No. 30946 (Amendment): R432-270-10. Admissions

DAR File No.: 30946
Filed: 02/01/2008, 02:15
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of the amendment is to allow more hospice residents to live in Assisted Living Facilities and to establish specific requirements for hospice residents in Type I assisted living facilities.

Summary of the rule or change:

This change will allow more than 25% of the residents of a Type II Assisted Living Facility to receive hospice services, and eliminates the need to request rule variances for each resident in excess of 25% of the census. It establishes specific worker to hospice resident ratio requirements in Type I Assisted Living Facilities.

State statutory or constitutional authorization for this rule:

Section 26-21-5

Anticipated cost or savings to:

the state budget:

Aggregate cost saving to the state budget will be approximately $280.

local governments:

No impact, since local governments do not operate assisted living facilities and are not involved in the enforcement of the rule.

small businesses and persons other than businesses:

In state fiscal year 2007, small businesses made a total of 28 hospice census variance requests. These variance requests are eliminated by this rule. Facilities which are small businesses will save an aggregate total of approximately $350. No "persons other than small businesses" are impacted as only business entities are licensed as Assisted Living Facilities. Residents in assisted living facilities may save money because they can stay in an assisted living facility instead of moving to a nursing home; however, the number of these residents is impossible to calculate.

Compliance costs for affected persons:

There will be no compliance costs because the rule adopts the same requirements as were made on most prior variances. It is difficult to estimate how many Type I assisted living facilities may choose to retain a hospice resident who is no longer able to independently evacuate the facility. Some Type I facilities may already have sufficient workers to meet the requirement. Those that do not have sufficient workers will likely transfer the resident to a more appropriate facility. The numerous variables make it impossible to estimate an impact on single facilities.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule adopts the standards that had governed a variance process in the past. Business will no longer need to apply for a variance, thus a small savings may accrue to those facilities. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Systems Improvement, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Angela Anderson or Allan Elkins at the above address, by phone at 801-538-6450 or 801-538-6595, by FAX at 801-538-6163 or 801-538-6163, or by Internet E-mail at [e-mail] or [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/17/2008

This rule may become effective on:

03/24/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-270. Assisted Living Facilities.

R432-270-10. Admissions.

(1) The facility shall have written admission, retention, and transfer policies that are available to the public upon request.

(2) Before accepting a resident, the facility must obtain sufficient information about the person's ability to function in the facility through the following:

(a) an interview with the resident and the resident's responsible person; and

(b) the completion of the resident assessment.

(3) If the Department determines during inspection or interview that the facility knowingly and willfully admits or retains residents who do not meet license criteria, then the Department may, for a time period specified, require that resident assessments be conducted by an individual who is independent from the facility.

(4) The facility shall accept and retain only residents who meet the following criteria:

(a) Residents admitted to a Type I facility shall meet the following criteria before being admitted:

(i) be ambulatory or mobile and be capable of taking life saving action in an emergency;

(ii) have stable health;

(iii) require no assistance or only limited assistance in the activities of daily living; and

(iv) require and receive intermittent care or treatment in the facility from a licensed health care professional either through contract or by the facility, if permitted by facility policy.

(b) Residents admitted to a Type II facility may be independent and semi-independent, but shall not be dependent.

(5) Type I and Type II assisted living facilities shall not admit or retain a person who:

(a) manifests behavior that is suicidal, sexually or socially inappropriate, assaultive, or poses a danger to self or others; or

(b) has active tuberculosis or other chronic communicable diseases that cannot be treated in the facility or on an outpatient basis; or may be transmitted to other residents or guests through the normal course of activities; or

(c) requires inpatient hospital or long-term nursing care.

(6) A Type I facility may accept or retain residents who:

(a) do not require significant assistance during night sleeping hours;

(b) are able to take life saving action in an emergency without the assistance of another person; and

(c) do not require significant assistance from staff or others with more than two ADL's.

(7) A Type II facility may accept or retain residents who require significant assistance from staff or others in more than two ADL's, provided the staffing level and coordinated supportive health and social services meet the needs of the resident.

(8) The prospective resident or the prospective resident's responsible person must sign a written admission agreement prior to admission. The admission agreement shall be kept on file by the facility and shall specify at least the following:

(a) room and board charges and charges for basic and optional services;

(b) provision for a 30-day notice prior to any change in established charges;

(c) admission, retention, transfer, discharge, and eviction policies;

(d) conditions under which the agreement may be terminated;

(e) the name of the responsible party;

(f) notice that the Department has the authority to examine resident records to determine compliance with licensing requirements; and

(g) refund provisions that address the following:

(i) thirty-day notices for transfer or discharge given by the facility or by the resident,

(ii) emergency transfers or discharges,

(iii) transfers or discharges without notice, and

(iv) the death of a resident.

(9) A type I assisted living facility may accept and retain residents who have been admitted to a hospice program, under the following conditions:

(a) [hospice residents comprise no more than 25 percent of the facility's resident census.]residents on hospice services must meet retention criteria for a type I assisted living residence;

(b) the facility keeps a copy of the physician's diagnosis and orders for care;

(c) the facility makes the hospice services part of the resident's service plan which shall explain who is responsible to meet the resident's needs; and

[(d) if a resident is admitted to a hospice program and is no longer capable of exiting the facility without assistance and the facility wants to retain the resident in the facility, the facility must:

(i) submit a Request for Agency Action Variance Application to the Department; and

(ii) ensure that the an individual capable of assisting the resident to exit the facility in an emergency is with the resident 24 hours a day, seven days a week.](d) if a hospice resident is no longer capable to exit the facility without assistance, the facility may retain resident on the following conditions:

(i) the facility must assign a worker solely to the resident;

(ii) the worker must be capable to assist the resident to exit the building in an emergency;

(iii) an assigned worker must be available on site to the resident 24 hours a day, seven days a week; and

(iv) all such hospice residents comprise no more than 25 percent of the facility's resident census.

(10) A type II assisted living facility may accept and retain residents who have been admitted to a hospice program, under the following conditions:[

(a) hospice residents comprise no more than 25 percent of the facility's resident census.]

[(b)](a) the facility keeps a copy of the physician's diagnosis and orders for care;

[(c)](b) the facility makes the hospice services part of the resident's service plan which shall explain who is responsible to meet the resident's needs; and

[(d)](c) if a resident becomes dependent while on hospice care and the facility wants to retain the resident in the facility, the facility must:

(i) develop an emergency plan to evacuate the hospice resident in the event of an emergency; and

(ii) integrate the emergency plan into the resident's service plan.

 

KEY: health facilities

Date of Enactment or Last Substantive Amendment: [May 10, 2005]2008

Notice of Continuation: January 31, 2005

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-1