Assisted living facilities R432-270
The state's regulations were effective July 1995 and establish assisted living as a place of residence where elderly and disabled persons can receive 24-hour individualized personal and health related services to help maintain maximum independence, choice, dignity, privacy and individuality in a home-like environment. The rules provide for three levels of license: large facilities, 17 or more residents; small facilities, 6-16 residents; and limited capacity facilities, up to five residents.
In 1998 there were 8 licensed facilities and 260 units. One nursing home has converted to assisted living. There were also 109 licensed residential health care facilities with 1,956 beds. Five nursing homes with 173 beds converted to this level of licensure.
Assisted living HB 201, which was passed during the 1994 legislative session, defines assisted living as "a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services, available 24-hours per day, to residents who have been assessed under division rule to need any of these services. Each resident shall have a service plan based on the assessment, which may include: specified services of intermittent nursing care, administration of medication, and supportive services promoting residents' independence and self-sufficiency."
Residential health care facility means a facility providing assistance with activities of daily living and social care to two or more residents who require protected living arrangements.
A residential living unit means a one or two bedroom unit which may also include a bathroom and additional living space. A maximum of two residents may occupy a resident living unit and only by the consent of the residents. Additional living space means a living room, dining space and kitchen facilities, or a combination of these facilities, in a resident living unit. Units must have lockable doors and tenants must have a key.
Facilities providing only bedrooms must provide a toilet and lavatory for every four residents and a bathtub or shower for every 10 residents. Occupancy units without additional living space must be a minimum of 120 square feet for single occupancy units and 200 square feet for double occupancy units. Bedrooms in units that do provide additional living space must be at least 100 square feet for single units and 160 square feet for double units.
Facilities may not serve anyone who requires inpatient hospital care or 24-hour continual nursing care that will last more than 15 calendar days or people who cannot evacuate without the physical assistance of one person. Written acceptance, retention and transfer policies are required of each facility. Facilities may not accept anyone who is suicidal, assaultive or a danger to self or others, has active tuberculosis or other communicable disease that cannot be adequately treated at the facility or on an outpatient basis or may be transmitted to other residents through general daily living.
A physician's statement is required that documents the resident's ability to function in the facility and describes the following information: whether the resident's health condition is stable, free from communicable disease, allergies, diets, current prescribed medications with dose, route, time of administration and assistance required, physical or mental limitations and activity restrictions.
The rules allow pets to be kept if permitted by local ordinances.
Facilities must provide personal care, food service, housekeeping, laundry, maintenance, activity programs, medication administration and assistance with self-administration and arrange for necessary medical and dental care.
The state had anticipated amending its HCBS waiver to add assisted living as a covered service, however, officials have had difficulty developing rates that current licensed providers would accept. Further work is being done. In addition, a task force developing a capitated long term care demonstration program plans to include assisted living as a service covered by the capitation payment.
Facilities are allowed to provide medication administration by licensed staff and assistance with self-medication by unlicensed staff (opening containers, reading instructions, checking dosage against the label, reassuring the resident that the correct dosage was taken and reminding residents that a prescription needs to be refilled.
Direct care staff are required on-site 24-hours a day to meet resident needs as determined by assessments and service plans. Staff providing personal care must be CNAs or complete a CNA training program within four months.
Administrators must complete a national certification program and meet one of the following criteria: experience, licensing or college degree.
Staff Orientation shall include job descriptions; ethics, confidentiality, and resident rights; fire and disaster plan; policy and procedures; and reporting responsibility for abuse, neglect and exploitation. In-service shall be tailored to include all the following subjects that are relevant to the person's job:
Principles of good nutrition, menu planning, food preparation and storage;
Principles of good housekeeping and sanitation;
Principles of providing personal care and social care;
Proper procedures in assisting residents with medications;
Recognizing early signs of illness and determining when there is a need for professional help;
Accident prevention, including safe bath and shower water temperatures; and
Communication skills which enhance resident dignity.
Administrators must be of good moral character with no felony convictions.
Board and Care
Residential health care facilities are not allowed to provide nursing services and therapies although residents may contract on their own with a community home health agency to receive these services. RHC residents must be ambulatory and able to evacuate in an emergency. Assisted living residents may be semi-independent or require assistance from one person to transfer or ambulate.