The facility must take all reasonable steps to comply with this requirement, including, but not limited to, obtaining and checking personal and work references and contacting the Division of Licensing and Protection to check if prospective employees are on the abuse registry or have a record of convictions. Facilities must monitor and ensure the delivery of third-party services. Type of Staff. Opening the medication container or medication organizer for the resident. Assisted living residence means a program or facility that combines housing and health and other services to support residents' independence and aging in place. Dementia Staff Training. West Virginia Department of Health and Human Resources Persons eligible for Medicaid because they are receiving SSI have no income other than the federal payment and a state supplement (if any). A residence must have sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled resident needs as required by the residents' assessments and service plans on a 24-hour-per-day basis. The pharmacist must report potential drug therapy irregularities and make recommendations for improving the drug therapy of a resident to the resident's prescriber and the administrator. Florida covers services in ALFs with a standard license and with a specialty license under a statewide 1915(b)(c) MLTC program. The two most commonly mentioned third-party providers are home health agencies (24 states) and hospice agencies (32 states). For these Medicaid beneficiaries, potential loss of SSI is not a consideration. Services include case management; assistance with the performance of activities of daily living (ADLs); medication assistance, monitoring, and administration; 24-hour on-site assistive therapy;124 restorative nursing; nursing assessment; health monitoring; and routine nursing tasks. The Department inspects all licensed facilities every 18 months. The complete regulations are online at the links provided at the end. Procedures for the proper application of physical restraints. Residents who choose not to or cannot self-administer medication must have medication administered by a person who: (1) holds a current license to administer medication; (2) holds a current medication aide permit (this person must function under the direct supervision of a licensed nurse on duty or on call); or (3) is an employee of the facility to whom the administration of medication has been delegated by a registered nurse who has trained them to administer medications or verified their training, according to rules in the state's Nursing Practice Act. The orientation and 5 days of supervised training meets the first year's annual training requirements. The program must be reviewed as the resident's condition requires. SCU and program staff must complete a minimum of 30 hours of training related to the care of residents with Alzheimer's disease or other dementias. Facilities with more than 20 residents must ensure that at least one employee is awake and on duty at all times. Assisted housing programs must list all standard charges and make them available to the public. In such states, consumer protections vary depending on the licensing category. If an ALF serves one or more residents with special needs, all LTC workers must receive training regarding the specialty needs of individual residents in the facility. As discussed in the previous section, any family supplementation is considered part of the excess income that must be spent down. Apartment-style units are not required. A subchapter of the RCH rules includes provisions for facilities that serve three or fewer residents; this profile includes provisions for assisted living centers and RCHs for four or more residents. Medication management including storage, administration, receiving orders, securing medications, interactions, and adverse reactions. Initial training consists of at least 30 hours total covering the following topics: resident care and services; social services; financial management; administration; gerontology; and rules, regulations, and standards relating to the operation of an ALF. At least one awake qualified staff person must be on site 24 hours per day. Assisted living in the United States: A new paradigm for residential care for frail older persons? The rules include extensive provisions regarding assisting with self-administration and administering medications. Community-based residential facilities must provide general services, including supervision, information and referral, leisure time activities, transportation, and health monitoring; resident-specific services, including personal care, activity programming for persons with dementia,133 independent living skills, behavior management, communication skills, and up to 3 hours of nursing care per week (unless hospice is involved); and medication assistance and administration. Type of Staff. The ALF must have a staffing plan that specifies supervisory responsibilities, including the person responsible in the director's absence. Electronic locking devices may be used on exterior doors if they release in an emergency. The primary function of licensed nurses in residential care settings is the provision and oversight of nursing services that are covered by the state's Nurse Practice Acts. There must be a sufficient number of qualified, awake personnel available to provide effective resident care. The state uses several Medicaid 1915(c) Waiver programs (Elderly, Traumatic Brain Injury, Community Alternatives for Disabled Adults, and Community Alternative Care) to pay for one or more of the following three services: AFC, customized living, and 24-hour customized living. Social Security Administration. Level I facilities must meet the staffing ratios specified in regulation. This model offered what nursing homes and traditional board and care facilities generally do not: privacy and the ability to have greater control over daily activities. A primary purpose of regulating residential care settings is to ensure that providers are able to meet the needs of the aged/disabled population they serve. This profile includes summaries of selected regulatory provisions for assisted living centers and RCHs. Facilities must also provide financial management, monitoring, and emergency response, and must make reasonable accommodations for aging in place that may include the provision of supplemental services provided by the resident's family. By the mid-1990s, the popularity of the new assisted living model led many residential care settings to call themselves assisted living even though they did not provide the privacy and autonomy that are the model's key features.g, h Some states now use the term assisted living in a general sense, to apply to preexisting residential care types, including board and care homes and rest homes, whereas other states have added assisted living as a new licensure category. However, the online sources do not yet reflect some changes that have been made to the regulatory provisions--either through rule-making or statutory change. Managers must complete 20 hours of training every 2 years. Prior to admission, the resident or his/her legal representative must be informed of the services and programs available. The services of licensed nursing staff and nurse aides are included in the count of nursing care. Programs may provide assistance with self-administration of medications or may administer medications. Both licensure categories permit residents to contract with home health and hospice services. A definition of the categories of residents to be served. The expectation is that individuals will be permitted to age in place provided that their mobility, ambulation, and transfer needs can be met by one staff person; cognitive impairment is at a moderate or lesser degree of severity; and behavioral symptoms consistently respond to appropriate intervention. Assisted living centers (11+ residents) may provide either residential units or bedrooms that are single-occupancy or double-occupancy. Residents may not be locked inside or outside their rooms. However, it is unclear how facilities comply with this requirement if one double unit is available to two applicants who both want a private unit. services (including service planning and requirements for third-party providers); provisions for apartments and private units; provisions for dementia care (including staffing, staff training, and unit requirements, if any); sources of payment accepted (e.g., Medicaid, Supplemental Security Income [SSI], private insurance); a checklist of services provided (optional and required), and associated fees, if any; the type of staff who administer medications (e.g., licensed nurse, med tech); a checklist of discharge and transfer criteria; services included in the base rate and those that are assessed additional fees; regulatory requirements regarding aging in place; building features (call system, security to prevent wandering); lack of clinical indication for use of medication; the use of a subtherapeutic dose of any medication; failure of the resident to receive an ordered medication; medications administered in excessive dosage, including duplicate therapy; medications administered in excessive duration; be integrated in and support full access to the greater community; be selected by the individual from among setting options; ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint; optimize autonomy and independence in making life choices; and. If 50 or more residents require nursing services and/or medication administration, at least one nursing staff person (a registered nurse, licensed practical nurse, or certified nurse aide) must be on staff at all times. Staff Ratios. No provisions identified. A monthly supplement, in combination with the recipient's regular monthly income, is used to pay for accommodations, supervision, and personal care services in approved community-based living arrangements, including adult foster homes and RCFs. A sufficient number of qualified employees and other adults must be present in each facility to provide for residents' welfare, comfort, and safety at all times of the day and night. Administration does not include reminders, cues, and/or opening of medication containers or assistance with eye drops, such as steadying the resident's hand, when requested by a resident.
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