Residential care homes Same provisions.
Assisted living centers Each center must have a quality assurance committee that meets at least quarterly to monitor trends, monitor customer satisfaction and document quality assurance efforts and outcomes. The committee must include an RN or physician, the administrator, a direct care staff member or person responsible for administering medications and a pharmacist consultant if a medication problem is to be monitored or investigated. The Department may inspect centers whenever it deems it necessary.
Assisted living centers There is a $2000 application fee for each facility seeking a license.
Residential care homes $50 per application.