Chapter 294
2013 -- H 5658 SUBSTITUTE A
Enacted 07/15/13
A N A C T
RELATING TO
HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING ACT
Introduced By: Representatives Cimini, Tanzi, Ferri, Naughton, and Bennett
Date Introduced: February 27, 2013
It is enacted by the
General Assembly as follows:
SECTION 1. Sections 23-17.4-2, 23-17.4-6, 23-17.4-15.8 and 23-17.4-16.2
of the
General Laws in Chapter
23-17.4 entitled "Assisted Living Residence Licensing Act" are hereby
amended to read as follows:
23-17.4-2.
Definitions. -- As used in this chapter:
(1) "Activities of
daily living (ADLs)" means bathing, dressing,
eating, toileting,
mobility and transfer.
(2)
"Administrator" means any person who has responsibility for day to
day
administration or operation of an assisted living residence.
(3) "Alzheimer's
dementia special care unit or program" means a distinct living
environment within an assisted living residence that has been
physically adapted to accommodate
the particular needs and behaviors of those with
dementia. The unit provides increased staffing,
therapeutic activities designed specifically for those with
dementia and trains its staff on an
ongoing basis on the effective management of the physical and
behavioral problems of those with
dementia. The residents of the unit or program have had a
standard medical diagnostic evaluation
and have been determined to have a diagnosis of Alzheimer's
dementia or another dementia.
(4) "Assisted
living residence" means a publicly or privately operated residence that
provides directly or indirectly by means of contracts or
arrangements personal assistance and may
include the delivery of limited health services, as defined
under subdivision 23-17.4-2(12), to
meet the resident's changing needs and preferences,
lodging, and meals to six (6) or more adults
who are unrelated to the licensee or administrator,
excluding however, any privately operated
establishment or facility licensed pursuant to chapter 17 of this
title, and those facilities licensed
by or under the jurisdiction of the department of mental
health, retardation behavioral healthcare
developmental disabilities,
and hospitals, the department of children, youth, and families, or any
other state agency. The department shall develop levels of
licensure for assisted living residences
within this definition as provided in section 23-17.4-6.
Assisted living residences include
sheltered care homes, and board and care residences or any
other entity by any other name
providing the services listed in this subdivision which meet
the definition of assisted living
residences.
(5) "Capable of
self-preservation" means the physical mobility and judgmental ability of
the individual to take appropriate action in emergency
situations. Residents not capable of self-
preservation are limited to facilities that meet more stringent
life safety code requirements as
provided under section 23-17.4-6(b)(3).
(6) "Director"
means the director of the
(7) "Licensing
agency" means the
(8) "Qualified
licensed assisted living staff members" means a certified nursing
assistant
as provided under subdivision 23-17.9-2(a)(3), a
licensed practical nurse as provided under
subdivision 5-34-3(9) and/or a registered nurse as provided under
subdivision 5-34-3(10).
(8)(9)
"Personal assistance" means the provision of one or more of the
following services,
as required by the resident or as reasonably requested
by the resident, on a scheduled or
unscheduled basis, including:
(i)
Assisting the resident with personal needs including activities of daily
living;
(ii) Assisting the
resident with self-administration of medication or administration of
medications by appropriately licensed staff;
(iii) Providing or
assisting the resident in arranging for health and supportive services as
may be reasonably required;
(iv)
Monitoring the activities of the resident while on the premises of the
residence to
ensure his or her health, safety, and well-being; and
(v) Reasonable
recreational, social and personal services.
(9)(10)
"Resident" means an individual not requiring medical or nursing care
as provided
in a health care facility but who as a result of choice
and/or physical or mental limitation requires
personal assistance, lodging and meals and may require the
administration of medication and/or
limited health services. A resident must be capable of self-preservation in emergency
situations,
unless the facility meets a more stringent life safety code
as required under section 23-17.4-
6(b)(3). Persons needing
medical or skilled nursing care, including daily professional observation
and evaluation, as provided in a health care facility,
and/or persons who are bedbound or in need
of the assistance of more than one person for
ambulation, are not appropriate to reside in assisted
living residences. However, an established resident may
receive daily skilled nursing care or
therapy from a licensed health care provider for a condition
that results from a temporary illness
or injury for up to forty-five (45) days subject to an extension
of additional days as approved by
the department, or if the resident is under the care of a
Rhode
provided the assisted living residence assumes responsibility
for ensuring that the required care is
received. Furthermore, a new resident may receive daily
therapy services and/or limited skilled
nursing care services, as defined through rules and
regulations promulgated by the department of
health, from a licensed health care provider for a condition
that results from a temporary illness or
injury for up to forty-five (45) days subject to an
extension of additional days as approved by the
department, or if the resident is under the care of a licensed
hospice agency provided that assisted
living residence assumes responsibility for ensuring that
the care is received. Notwithstanding
the aforementioned, residents who are bed bound or in
need of assistance of more than one staff
person for ambulation may reside in a residence if they are receiving
hospice care in accordance
with the rules and regulations promulgated by the
department of health. For the
purposes of this
chapter, "resident" shall also mean the resident's
agent as designated in writing or legal guardian.
(11) "Supervision"
means the supervision requirements of qualified licensed assisted
living staff delivering limited health services in
accordance with this chapter, as defined through
rules and regulations promulgated by the department of
health.
(12) "Limited health
services" means health services, as ordered by the resident's
physician, provided by qualified licensed assisted living staff
members with supervision as
required in rules and regulations promulgated by the
department of health. Nothing in this
definition shall be construed to limit the right of assisted
living residents to access home nursing
care or hospice provider services.
23-17.4-6.
Issuance of license -- Posting -- Transfer. -- (a) Issuance of license. - Upon
receipt of an application for a license, the licensing agency
shall issue a license if the applicant
and assisted living residence meet the requirements
established under this chapter; the director
shall establish levels of licensure as provided in subsections
(b) and (c) subsection (c) below and
any rules and regulations that may be established
in accordance herewith. A license issued under
this chapter shall be the property of the state and loaned
to the licensee, and it shall be kept posted
in a conspicuous place on the licensed premises. Each
license shall be issued only for the
premises and persons named in the application, and shall not
be transferable or assignable except
with the written approval of the licensing agency.
(b) Fire code and
structural requirements.
(1) A residence with
state fire code deficiencies may be granted a license which may be
renewed subject to the submission of a plan of correction
acceptable to the state division of fire
safety, and provided the nature of the deficiencies are such
that they do not jeopardize the health,
safety, and welfare of the residents.
(2) A residence with
residents who are blind, deaf, and physically disabled shall be
subject to the applicable requirements of the American
National Standards Institute (ANSI
standards)(1961), and any other provisions that may be required
by rules and regulations pursuant
to this chapter.
(3) A residence that
elects to comply with a higher life safety code and is so approved by
the state division of fire safety and meets the
department's requirements for the appropriate level
of licensure may admit residents not capable of self
preservation.
(c) Levels of
licensure. - The department shall establish requirements for a basic license
that apply to all assisted living residences. In addition,
the department shall establish additional
licensing levels of assisted living including, but not limited
to:
(1) "Dementia
care" licensure shall be required when one or more residents have a
physician's diagnosis of dementia or an assessment, as required
by section 23-17.4-15.6,
indicating dementia-related functional impairments, and meet any
of the following:
(i)
Safety concerns due to evidence of elopement or other dementia behaviors;
(ii) Inappropriate
social behaviors that repeatedly infringe upon the rights of others;
(iii) Inability to self
preserve due to dementia;
(iv)
A physician's recommendation that the resident needs dementia support
consistent
with this level; or if the residence advertises or
represents special dementia services or if the
residence segregates residents with dementia.
(2) In addition to the
requirements for the basic license, licensing requirements for the
"dementia care" level
shall include the following:
(i)
Staff training and/or requirements specific to dementia care as determined by
the
department;
(ii) A registered nurse
on staff and available for consultation at all times and at least one
staff person with appropriate training and education as
determined by regulation, on duty at all
times in Alzheimer's dementia special care units;
(iii) The residence
shall provide for a secure environment appropriate for the resident
population.
(3) "Medication
administration" when one or more residents requires medication
administration by appropriately qualified staff as determined by the
department.
(4) "Limited
health services" licensure shall be required if the assisted living
residence
offers to provide limited health services as defined herein.
Conditions and requirements for the
licensing of limited health services shall be determined in
accordance with subdivision 23-17.4-6
(b)(6).
(5) A resident may
continue to receive limited health services in an assisted living
residence so long as the resident, the resident's family, the
resident's physician, and the operator
of the assisted living residence consent to the
resident's continued stay in the assisted living
residence; and provided, that all parties commit to assuring
the resident can safely receive
services.
(6) In addition to
the requirements for the basic license, in accordance with section 23-
17.4-4 and all provisions of this chapter, the
department shall establish licensing requirements for
"limited health
services" levels including, but not limited to, the following factors:
(i)
Resident safety guidelines in accordance with the provisions of this chapter;
(ii) Staff training
and/or requirements specific to the delivery of limited health services;
(iii) Supervision
requirements including appropriate training in accordance with section
23-17.4-15.8;
(iv)
Best practice standards for delivering limited health services;
(v) Quality
assurance in accordance with chapter 23-17.4-10.1;
(vi)
Resident protection and required disclosures in accordance with
section 23-17.4-16.2
and all provisions of this chapter; and
(vii) Protections and
assurances for health information exchange, in accordance with this
chapter and all applicable state and federal laws and
regulations.
(7) Nothing in this
section or chapter shall require an assisted living residence to obtain a
limited health service license.
(c) The director
shall promulgate all necessary rules and regulations in order to fulfill the
purposes of this chapter.
(d) If any provision
of this chapter or its application to any person or circumstances is
held invalid, the invalidity shall not affect other
provisions of applications of this chapter which
can be given effect without the invalid provision or
application, and to this end the provisions of
this chapter are declared to be severable.
23-17.4-15.8.
Staff. – (a) The
administrator shall be responsible for ensuring sufficient
and qualified staff to provide a safe and healthy
environment and to provide the services specified
on each resident's service plan. The department shall
establish requirements for staff
qualifications and training for each level of license.
(b) The
requirements for dementia care units shall include staff training on
dementia care
issues and practices as follows.:
(1) All staff of
dementia-level licensed residences that have direct contact with residents
shall have four (4) hours of initial training on
dementia-care issues and practices and two (2)
hours of continued education annually thereafter.
(2) Training on
dementia care issues and practices provided and documented at any
licensed assisted living residence or nursing facility or by
an entity authorized to provide
continuing education credits may be counted toward meeting these
requirements. At least one
qualified awake and on duty staff person shall be on the
premises at all times.
(c) The requirements
for residences that provide limited health services shall include staff
training on limited health services care issues and practice
as follows:
(1) All staff
delivering direct service with residents for limited health services in
assisted
living residences shall have initial training on delivering
limited health service care and practice
of continued education as determined through rules and
regulations promulgated by the
department of health.
(2) Training on
limited health service issues and practices provided and documented at
any assisted living residence or nursing facility or by
an entity authorized to provide continuing
education credits as determined through rules and regulations
promulgated by the department of
health.
(3) Staff delivering
limited health services shall be supervised in accordance with
subdivision 23-17.4-2(11) and all provisions of this chapter,
with the specialized knowledge,
judgment and skills related to the delivery of limited health
services twenty-four (24) hours a day
seven (7) days a week as determined through rules and
regulations promulgated by the
department of health.
23-17.4-16.2.
Special care unit disclosure by residences. --
Special care unit and
limited health services disclosure by residences. -- (a) Any assisted living
residence which
offers to provide or provides services to residents with
Alzheimer's disease or other dementia by
means of an Alzheimer's special care unit and/or limited
health services shall be required to
disclose the type of services provided, in addition to those
services required by the rules and
regulations for the licensing of assisted living residences. That
disclosure Disclosures shall be
made to the licensing agency and to any person seeking
placement in an Alzheimer's special care
unit of and/or any person receiving limited
health services from an assisted living residence. The
information disclosed shall explain that additional care is provided
in each of the following areas:
(1) Philosophy. - The
Alzheimer's special care unit's unit and/or delivery of limited
health services shall develop a written statement of its overall philosophy and
mission which
reflects the needs of residents afflicted with dementia and/or
needing limited health services.
(2) Pre-occupancy,
occupancy, and termination of residence. - The process and criteria
for occupancy, transfer, or termination of residency from
the unit and/or the termination of
limited health services.
(3) Assessment, service
planning, and implementation. - The process used for
assessment and establishing the plan of service and its
implementation, including the method by
which the plan of service evolves and is responsive to
changes in condition.
(4) Staffing patterns
and training ratios. - Staff training and continuing education
practices.
(5) Physical
environment. - The physical environment and design features appropriate to
support the functioning of cognitively impaired adult
residents.
(6) Resident
activities. - The frequency and types of resident activities.
(7) Family role in
providing support and services. - The involvement in families and
family support programs.
(8) Program costs. -
The cost of care and any additional fees.
(b) The licensing
agency shall develop a standard disclosure form and shall review the
information provided on the disclosure form by the residential
care and assisted living facility to
verify the accuracy of the information reported on it. Any
significant changes in the information
provided by the residential care and assisted living facility
will be reported to the licensing
agency at the time the changes are made.
SECTION 2. This act shall take effect on April 30, 2014.
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LC01387/SUB A/2
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