2013 -- S 0691

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LC01600

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING

ACT

     Introduced By: Senators Miller, Nesselbush, Cool Rumsey, Sheehan, and Goldin

     Date Introduced: March 06, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 23-17.4-2, 27-17.4-3 and 23-17.4-10 of the General Laws in

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Chapter 23-17.4 entitled "Assisted Living Residence Licensing Act" are hereby amended to read

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as follows:

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     23-17.4-2. Definitions. -- As used in this chapter:

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      (1) "Activities of daily living (ADLs)" means bathing, dressing, eating, toileting,

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mobility and transfer.

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      (2) "Administrator" means any person who has responsibility for day to day

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administration or operation of an assisted living residence.

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      (3) "Alzheimer's dementia special care unit or program" means a distinct living

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environment within an assisted living residence that has been physically adapted to accommodate

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the particular needs and behaviors of those with dementia. The unit provides increased staffing,

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therapeutic activities designed specifically for those with dementia and trains its staff on an

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ongoing basis on the effective management of the physical and behavioral problems of those with

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dementia. The residents of the unit or program have had a standard medical diagnostic evaluation

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and have been determined to have a diagnosis of Alzheimer's dementia or another dementia.

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      (4) "Assisted living residence" means a publicly or privately operated residence that

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provides directly or indirectly by means of contracts or arrangements personal assistance to meet

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the resident's changing needs and preferences, lodging, and meals to six (6) or more adults who

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are unrelated to the licensee or administrator, excluding however, any privately operated

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establishment or facility licensed pursuant to chapter 17 of this title, and those facilities licensed

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by or under the jurisdiction of the department of mental health, retardation, and hospitals, the

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department of children, youth, and families, or any other state agency. The department shall

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develop levels of licensure for assisted living residences within this definition as provided in

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section 23-17.4-6. Assisted living residences include sheltered care homes, and board and care

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residences or any other entity by any other name providing the services listed in this subdivision

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which meet the definition of assisted living residences.

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      (5) "Capable of self-preservation" means the physical mobility and judgmental ability of

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the individual to take appropriate action in emergency situations. Residents not capable of self-

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preservation are limited to facilities that meet more stringent life safety code requirements as

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provided under section 23-17.4-6(b)(3).

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      (6) "Director" means the director of the Rhode Island department of health.

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      (7) "Licensing agency" means the Rhode Island department of health.

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      (8) "Personal assistance" means the provision of one or more of the following services,

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as required by the resident or as reasonably requested by the resident, on a scheduled or

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unscheduled basis, including:

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      (i) Assisting the resident with personal needs including activities of daily living;

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      (ii) Assisting the resident with self-administration of medication or administration of

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medications by appropriately licensed staff;

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      (iii) Providing or assisting the resident in arranging for health and supportive services as

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may be reasonably required;

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      (iv) Monitoring the activities of the resident while on the premises of the residence to

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ensure his or her health, safety, and well-being; and

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      (v) Reasonable recreational, social and personal services.

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      (9) "Resident" means an individual not requiring medical or nursing care as provided in

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a health care facility but who as a result of choice and/or physical or mental limitation requires

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personal assistance, lodging and meals and may require the administration of medication. A

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resident must be capable of self-preservation in emergency situations, unless the facility meets a

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more stringent life safety code as required under section 23-17.4-6(b)(3). Persons needing

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medical or skilled nursing care, including daily professional observation and evaluation, as

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provided in a health care facility, and/or persons who are bedbound or in need of the assistance of

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more than one person for ambulation, are not appropriate to reside in assisted living residences.

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However, an established resident may receive daily skilled nursing care or therapy from a

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licensed health care provider for a condition that results from a temporary illness or injury for up

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to forty-five (45) days subject to an extension of additional days as approved by the department,

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or if the resident is under the care of a licensed hospice agency provided the assisted living

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residence assumes responsibility for ensuring that the care is received. Furthermore, a new

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resident may receive daily therapy services and/or limited skilled nursing care services, as defined

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through rules and regulations promulgated by the department of health, from a licensed health

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care provider for a condition that results from a temporary illness or injury for up to forty-five

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(45) days subject to an extension of additional days as approved by the department, or if the

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resident is under the care of a licensed hospice agency provided that assisted living residence

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assumes responsibility for ensuring that the care is received. For the purposes of this chapter,

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"resident" shall also mean the resident's agent as designated in writing or legal guardian.

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     (10) "Department" means Rhode Island department of health.

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     23-17.4-3. Purpose of provisions. -- Assisted living residences offer residential, personal

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care and routine health services to encourage residents' independence, dignity quality of life and

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resident choice in the least restrictive environment that offers appropriate social and safety

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supports. The purpose of this chapter is to provide for the development, establishment, and

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enforcement of standards:

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      (1) For the care of residents in an assisted living residence;

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      (2) For the maintenance and operation of assisted living residences which will:

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      (i) Promote the dignity, individuality, independence, privacy, and autonomy of residents;

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      (ii) Provide a safe and home-like environment;

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      (iii) Protect the safety, health and welfare of residents;

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      (3) For the encouragement of quality of life for all residents; and

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      (4) For the encouragement of quality in all aspects of the operations of assisted living

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residences. ; and

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     (5) To optimize assisted living residents' ability to live in the residence safely,

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independently, and comfortably despite physical or mental decline that might occur with aging or

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disability, otherwise known as "aging in place."

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     23-17.4-10. Regulations, inspections, and investigations. -- (a) The licensing agency

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shall after public hearing pursuant to reasonable notice, adopt, amend, promulgate, and enforce

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any rules, regulations, and standards with respect to assisted living residences for adults licensed

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under this chapter as may be designed to further the accomplishment of the purposes of this

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chapter, as outlined in section 23-17.4-3, in promoting safe and adequate living environments for

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individuals in assisted living residences in the interest of public safety and welfare. These

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regulations may provide for the establishment of levels of service provided by the residence.

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      (b) In addition to the annual inspection required by section 23-17.4-7, the licensing

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agency shall make or cause to be made any inspections and investigations that it deems necessary

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by duly authorized agents of the director at any time and frequency determined by the licensing

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agency. The licensing agency shall establish regulations to determine the frequency of inspections

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that shall include, but not limited to, the residence's past compliance with regulations, complaint

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investigations, quality of care issues and license type.

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      (c) Upon request of the licensing agency, health agencies and professionals may share

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resident health status information with the department of health for the purpose of determining

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each resident's capability of self preservation.

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      (d) Each assisted living residence licensed under this chapter shall have a plan for

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preventing the hazards of resident wandering from the facility. This plan shall be submitted to the

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licensing agency in a format determined by the director.

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     (e) On or before December 31, 2013, the licensing agency shall initiate a comprehensive

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review of its rules and regulations for licensing assisted living residences. The purpose of this

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comprehensive review shall be to ensure that said rules and regulations optimally reflect the

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purposes of this chapter and do not erect unnecessary barriers to aging in place. Further, the

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department shall ensure that its rules and regulations not prevent qualified, appropriately licensed

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ALR staff members from performing routine, non-skilled nursing tasks.

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     SECTION 2. This act shall take effect upon passage.

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LC01600

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING

ACT

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     This act would direct the department of health to complete a comprehensive review of its

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rules and regulations for licensing assisted living residences.

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     This act would take effect upon passage.

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LC01600

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