Assisted living Chapter 4
In 1992, the Director of the Department of Health formed a task force to determine how board and care homes can be established as low cost options in the continuum of care for the elderly. The task force reviewed who qualifies, current and future needs, existing and potential resources and cost reimbursement options. The task force included state agencies including the housing agency, ombudsman, consumer advocacy (AARP), home health agencies, not-for-profit nursing homes, board and care homes, and domiciliary care homes. The group's report was issued in October, 1992. In 1993, the legislature passed a definition of assisted living that allowed limited nursing care to be provided. Regulations were effective in October 1994 that re-name and modify the board and care licensure category. Board and care facilities can also be licensed as an assisted living facility in order to provide limited skilled nursing services and medication administration.
Assisted living means "a dwelling or rooming house operated by any person, firm or corporation engaged in providing limited nursing care, personal care and boarding home care, but not habilitative care, for persons not related to the owner of the facility."
Boarding home care means "a dwelling or rooming house operated by any person, firm or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative or nursing care, or personal not related to the owner."
Rooms must provide 120 square feet for single occupancy and 80 square per person for double occupancy. No more than two people may share a bedroom. Bedrooms include toilets and sinks. One tub and shower room is required for every 10 residents.
The regulations allow residents who need limited nursing to be served. Previously, residents needing skilled nursing had to transfer to a nursing facility. However, residents who need continuous assistance with transfer and mobility, are unable to feed themselves, need total assistance with bathing and dressing, require catheter care, continuous oxygen and monitoring, have significant physical deterioration requiring more than seven days bed rest, wander excessively, need wound care requiring sterile dressings, stage II skin care and beyond, exhibit inappropriate social behavior and demonstrate chemical abuse that puts residents at risk may not be served.
The facility must describe the services provided and the charges for services. Facilities must provide meals, housekeeping, personal and other laundry services, assistance with transportation, assistance obtaining medical, dental and optometric care and social services, partial assistance with personal care, limited assistance with dressing, minor non-sterile dressing changes, stage I skin care, infrequent assistance with mobility, cuing for ADLs with visually impaired residents and intermittently confused and/or agitated residents requiring occasional reminders to time, place and person, care for residents who care for their own catheter/ostomy without assistance, care for residents who are incontinent but care for themselves, RN assessments and medication review, and 24-hour supervision.
Services that may not be provided in assisted living include continuous assistance with transfer and mobility, care for residents who cannot feed themselves independently, total assistance with bathing or dressing, provision of catheter or ostomy care, care of residents who are on continuous oxygen if monitoring is required, residents whose medical condition requires more than 7 days bedrest, residents who wander, need stage II skin care and beyond, wound care and incontinence care.
The regulations allow assistance with self-administration which includes but is not limited to reminders, removing from containers, assistance with removing caps, and observing the resident take the medication.
The task force report recommended that the Wyoming Department of Commerce be authorized to make loans to finance the development, remodeling and construction of board and care and/or assisted living facilities in underserved communities. No subsidies are available for low income residents.
Staff shall be sufficient to meet the needs of residents. An RN, LPN or CNA must be on every shift. At least one awake staff is required for all facilities serving 10 more residents.
Administrators Managers shall be a certified nursing assistant or the equivalent, or otherwise be capable of making informed decisions regarding quality of care.
Staff Management shall provide to new employees an orientation, education regarding resident rights, evacuation and emergency procedures and training and competent supervision designed to improve resident care. All facilities must have an active quality assurance program to ensure effective utilization and delivery of resident care services.
Facilities are surveyed no less than annually.