Adult Care Home Regulation Presentation Overview (Doug Barrick, Policy Coordinator, Adult Care Licensure Section)

• • • • • • • • •

Assisted Living Description of Facilities Rules Resident Admission and Assessment Types and Numbers of Homes and Licenses Licensing Staff Regulatory Oversight Funding

Assisted Living • Defined in G.S. 13D-2.1 • Primary laws related to Adult Care Homes are in G.S. 131D • Resident Rights – G.S. 131D-21 • Adult Care Homes - licensed • Multiunit Assisted Housing with Services (MAHS) - registration and disclosure required

Description of Facilities (based on G.S. 131D-2 and 10A NCAC 13F/13G .0701)

• Adult care homes provide room, board and care for two or more adults (18 and older) who, because of temporary or chronic physical condition or mental disability, need a substitute home and the availability of 24-hour scheduled and unscheduled personal care services to include: – ADL assistance such as dressing, bathing, toileting, eating, ambulation, medication assistance or administration – supervision – monitoring or assistance with more healthcare related needs

Rules • Family Care Homes: 10A NCAC 13G • Adult Care Homes: 10A NCAC 13F • Medical Care Commission adopts, amends, repeals rules • It normally takes 9-12 months or longer for a new or amended rule to become effective.

Residents Not to be Admitted • G.S. 131D-2.2 – ventilator dependent – continuous licensed nursing care – physician certification that placement not appropriate – health needs cannot be met as determined by residence – needs as the Medical Care Commission determines cannot be met

• Rule 10A NCAC 13F/G .0701 – treatment of mental illness, alcohol or drug abuse – maternity care – lodging with no need for personal assistance or supervision – direct threat to health or safety of others

Types of Adult Care Homes (as established in G.S. 131D-2.1) • Family Care Homes (FCH) – 2-6 beds – Residential setting • Adult Care Homes of 7+ Beds (ACH) – Institutional building code – Certificate of Need (CON)

License Designations • Family Care Home (FCL) • Family Care Home that Services Only the Elderly • Adult Care Home (HAL) • Adult Care Home that Services Only the Elderly • Adult Care Home with Special Care Unit for Residents Alzheimer’s Disease or Related Disorders • Adult Care Home with Special Care Unit for Residents with Mental Health Disorders

Number of Licensed Facilities (as of December ’09) Facilities

Beds

631

3533

(55+ only)

(66)

(373)

ACH

627

36,564

(55+ only) (Alz. SCU) (MH SCU)

(188) (160) (0)

(13,007) (5,072) (0)

TOTAL

1258

40,097

FCH (2-6 beds)

(7+ beds)

Location of Facilities

• Facilities are located in every county except Gates and Hyde. • Local zoning requirements apply.

Licensing • Initial license issued for six months (G.S. 131D2.4) • Issuance of a new license issued based on owner, principal or affiliate compliance history with time frames established in statute if license initially denied (G.S. 131D-2.4) • License renewed annually with payment of renewal fee established in statute and no outstanding fees, fines or penalties imposed by the State (G.S. 131D-2.4) • Licensing fees apply (G.S. 131D-2.5)

Admission and Assessment • DMA Form FL-2 with physician signature required for admission • Assessment within 72 hours of admission using the Resident Register (ACLS Form) • Assessment within 30 days of admission using the DMA-3050R

Facility Staff Administrator Administrator/Supervisor-in-Charge Personal care aides, including medication aides Activity Director Sufficient housekeeping & food service staff Licensed health professionals on staff not required, but home health agencies may provide medical care and RN’s must be involved on at least a quarterly basis when certain resident care tasks are required • Training and CE required • State administered tests for administrators and medication aides • • • • • •

REGULATORY OVERSIGHT Routine Monitoring • Routine inspections of facilities for rule and rights compliance are conducted by county department of social services staff called adult home specialists (AHS). • AHS visits homes at least quarterly • Corrective action reports document noncompliance and negative action proposals are prepared for serious non-compliance

Surveys • Initial and annual surveys conducted by ACLS surveyors with county adult home specialists participation as available • DHSR Construction inspection every 2 years • SOD’s (Statements of Deficiencies) document results of surveys and penalty proposals are prepared for serious noncompliance • Follow-up surveys for Type A and B violations

Complaint Investigations • The County DSS investigates complaints as referred by the Division’s Complaint Intake Unit or received directly by DSS according to G.S. 131D-26. • The Adult Care Licensure Section conducts investigations based on requests for State involvement or reports of serious conditions. • Complaint Intake Unit: 1-800-624-3004 or 919/855-4500

Other Inspections • Safety inspections by local building inspectors and fire departments • Annual sanitation inspections by local health departments.

Other Involvement • Regional ombudsmen and community advisory committees: – visit adult care homes as resident advocates – assist with informal complaint/grievance resolution – refer problems as needed to appropriate local and state agencies – Division of Aging provides oversight through Long Term Care Ombudsman program. • Case management services for residents with enhanced or heavy care needs through the County DSS.

Regulatory Sanctions • • • • •

Provisional license Suspension of admissions Monetary penalties (Type A and B) Revocation of license Summary suspension of a license without prior due process for imminent life-threatening conditions

Funding • State/County Special Assistance (SA) for room and board - $1,182/month payment to eligible residents. Approximately 70% of residents receive this payment consisting of 50% county, 50% state funds. • Medicaid pays facilities for personal care services for SA residents ($18.21/day for 1.1 hours basic pc). • Monthly Medicaid payments vary depending on basic personal care and enhanced personal care (extensive or total assistance with eating, toileting, and/or ambulation). • Alzheimer’s Special Care Units receive funding through SA ($1515/month) and Medicaid.

Regulatory Agency • Adult Care Licensure Section (ACLS)of the Division of Health Service Regulation (DHSR) with offices in: Raleigh - 919/855-3765 Asheville - 828/670-3391 Clinton - 910/592-2932 Lexington – 336/236-7420 • Staff include registered nurses, pharmacists, dietitians, and social workers