2013 -- S 0691 SUBSTITUTE A AS AMENDED

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LC01600/SUB A/4

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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, 23-17.4-6, 23-17.4-15.8 and 23-17.4-16.2 of the

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General Laws in Chapter 23-17.4 entitled "Assisted Living Residence Licensing Act" are hereby

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amended to read 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 and may

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include the delivery of limited health services, as defined under subdivision 23-17.4-2(12), to

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

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who 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 behavioral healthcare

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developmental disabilities, and hospitals, the department of children, youth, and families, or any

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other state agency. The department shall develop levels of licensure for assisted living residences

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within this definition as provided in section 23-17.4-6. Assisted living residences include

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sheltered care homes, and board and care residences or any other entity by any other name

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providing the services listed in this subdivision which meet the definition of assisted living

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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) "Qualified licensed assisted living staff members" means a certified nursing assistant

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as provided under subdivision 23-17.9-2(a)(3), a licensed practical nurse as provided under

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subdivision 5-34-3(9) and/or a registered nurse as provided under subdivision 5-34-3(10).

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     (8)(9) "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)(10) "Resident" means an individual not requiring medical or nursing care as provided

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in 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 and/or

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limited health services. A resident must be capable of self-preservation in emergency situations,

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unless the facility meets a more stringent life safety code as required under section 23-17.4-

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6(b)(3). Persons needing medical or skilled nursing care, including daily professional observation

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and evaluation, as provided in a health care facility, and/or persons who are bedbound or in need

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of the assistance of more than one person for ambulation, are not appropriate to reside in assisted

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living residences. However, an established resident may receive daily skilled nursing care or

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therapy from a licensed health care provider for a condition that results from a temporary illness

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or injury for up to forty-five (45) days subject to an extension of additional days as approved by

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the department, or if the resident is under the care of a Rhode Island licensed hospice agency,

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provided the assisted living residence assumes responsibility for ensuring that the required care is

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received. Furthermore, a new resident may receive daily therapy services and/or limited skilled

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nursing care services, as defined through rules and regulations promulgated by the department of

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

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injury for up to forty-five (45) days subject to an extension of additional days as approved by the

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department, or if the resident is under the care of a licensed hospice agency provided that assisted

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living residence assumes responsibility for ensuring that the care is received. Notwithstanding

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the aforementioned, residents who are bed bound or in need of assistance of more than one staff

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person for ambulation may reside in a residence if they are receiving hospice care in accordance

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with the rules and regulations promulgated by the department of health. For the purposes of this

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

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     (11) "Supervision" means the supervision requirements of qualified licensed assisted

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living staff delivering limited health services in accordance with this chapter, as defined through

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rules and regulations promulgated by the department of health.

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     (12) "Limited health services" means health services, as ordered by the resident's

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physician, provided by qualified licensed assisted living staff members with supervision as

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required in rules and regulations promulgated by the department of health. Nothing in this

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definition shall be construed to limit the right of assisted living residents to access home nursing

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care or hospice provider services.

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     23-17.4-6. Issuance of license -- Posting -- Transfer. -- (a) Issuance of license. - Upon

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receipt of an application for a license, the licensing agency shall issue a license if the applicant

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and assisted living residence meet the requirements established under this chapter; the director

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shall establish levels of licensure as provided in subsections (b) and (c) subsection (c) below and

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any rules and regulations that may be established in accordance herewith. A license issued under

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this chapter shall be the property of the state and loaned to the licensee, and it shall be kept posted

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in a conspicuous place on the licensed premises. Each license shall be issued only for the

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premises and persons named in the application, and shall not be transferable or assignable except

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with the written approval of the licensing agency.

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      (b) Fire code and structural requirements.

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      (1) A residence with state fire code deficiencies may be granted a license which may be

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renewed subject to the submission of a plan of correction acceptable to the state division of fire

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safety, and provided the nature of the deficiencies are such that they do not jeopardize the health,

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safety, and welfare of the residents.

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      (2) A residence with residents who are blind, deaf, and physically disabled shall be

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subject to the applicable requirements of the American National Standards Institute (ANSI

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standards)(1961), and any other provisions that may be required by rules and regulations pursuant

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to this chapter.

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      (3) A residence that elects to comply with a higher life safety code and is so approved by

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the state division of fire safety and meets the department's requirements for the appropriate level

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of licensure may admit residents not capable of self preservation.

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      (c) Levels of licensure. - The department shall establish requirements for a basic license

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that apply to all assisted living residences. In addition, the department shall establish additional

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licensing levels of assisted living including, but not limited to:

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      (1) "Dementia care" licensure shall be required when one or more residents have a

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physician's diagnosis of dementia or an assessment, as required by section 23-17.4-15.6,

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indicating dementia-related functional impairments, and meet any of the following:

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      (i) Safety concerns due to evidence of elopement or other dementia behaviors;

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      (ii) Inappropriate social behaviors that repeatedly infringe upon the rights of others;

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      (iii) Inability to self preserve due to dementia;

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      (iv) A physician's recommendation that the resident needs dementia support consistent

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with this level; or if the residence advertises or represents special dementia services or if the

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residence segregates residents with dementia.

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      (2) In addition to the requirements for the basic license, licensing requirements for the

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"dementia care" level shall include the following:

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      (i) Staff training and/or requirements specific to dementia care as determined by the

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department;

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      (ii) A registered nurse on staff and available for consultation at all times and at least one

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staff person with appropriate training and education as determined by regulation, on duty at all

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times in Alzheimer's dementia special care units;

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      (iii) The residence shall provide for a secure environment appropriate for the resident

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population.

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      (3) "Medication administration" when one or more residents requires medication

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administration by appropriately qualified staff as determined by the department.

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     (4) "Limited health services" licensure shall be required if the assisted living residence

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offers to provide limited health services as defined herein. Conditions and requirements for the

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licensing of limited health services shall be determined in accordance with subdivision 23-17.4-6

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(b)(6).

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     (5) A resident may continue to receive limited health services in an assisted living

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residence so long as the resident, the resident's family, the resident's physician, and the operator

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of the assisted living residence consent to the resident's continued stay in the assisted living

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residence; and provided, that all parties commit to assuring the resident can safely receive

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services.

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     (6) In addition to the requirements for the basic license, in accordance with section 23-

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17.4-4 and all provisions of this chapter, the department shall establish licensing requirements for

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"limited health services" levels including, but not limited to, the following factors:

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     (i) Resident safety guidelines in accordance with the provisions of this chapter;

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     (ii) Staff training and/or requirements specific to the delivery of limited health services;

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     (iii) Supervision requirements including appropriate training in accordance with section

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23-17.4-15.8;

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     (iv) Best practice standards for delivering limited health services;

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      (v) Quality assurance in accordance with chapter 23-17.4-10.1;

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     (vi) Resident protection and required disclosures in accordance with section 23-17.4-16.2

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and all provisions of this chapter; and

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     (vii) Protections and assurances for health information exchange, in accordance with this

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chapter and all applicable state and federal laws and regulations.

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     (7) Nothing in this section or chapter shall require an assisted living residence to obtain a

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limited health service license.

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     (d) The director shall promulgate all necessary rules and regulations in order to fulfill the

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purposes of this chapter.

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     (e) If any provision of this chapter or its application to any person or circumstances is

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held invalid, the invalidity shall not affect other provisions of applications of this chapter which

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can be given effect without the invalid provision or application, and to this end the provisions of

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this chapter are declared to be severable.

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     23-17.4-15.8. Staff. – (a) The administrator shall be responsible for ensuring sufficient

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and qualified staff to provide a safe and healthy environment and to provide the services specified

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on each resident's service plan. The department shall establish requirements for staff

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qualifications and training for each level of license.

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     (b) The requirements for dementia care units shall include staff training on dementia care

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issues and practices as follows.:

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     (1) All staff of dementia-level licensed residences that have direct contact with residents

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shall have four (4) hours of initial training on dementia-care issues and practices and two (2)

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hours of continued education annually thereafter.

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     (2) Training on dementia care issues and practices provided and documented at any

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licensed assisted living residence or nursing facility or by an entity authorized to provide

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continuing education credits may be counted toward meeting these requirements. At least one

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qualified awake and on duty staff person shall be on the premises at all times.

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     (c) The requirements for residences that provide limited health services shall include staff

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training on limited health services care issues and practice as follows:

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     (1) All staff delivering direct service with residents for limited health services in assisted

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living residences shall have initial training on delivering limited health service care and practice

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of continued education as determined through rules and regulations promulgated by the

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department of health.

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     (2) Training on limited health service issues and practices provided and documented at

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any assisted living residence or nursing facility or by an entity authorized to provide continuing

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education credits as determined through rules and regulations promulgated by the department of

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health.

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     (3) Staff delivering limited health services shall be supervised in accordance with

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subdivision 23-17.4-2(11) and all provisions of this chapter, with the specialized knowledge,

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judgment and skills related to the delivery of limited health services twenty-four (24) hours a day

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seven (7) days a week as determined through rules and regulations promulgated by the

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department of health.

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     23-17.4-16.2. Special care unit disclosure by residences. -- Special care unit and

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limited health services disclosure by residences. -- (a) Any assisted living residence which

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offers to provide or provides services to residents with Alzheimer's disease or other dementia by

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means of an Alzheimer's special care unit and/or limited health services shall be required to

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disclose the type of services provided, in addition to those services required by the rules and

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regulations for the licensing of assisted living residences. That disclosure Disclosures shall be

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made to the licensing agency and to any person seeking placement in an Alzheimer's special care

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unit of and/or any person receiving limited health services from an assisted living residence. The

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information disclosed shall explain that additional care is provided in each of the following areas:

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      (1) Philosophy. - The Alzheimer's special care unit's unit and/or delivery of limited

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health services shall develop a written statement of its overall philosophy and mission which

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reflects the needs of residents afflicted with dementia and/or needing limited health services.

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      (2) Pre-occupancy, occupancy, and termination of residence. - The process and criteria

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for occupancy, transfer, or termination of residency from the unit and/or the termination of

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limited health services.

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      (3) Assessment, service planning, and implementation. - The process used for

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assessment and establishing the plan of service and its implementation, including the method by

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which the plan of service evolves and is responsive to changes in condition.

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      (4) Staffing patterns and training ratios. - Staff training and continuing education

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practices.

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      (5) Physical environment. - The physical environment and design features appropriate to

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support the functioning of cognitively impaired adult residents.

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      (6) Resident activities. - The frequency and types of resident activities.

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      (7) Family role in providing support and services. - The involvement in families and

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family support programs.

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      (8) Program costs. - The cost of care and any additional fees.

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      (b) The licensing agency shall develop a standard disclosure form and shall review the

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information provided on the disclosure form by the residential care and assisted living facility to

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verify the accuracy of the information reported on it. Any significant changes in the information

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provided by the residential care and assisted living facility will be reported to the licensing

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agency at the time the changes are made.

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     SECTION 2. This act shall take effect on April 30, 2014.

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LC01600/SUB A/4

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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 amend certain provisions of the general laws relative to the licensing of

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assisted living residences, and would provide for a "limited health services" license.

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     This act would take effect on April 30, 2014.

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LC01600/SUB A/4

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