2023 -- S 0794

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LC001454

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING

ACT

     

     Introduced By: Senators DiPalma, Miller, Lauria, and Murray

     Date Introduced: March 23, 2023

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17.4-2 of the General Laws in Chapter 23-17.4 entitled "Assisted

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Living Residence Licensing Act" is hereby amended to read as follows:

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     23-17.4-2. Definitions.

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     As used in this chapter:

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     (1) “Activities of daily living (ADLs)” means bathing, dressing, eating, toileting, mobility

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and transfer.

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     (2) “Administrator” means any person who has responsibility for day to day administration

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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 ongoing

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

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

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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 subsection (12), to meet the

 

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

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

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or facility licensed pursuant to chapter 17 of this title, and those facilities licensed by or under the

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jurisdiction of the department of behavioral healthcare, developmental disabilities and hospitals,

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the 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 § 23-

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

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any other entity by any other name providing the services listed in this subdivision which meet the

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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 § 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 § 23-17.9-2(a)(3), a licensed practical nurse as provided under § 5-34-3(13)

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and/or a registered nurse as provided under § 5-34-3(14).

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     (9) “Personal assistance” means the provision of one or more of the following services, as

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

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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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     (10) “Resident” means an individual not requiring medical or nursing care as provided in

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a healthcare 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 § 23-17.4-6(b)(3).

 

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Persons Unless provided herein, persons needing medical or skilled nursing care, including daily

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professional observation and evaluation, as provided in a healthcare facility, and/or persons who

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are bedbound or in need of the assistance of more than one person for ambulation, are not

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appropriate to reside in for initial admission to assisted living residences. However, an established

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resident may receive daily medical and/or skilled nursing care or therapy from a licensed healthcare

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provider for a condition that results from a temporary illness or injury for up to forty-five (45) days

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subject to an extension of additional days as approved by the department as necessary and/or

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appropriate for the resident's condition, known as assisted living flex care, or if the resident is under

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the care of a Rhode Island licensed hospice agency provided the assisted living residence assumes

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responsibility for ensuring that the required care is received. Furthermore, a new resident may

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receive daily therapy services and/or limited medical and/or skilled nursing care services, or

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therapy as defined through rules and regulations promulgated by the department of health, from a

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licensed healthcare provider as defined through rules and regulations promulgated by the

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department of health, from a licensed healthcare provider for a condition that results from a

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temporary illness or injury for up to forty-five (45) days subject to an extension of additional days

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as approved by the department as necessary and/or appropriate for the resident's condition, 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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Notwithstanding the aforementioned, residents who are bed bound or in need of assistance of more

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than one staff person for ambulation may reside in a residence if they are receiving hospice care in

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

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purposes of this chapter, “resident” shall also mean the resident’s agent as designated in writing or

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legal guardian.

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     (11) “Supervision” means the supervision requirements of qualified licensed assisted living

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

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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 required

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in rules and regulations promulgated by the department of health. a licensed health care

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professional, including, without limitation, stage I and stage II vascular ulcer treatment and

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prevention; simple wound care, including post-operative suture care/removal and stasis ulcer care;

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ostomy care, including appliance changes for residents who have established stomas; urinary

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catheter care; oxygen services, including both oxygen concentrators and portable tanks, monitoring

 

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pulse oximetry, assistance with respiratory equipment for residents who can no longer manage

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equipment on their own, including, without limitation, a bi-level positive airway pressure ventilator

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("BIPAP") that helps with breathing, a continuous positive airway pressure machine ("CPAP") that

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provides constant airflow, nebulizers and inhalers; and physical, occupational, speech and language

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therapy. Nothing in this definition shall be construed to limit the right of assisted living residents

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to access home nursing care or hospice provider services.

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     SECTION 2. This act shall take effect upon passage.

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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 allow assisted living facilities ("ALFs") the ability to provide assisted living

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flex care to better care for individuals whose health care needs progress over time. This act would

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allow ALFs to provide more intensive medical and skilled nursing care services to residents in the

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assisted living setting, as their care needs change over time, rather than requiring their transition to

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a skilled nursing facility when full-time skilled services are required for the resident. It would also

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remove the forty-five (45) day limitation on medical or skilled care permitted for a resident of an

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ALF, whose condition may require longer daily skilled care, because of that condition or illness.

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     This act would take effect upon passage.

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