State Assisted Living Policy: 1998. Oregon

06/01/1998

Citation

Assisted living OAR Division 56: 411-056-0000

Residential care facilities OAR Division 56:411-55-000

General Approach

The state adopted assisted living regulations and policies in 1992 to substitute for nursing home care and offer home-like environments which enhance dignity, independence, individuality, privacy, choice and decision making. Facilities are required to have written policies and procedures which describe how they will operationalize these principles. The regulations were being reviewed in 1998 and changes are expected to be made in the first quarter of 1999.

Residential care facility rules were revised in 1994 and the principles of assisted living were included in the revised rules.

Definition

"Assisted living means a program approach, within a physical structure, which provides or coordinates a range of services, available on a 24-hour-hour basis, for support of resident independence in a residential setting. Assisted living promotes resident self-direction and participation in decisions that emphasize choice, dignity, privacy, individuality, independence and home-like surroundings."

"Residential care facility means a facility that provides care for six or more persons over the age of 18 on a 24-hour basis in one or more buildings on contiguous property."

Unit Requirements

Assisted living Each unit must provide 220 square feet of space, not including a private bathroom. Units in pre-existing structures may provide 180 square feet. Units must have kitchen with a sink, refrigerator, cooking appliance and space for food preparation and storage, individual heat controls, lockable doors and a phone jack. Buildings must meet applicable zoning and building codes. Pre-existing structures must provide 160 square feet excluding the bathroom.

Residential care facility Rooms must be 80 square feet per resident and are limited to two residents. Toilets must be provided for every six residents and a tub/shower for every 10 residents.

Tenant Policy

Assisted living Facilities may care for residents for whom they are able to provide appropriate services. There are no other limitations. The state's "move out" criteria allow residents to choose to remain in their living environment despite functional decline. Facilities may ask residents to leave if the resident's behavior poses an imminent danger to self or others, if the facility cannot meet the resident's needs or services are not available, for non-payment or if the resident has a documented pattern of non-compliance with agreements necessary for assisted living.

RCF Two levels of licensure are available for residential care facilities. A Class I license is needed to serve residents who require only assistance with ADLs. These facilities cannot serve anyone who is non-ambulatory, requires feeding or is dependent in any ADL. Class II facilities provide assistance with ADLs and wish to serve people who are aging in place, have higher medical acuity, or are dependent in one more ADLs.

Services

Assisted living An interdisciplinary team conducts an assessment with each resident and develops a plan that responds to their needs and reflects the principles of dignity, choice, individuality and independence and home-like environment. Services include assistance with ADLs, nursing assessment, health monitoring, routine nursing tasks, medication assistance, housekeeping, three meals a day, laundry, and opportunities for socialization that utilize community resources. Each facility must also have the capability to provide or arrange for medical and social transportation, ancillary services for medically related care, barber/beauty services, social/recreational, hospice, home health care and maintenance of a personal financial account for residents.

RCF
A screening and assessment are required for each resident and a service plan consistent with the assessment must be developed that reflects the principles of dignity, choice, individuality and independence and home-like environment. Services include personal services (assistance with ADLs), laundry, three meals a day, housekeeping, activities and health services. Facilities must assure that needed health services are obtained. Nursing tasks may be delegated.

Financing

Assisted living The state provides five levels of payment for services to Medicaid recipients residing in assisted living settings. Residents must meet the nursing home level of care criteria. A room and board payment of $420.70 is paid in addition to the service rate. The levels are assigned based on a service priority score determined through an assessment (see table below). ADLs include eating/nutrition, dressing/grooming, bathing/personal hygiene, mobility, bowel and bladder control and behavior.

Medications

Assisted living The regulations allow residents to keep medications in their unit if they are capable of self-administration. Facilities are allowed to administer medications and they must have policies and procedures which assure all administered medications are reviewed every 90 days.

RCFs may provide assistance with and administration of medications.

Staffing

Assisted living Each facility must have sufficient staff to deliver the services specified in resident plans of care.

RCF The regulations contain staff ratios for Class I and Class II facilities that vary by time of day and the number of residents.

Training

Assisted living administrators shall have 20 hours of continuing education credits each year. Each administrator shall serve an internship in an established assisted living facility. Facilities must demonstrate their competency concerning the provisions of services and principles of assisted living.

RCF administrators must provide satisfactory evidence regarding education, experience, special training and knowledge. Administrators of Class I facilities must have 12 hours of training providing care in long term care settings. Class II administrators must have two years of successful experience or equivalent education in providing care.

Staff

Assisted living Each facility administrator shall document that staff have received assisted living training as prescribed by the division. The facility administrator shall be accountable for training all facility staff in provision of services and principles of assisted living. The facility staff shall demonstrate competency in the provision of services and the principles of assisted living.

RCF
Direct care staff must complete 6 hours of job related pre-service orientation covering the philosophy of residential care, review of resident's unique needs, use of the service plan, nurse delegation, fire evacuation plans and instruction in universal precaution.

Background Check

Assisted living and RCF owners, administrators and staff must satisfy a criminal records clearance under OAR Chapter 411, Division 9 and sign a criminal record authorization, form SDS 303. A fingerprint check may be required.

Monitoring

Assisted living State or Area Agency on Aging staff conduct periodic monitoring visits. Staff review compliance with state rules and written outcome measures which reflect planned and actual results covering functional abilities, psycho-social well being, stability of medical conditions and client/family satisfaction.

RCFs Facilities are inspected at least every two years.

Fees

A licensing fee of $60 is required.

OREGON SERVICE PRIORITY CATEGORIES AND PAYMENT RATES--ASSISTED LIVING
  Impairment  
Level
Service
Priority
Service R&B Total
Rate
Level V Service priority A or priority B and dependent in the behavior ADL.   $1643.48     $420.70     $2064.18  
Level IV Service priority B or priority C with assistance required in the behavior ADL. $1330.48 $420.70 $1751.18
Level III   Service priority C or priority D with assistance required in the behavior ADL. $1016.48 $420.70 $1437.18
Level II Service priority D or priority E with assistance required in the behavior ADL. $767.48 $420.70 $1188.18
Level I Service priority E or F or priority G with assistance required in the behavior ADL. $579.48 $420.70 $1000.18

 

OREGON SERVICE PRIORITY CATEGORIES AND PAYMENT RATES--RCFs
  Impairment  
Level
Service Priority   Service   R&B Total
Rate
Level V At minimum, dependent in behavior, continence and mobility $772.00   $420.70     $1192.70  
Level IV Dependent in 2 of the 3 critical needs (behavior, continence or mobility) or dependent in 1 or 3 critical needs and have night needs. $636.00 $420.70 $1058.70
Level III   Dependent in 1 ADL. $508.00 $420.70 $928.70
Level II Needs assistance in 2 of the 3 critical needs or assistance in any 3 ADLs. $384.00 $420.70 $794.70
Level I Needs assistance with any 2 ADLs and night needs. $262.00 $420.70 $682.70

 

SERVICE PRIORITY CATEGORIES
  Category   Impairments
A Dependent in 3-6 ADLs
B Dependent in 1-2 ADLs
C Requires assistance in 4-6 ADLs
D Requires assistance in 3 critical ADLs
E Requires assistance in 2 critical ADLs
F Requires assistance in 3 ADLs
G Requires assistance with 1 critical ADL and meets conditions of at least 1 other essential factor or requires assistance with 1 critical ADL and 1 less critical ADL.
NOTE: Critical ADLs are bowel and bladder control, eating/nutrition, behavior/cognition; less critical ADLs are dressing/grooming, bathing/personal hygiene, mobility.

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