No. 31768 (Amendment): R432-270. Assisted Living Facilities

DAR File No.: 31768
Filed: 07/29/2008, 02:58
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Residents of Assisted Living Facilities that become hospice patients will be able to stay in the facility as long as the facility makes arrangements to evacuate them in the event of an emergency.

Summary of the rule or change:

This amendment adds a definition of "Hospice Patient" at Subsection R432-270-3(2)(e) and renumbers subsequent parts of Subsections R432-270-3(2)(f) through (n). It amends Subsections R432-270-10(9)(a) and (c) to define the characteristics of hospice patients who may remain in a Type I facility and the conditions under which they may remain. It imposes a limit of 25% of census on the percentage of residents in a Type I Assisted Living facility that may be hospice patients who cannot exit the building without assistance. In addition, it eliminates the 25% limit on the percentage of the census of an Assisted Living facility Type II who may be hospice patients, and defines the conditions under which hospice patients may be retained in Type II facilities. These changes were requested by the Utah Assisted Living Association, which represents Assisted Living facilities. The Department's statutory Health Facilities Committee held two subcommittee meetings to receive public and industry comment. The subcommittee recommended these changes and the Health Facilities Committee voted on 05/23/2008 to authorize the amendment of this rule with the language contained in the amendment.

State statutory or constitutional authorization for this rule:

Section 26-21-5

Anticipated cost or savings to:

the state budget:

Aggregate cost savings to the state budget will be approximately $280 from staff time no longer spent on reviewing variance requests from Type II facilities with hospice patients in excess of 25% of census.

local governments:

There is no impact on local governments since they 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 unnecessary if this rule is adopted. 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 Type II 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:

No action by a facility or resident is mandated by this rule. Type I Assisted Living facilities and residents will have the option to stay even if the resident is no longer able to independently evacuate the facility. The number of such residents is unknown. Some Type I facilities may already have sufficient trained workers or volunteers to meet the requirement. Those that do not have sufficient workers or volunteers may transfer the resident to a more appropriate facility or train additional staff. The numerous variables make it impossible to estimate an impact on single facilities. Type II facilities will have no new compliance costs because the amendment does not add new requirements for them.

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

This rule change will give residents and facilities the option of not discharging a resident that needs hospice care. The fiscal impact on assisted living facilities should be positive. Impact on nursing homes may be negative, but these facilities are aware of this proposed rule change and have raised no objections to date. Fiscal impact will be evaluated again after the public comment period. 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:

09/15/2008

This rule may become effective on:

09/22/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-270. Assisted Living Facilities.

R432-270-3. Definitions.

(1) The terms used in these rules are defined in R432-1-3.

(2) In addition:

(a) "Assessment" means documentation of each resident's ability or current condition in the following areas:

(i) memory and daily decision making ability;

(ii) ability to communicate effectively with others;

(iii) physical functioning and ability to perform activities of daily living;

(iv) continence;

(v) mood and behavior patterns;

(vi) weight loss;

(vii) medication use and the ability to self-medicate;

(viii) special treatments and procedures;

(ix) disease diagnoses that have a relationship to current activities of daily living status, behavior status, medical treatments, or risk of death;

(x) leisure patterns and interests;

(xi) assistive devices; and

(xii) prosthetics.

(b) "Activities of daily living (ADL)" are the following:

(i) personal grooming, including oral hygiene and denture care;

(ii) dressing;

(iii) bathing;

(iv) toileting and toilet hygiene;

(v) eating during mealtime;

(vi) self administration of medication; and

(vii) independent transferring, ambulation and mobility.

(c) "Dependent" means a person who meets one or all of the following criteria:

(i) requires inpatient hospital or 24-hour continual nursing care that will last longer than 15 calendar days after the day on which the nursing care begins;

(ii) is unable to evacuate from the facility without the physical assistance of two persons.

(d) "Home-like" as used in statute and this rule means a place of residence which creates an atmosphere supportive of the resident's preferred lifestyle. Home-like is also supported by the use of residential building materials and furnishings.

(e) "Hospice patient" means an individual who is admitted to a hospice program or agency.

(f) "Licensed health care professional" means a registered nurse, physician assistant, advanced practice registered nurse, or physician licensed by the Utah Department of Commerce who has education and experience to assess and evaluate the health care needs of the resident.

([f]g) "Self-direct medication administration" means the resident can:

(i) recognize medications offered by color or shape; and

(ii) question differences in the usual routine of medications.

([g]h) "Semi-independent" means a person who is:

(i) physically disabled but able to direct his own care; or

(ii) cognitively impaired or physically disabled but able to evacuate from the facility or to a zone or area of safety with limited physical assistance of one person.

([h]i) "Service Plan" means a written plan of care for services which meets the requirements of R432-270-13.

([i]j) "Services" means activities which help the residents develop skills to increase or maintain their level of psycho-social and physical functioning, or which assist them in activities of daily living.

([j]k) "Significant change" means a major change in a resident's status that is self-limiting or impacts on more than one area of the resident's health status.

([k]l) "Significant assistance" means the resident is unable to perform any part of an ADL and is dependent upon staff or others to accomplish the ADL as defined in R432-270-3(2)(b).

([l]m) "Social care" means:

(i) providing opportunities for social interaction in the facility or in the community; or

(ii) providing services to promote independence or a sense of self-direction.

([m]n) "Unit" means an individual living space, including living and sleeping space, bathroom, and optional kitchen area.

 

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.

(b)] 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 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.]a facility may retain hospice patient residents who are not capable to exit the facility without assistance upon the following conditions:

(i) the facility must assure that a worker or an individual is assigned solely to each specific hospice patient is on-site to assist the resident in emergency evacuation 24 hours a day, seven days a week;

(ii) the facility must train the assigned worker or individual to specifically assist in the emergency evacuation of the assigned hospice patient resident;

(iii) the worker or individual must be physically capable of providing emergency evacuation assistance to the particular hospice patient resident; and

(iv) hospice residents who are not capable to exit the facility without assistance comprise no more than 25 percent of the facility's resident census.

(10) A type II assisted living facility may accept and retain hospice patient 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)] 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