3 ANÁLISIS COMPARADO DE LAS INICIATIVAS DE CIUDADANÍA
3.3 Perfiles migratorios
Agency Department of Health, Bureau of Health Facilities Licensure and Certification
Phone (601) 364-1110
Contact Marilynn Winborne Phone (601) 364-1110
Licensure Term Personal Care Homes Residential Living and Personal Care Homes Assisted Living
Definition Personal care homes are licensed facilities that provide
assistance to residents in performing one or more of the activities of daily living (ADLs), including, but not limited to, bathing, walking, excretory functions, feeding, personal grooming, and dressing.
Personal care homes/residential living provide services to individuals who require personal care services or individuals, who due to functional impairments, may require mental health services.
Personal care homes/assisted living provide personal care and the addition of supplemental services to include the provision of medical services (i.e., medication procedures and medication administration), and emergency response services.
Opening Statement Legislation enacted in 2010 authorized the state Department of Health to revoke the license and require closure of any
institution for the aged or infirm, including personal care homes and assisted living communities, to protect the health and safety of the residents of such institutions or the general public. The legislation also authorizes the department to apply any other remedy less than closure for this purpose.
Facility Scope of Care Facilities may provide assistance with ADLs that may extend beyond providing shelter, food, and laundry. Assistance may include, but is not limited to, bathing, walking, toileting, feeding, personal grooming, dressing, and financial management.
Third Party Scope of Care
Limited home health services may be provided in facilities.
Move-In/Move-Out Requirements
Personal care homes/assisted living facilities may only admit residents whose needs can be met by the facility. An appropriate resident is primarily an aged ambulatory person who requires domiciliary care and who may require non-medical services, medical services such as medication assistance, emergency response services, and home health services as prescribed by a physician's order and as allowed by law.
Disclosure Items There is no required form but admission agreements must contain specific information.
Physical Plant Requirements
Private and shared resident units must provide a minimum of 80 square feet per resident.
Residents Allowed Per Room
A maximum of four residents is allowed per resident unit.
Bathroom Requirements Separate toilet and bathing facilities must be provided on each floor for each sex in the following ratios as a minimum: one bathtub/shower for every 12 or fewer residents; and one lavatory and one toilet for every six or fewer residents.
Medication Management Facilities may monitor the self-administration of medication. Only licensed personnel are allowed to administer medication. For both personal care residential and personal care assisted living, a person may neither move in nor continue to reside in a licensed facility if the person:
(1) Is not ambulatory;
(2) Requires physical restraints;
(3) Poses a serious threat to self or others;
(4) Requires nasopharyngeal and/or tracheotomy suctioning; (5) Requires gastric feedings;
(6) Requires intravenous fluids, medications, or feedings; (7) Requires an indwelling urinary catheter;
(8) Requires sterile wound care; or
(9) Requires treatment of decubitus ulcer or exfoliative dermatitis.
A resident may continue to live in a personal care home when a resident or the resident's responsible party (if applicable) consents in writing for the resident to continue to reside in the home and approved in writing by a licensed physician, unless the licensing agency determines that skilled nursing services would be appropriate. No home may allow more than two residents, or 10 percent of the total number of residents, whichever is greater, to remain under these circumstances.
Resident Assessment A medical evaluation is required annually for each resident but there is no required form.
Life Safety Automatic Fire Sprinklers: All new personal care homes must be protected with automatic fire sprinklers. If the facility has a capacity of 16 or fewer beds, a 13D-styled automatic sprinkler system compliant with the National Fire Protection Association (NFPA) Standard 13D, "Standard for the Protection of One- and Two-Family Dwellings and Manufactured Homes," is sufficient. For facilities with capacity greater than 16 beds, a sprinkler consistent with NFPA 13 is required.
Smoke Detectors: Smoke detectors must be installed in each hallway no more than 30 feet apart, in all bedrooms, and in all storage rooms. Smoke detectors must be electrically powered by the building’s electrical system and have battery back-up.
Alzheimer's Unit Requirements
Regulations for Alzheimer's disease/dementia care units were adopted in 2001 and apply to licensed nursing homes or licensed personal care homes and are in addition to other rules and regulations applicable to these licensed facilities. A registered nurse or licensed practical nurse must be present on all shifts and a minimum of two staff members must be on the unit at all times. Minimum requirements for nursing staff are based on the ratio of three hours of nursing care per resident per 24 hours. Licensed nursing staff and nurse aides can be included in the ratio. If the Alzheimer's/dementia care unit is not freestanding, licensed nursing staff may be shared with the rest of the facility. Facilities are only permitted to house persons with up to stage II Alzheimer's disease. A licensed social worker, licensed
professional counselor, or licensed marriage and family therapist must provide social services to residents and support to family members. The social service consultation must be on site and be a minimum of eight hours per month.
There are specific physical design standards for
Alzheimer's/dementia units including security controls on all entrances and exits, and a secure, exterior exercise pathway.
Staffing Requirements A full-time operator must be designated to manage the facility. Detailed staffing ratios apply.
Administrator Education/Training
Operators must be at least 21 years of age, be a high school graduate or have passed the GED and not be a resident of the licensed facility. The administrator must verify that he or she is not listed on the Mississippi Nurses Aide Abuse Registry.
Administrators must spend two concurrent days with the licensing agency for training and mentoring. This training and monitoring provision is required only one time for each
administrator and an administrator who was previously employed by the licensing agency in a surveyor capacity is exempt.
Staff Education/Training Direct care staff must be at least 18 years of age and must verify that they are not listed on the Mississippi Nurse Aide Abuse Registry. Personnel must receive training on a quarterly basis on topics and issues related to the population being served by the
Staff Training for Alzheimer's Care
An orientation program including specific topics must be provided to all new employees assigned to the
Alzheimer's/dementia unit. Ongoing in-service training must be provided to all staff who are in direct contact with residents on a quarterly basis and must include training on at least three of eight specific topics.
Building Construction: Facilities licensed after Aug. 14, 2005 must be constructed to have a one-hour fire resistance rating as prescribed by the current edition of the NFPA Standard 220, “Types of Building Construction.”
Continuing Education (CE) Requirements None specified. Entity Approving CE Program None specified.
facility. All direct care staff must successfully complete a criminal history record check. When on duty, staff must be awake and fully dressed to provide personal care to the residents. The following staffing ratio applies:
(1) One direct care staff person per 15 or fewer residents between 7:00 a.m. and 7:00 p.m.
(2) One direct care staff person per 25 or fewer residents between the hours of 7:00 p.m. and 7:00 a.m.
Additionally, personal care homes assisted living must:
(1) Post a list of on-call personnel in the event of an emergency during the 7:00 p.m. to 7:00 a.m. shift.
(2) Have a licensed nurse on the premises for eight hours per day. Licensed nurses are not to be included in the resident- attendant ratio.
(3) If a resident is unable to self-administer prescription
medication, a licensed nurse must be present to administer the medication.
Medicaid Policy and Reimbursement
A Medicaid home and community-based services waiver with a limited number of slots covers services in assisted living facilities for residents that are Medicaid eligible. Facilities are reimbursed on a flat rate, per diem basis.
Missouri
Agency Department of Health and Senior Services, Division of Regulation and Licensure, Section for Long Term Care Regulation
Phone (573) 526-8524
Contact Matt Younger Phone (573) 526-8524
Licensure Term Assisted Living Facilities and Residential Care Facilities
Definition An assisted living facility (ALF) is any premises, other than a residential care facility, intermediate care facility, or skilled nursing facility, that is utilized by its owner, operator, or manager to provide 24-hour care and services and protective oversight to three or more residents who are provided with shelter, board, and who may need and are provided with the following:
-- Assistance with any activities of daily living (ADLs) and any instrumental activities of daily living (IADLs).
-- Storage, distribution, or administration of medications. -- Supervision of health care under the direction of a licensed physician provided that such services are consistent with a social model of care.
ALFs do not include facilities where all of the residents are related within the fourth degree of consanguinity or affinity to the owner, operator, or manager of the facility.
A residential care facility (RCF) is any premises, other than an ALF, intermediate care facility, or skilled nursing facility, which is utilized by its owner, operator, or manager to provide 24-hour care to three or more residents, who are not related within the fourth degree of consanguinity or affinity to the owner, operator, or manager of the facility and who need or are provided with shelter, board, and protective oversight, which may include storage and distribution or administration of medications and care during short-term illness or recuperation.
Opening Statement The regulations were amended on October 30, 2008 and December 4, 2008.
Disclosure Items For both ALFs and RCFs, at the time of admission the facility is required to disclose information regarding the services the facility is able to provide or coordinate and the cost of services. Also, the facility is required to provide statements of resident rights, a copy of any facility policies that relate to resident conduct and responsibilities, and information concerning
community-based services available in the state. Facilities that provide care to residents with Alzheimer’s disease or other dementias by means of an Alzheimer’s special care unit or
Facility Scope of Care ALFs must provide 24-hour care and protective oversight including but not limited to: assistance with ADLs and IADLs, medication management, dietary services, activities, and food sanitation.
RCFs must provide 24-hour care, shelter, board, and protective oversight including but not limited to: assistance with storage, distribution, and/or administration of medications; dietary services; food sanitation, etc. The facility can provide care to residents during a short-term illness or recuperation period.
Third Party Scope of Care
Facilities may obtain services from third party providers that are necessary to meet residents’ needs. Each resident shall be
allowed the option of purchasing or renting goods or services not included in the per diem or monthly rate from a supplier of his or her own choice, provided the quality of goods or services meets the reasonable standards of the facility.
Move-In/Move-Out Requirements
For ALFs, the following conditions would prevent admission into a facility:
-- Exhibiting behaviors that present a reasonable likelihood of serious harm to self and/or others.
-- Requiring a restraint (physical or chemical). -- Requiring skilled nursing care.
-- Requiring more than one person to provide physical assistance (excluding bathing and transferring).
-- Being bed-bound.
-- Being under 16 years of age.
Residents on hospice who require skilled nursing care, require more than one person to provide physical assistance, or are bed- bound may be admitted or continue to reside in the facility provided the resident, his or her legally authorized
representative or designee, or both, and the facility, physician, and licensed hospice provider all agree that such program of care is appropriate for the resident. Residents experiencing short periods of incapacity due to illness or injury or recuperation from surgery may be allowed to remain or be readmitted from a
hospital if the period of incapacity does not exceed 45 days and written approval of a physician is obtained.
The following conditions would permit a transfer/discharge from an ALF:
-- The resident’s needs cannot be met in the facility.
-- The resident no longer needs the services provided by the facility.
-- The health and/or safety of other residents in the facility is program are required to disclose the form of care or treatment. ALFs are additionally required to disclose grounds for
endangered.
-- After appropriate notice and reasonable efforts by the facility, the resident has not paid for his/her stay.
-- The facility ceases to operate.
Before an ALF can transfer/discharge a resident it is required to give the resident a 30-day notice. If the health and/or safety of the resident and other residents in the facility are endangered, the resident may qualify for an emergency transfer/discharge. Facilities are required to record and document in detail the reason for a 30-day and/or emergency transfer /discharge. For RCFs, the facility shall not admit residents whose needs cannot be met or those under 16 years of age.
The following conditions would permit a transfer/discharge from an RCF:
-- The resident’s needs cannot be met in the facility.
-- The resident no longer needs the services provided by the facility.
-- The health and/or safety of other residents in the facility is endangered.
-- After appropriate notice and reasonable efforts the resident has not paid for his/her stay.
-- The facility ceases to operate.
Residents suffering from short periods of incapacity due to illness, injury, or recuperation from surgery may be allowed to remain or be readmitted from a hospital if the period of
incapacity does not exceed 45 days and written approval of a physician is obtained.
Before RCFs can transfer/discharge a resident they are required to give the resident a 30-day notice. If the health and/or safety of the resident and other residents in the facility are endangered, the resident may qualify for an emergency transfer/discharge. Facilities are required to record and document in detail the reason for a 30-day and/or emergency transfer/discharge.
Resident Assessment For ALFs, prior to admission the facility must complete a pre- move-in screening. Within five calendar days after admission an appropriately trained and qualified individual will conduct a community-based assessment. Also, within ten days after admission the resident must have an admission physical
examination. The examination must be performed by a licensed physician with documentation of the resident’s current medical status and any special orders or procedures that should be followed. The community-based assessment shall be reviewed whenever there is a significant change in the resident’s condition and/or at least semiannually.
Physical Plant Requirements
For both ALFs and RCFs, resident units must provide a minimum of 70 square feet per resident.
Residents Allowed Per Room
For both ALFs and RCFs, the maximum number of beds/residents allowed is four per unit.
Bathroom Requirements For both ALFs and RCFs, at least one tub or shower must be provided for every 20 residents and one toilet and lavatory for every six residents.
Medication Management For ALFs, a physician, pharmacist, or registered nurse must review the medication regimen of each resident every other month. At a minimum, staff who administer medications must be a Level I Medication Aide (LIMA). Facilities are required to have a safe and effective system of medication control and use. In a level one RCF, a pharmacist or registered nurse (RN) must review the medication regimen of each resident every three months. In a level two RCF, a pharmacist or RN must review the medication regimen of each resident every other month. At a minimum, staff who administer medications must be a LIMA. Facilities are required to have a safe and effective system of medication control and use.
For RCFs, residents admitted to the facility shall have an admission physical examination no later than ten days after admission. The examination must be performed by a licensed physician with documentation of the resident’s current medical status and any special orders or procedures that should be followed. The facility must perform a monthly resident review of the following:
-- The resident’s general medical condition and needs.
-- Review of medication consumption of any resident controlling his/her own medication.
-- Daily record of medication administration. -- Logging of medication regimen review process. -- Monthly weight.
-- Record of each referral for services from an outside service provider.
-- Record of any resident incidents including behaviors that present a reasonable likelihood of serious harm to himself or herself or others.
-- Record of accidents that potentially could result in injury or did result in injuries involving the resident.
Life Safety ALFs and RCFs with more than 20 residents that do not have an approved sprinkler system, and single-story and multi-level ALFs that accept or retain any individual with a physical,
cognitive, or other impairment that prevents the individual from safely evacuating the facility with minimal assistance, will be required to have an approved sprinkler system by December 31, 2012. Facilities that have an approved sprinkler system shall continue to meet all laws, rules, and regulations for testing, inspection, and maintenance of the sprinkler system. All ALFs
Alzheimer's Unit Requirements
Any facility with an Alzheimer's special care unit is required to provide a document with information on selecting an Alzheimer's special care unit to any person seeking information about or placement in such a unit.
For both ALFs and RCFs, during the admission disclosure, a facility must explain how care in the Alzheimer’s special care unit or program is different from the rest of the facility and if the services are appropriate. The disclosure must include the
following:
-- A written statement of its overall philosophy and mission reflecting the needs of residents afflicted with dementia; -- The process and criteria for placement in, and transfer or discharge from, the unit or program;
-- The process used for assessment and establishment of the plan