Residential care and assisted living facilities R23-17.4 SCF
The state's regulations use the term "residential care and assisted living facilities." Legislation was passed in 1997 authorizing the RI Housing and Mortgage Finance Agency (HMFA), working in collaboration with the Department of Human Services and the Department of Elderly Affairs, to serve up to 200 low and moderate income chronically impaired or disabled adults who are eligible for or at risk of entering a nursing home in facilities certified and financed by the HMFA.
Fifty four facilities are licensed and nine nursing homes have converted to assisted living.
"A publicly or privately operated residence that provides directly or indirectly by means of contracts or arrangements personal assistance, lodging, and meals to two (2) or more adults. ... Residential care and assisted living facilities include sheltered care homes, and board and care residences, or any other entity by any other name providing the above services which meet the definition of residential care and assisted living facility." There are four levels of licensure for residential care and assisted living facilities. A residence may have areas within the facility that are licensed separately. The levels are:
Level F1: licensure for residents who are not capable of self preservation; and/or
Level F2: licensure for residents who are capable of self preservation; or
Level M1: licensure for residents who require that the facility centrally store and administer medications; or
Level M2: licensure for residents who require assistance (as elaborated in section 19.3.1) with self-administration of medications; or a
Combination per area of facility.
The state's Medicaid waiver defines assisted living as "personal care and services, homemaker, chore, attendant care, companion services, medication oversight (to the extent permitted under state law), therapeutic social and recreational programming, provided in a home-like environment in a licensed community care facility. This service includes 24-hour on-site response staff to meet unscheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security."
Resident rooms may have no more than two beds. Single rooms must have at least 100 square feet in area, and double bedrooms must be at least 160 square feet in area. There must be at least one bath per 10 beds and one toilet per eight beds or fraction thereof on each floor where residents' rooms are located and not otherwise serviced by bathing facilities within the resident's room. There must be an area within the resident's bedroom and/or facility to be under lock for the safe keeping of personal possessions.
The Medicaid waiver allows sharing of units only by the consent of the residents
The demonstration legislation defines a unit as "an apartment, condominium, bed or other dwelling quarters in an assisted living facility as defined by this statute."
Residents must be adults, not requiring medical or nursing care as provided in a health care facility, but who may require the administration of medication. A resident must be capable of self-preservation in emergency situations, unless the facility meets a more stringent life safety code; or residents must be reasonably oriented and not require care beyond that permitted by the level of service for which the facility is licensed.
Twenty-four hour adult staffing; personal services; assistance with self-administration of medication or administration of medications by appropriately licensed staff; assistance with arranging for supportive services that may be reasonably required; monitoring health, safety, and well-being; and reasonable recreational, social and personal services. Nurse review is necessary under all levels of medication licensure. A registered nurse must visit the facility at least once every 30 days to monitor the medication regimen for all residents; evaluate the health states of residents; make necessary recommendations to the administrator; follow up on previous recommendations; and provide signed, written reports to the facility documenting the visit.
Facilities offering care in special care units such as Alzheimer's Special Care Units must disclose information to the licensing agency and any person seeking placement in such a unit that explains the additional care that is provided by the unit including information on: the philosophy of care; pre-admission, admission, and discharge process; assessment, care planning and implementation; staffing patterns and training ratios; physical environment; resident activities; family role in care; and program costs.
The demonstration project authorizes personal care, homemaker, chore, attendant care, companion services, medication oversight, therapeutic social and recreational programming, transportation, twenty four hour on site response staff to meet scheduled or unpredictable needs and nursing and skilled therapy services which are incidental to the provision of supportive services.
The Medicaid HCBS waiver covers assisted living and a new pilot program was authorized by the legislature in 1997. The HCBS waiver serves a maximum of 630 people per year of which 30 slots are set aside for beneficiaries leaving nursing homes. Nineteen facilities currently contract with Medicaid and serve 20 beneficiaries. Facilities receive a prospective Medicaid payment based on their customary rate not to exceed $1400 a month, including room and board covered by SSI. Beneficiaries retain $100 a month as a personal needs allowance.
RNs must administer medications and monitor health conditions. Unlicensed staff may only remind residents to take their medications and observe. Staff must have four hours of training by an RN regarding policies and procedures and have passed an exam based on the training.
Facilities must have a responsible adult on the premises at all times, who is in charge of the operation of the facility and who is physically and mentally capable of communication with emergency personnel. All facilities must provide staffing which is sufficient to provide the necessary care and services to attain or maintain the highest practicable physical, mental and psycho-social well being of the resident, according to the appropriate level of licensing.
Administrators must be at least 21 years old and obtain certification as a residential care/assisted living facility administrator or equivalent training. Certification requirements include at least 40 classroom hours of course work covering topics referenced in the regulations. The course work must take place in a college, vocational training, state or national certification program which is approved by the Director of Health. Licensed nursing home administrators are considered certified. Administrators must complete at least 16 hours of continuing education annually.
Staff shall have training as appropriate for maintaining the above conditions within the facility, specifically in the areas of: fire safety procedures; medical emergency procedures; emergencies; resident rights; and first aid.
Orientation and training appropriate for job specifications shall be provided in the areas of: assistance with medications; assistance with personal care; supervision; record keeping; housekeeping/sanitation; food service; and infection control.
The Medicaid waiver requires a minimum 1 hour orientation and 12 hours annual in-service training for staff.
All employees are subject to a nationwide criminal records check through state or local police.
The licensing agency may inspect and investigate facilities as it deems necessary. Representatives of the licensing agency have the right to enter facilities any time without prior notice to inspect the premises and services. Every facility is given notice by the licensing agency of all deficiencies reported as a result of an inspection or investigation.