In this issue:
August 30, 2010
"Assisted Living Staffing Ratios"
Part Four of Susan's Nine Part Series
THE MAGNIFICENT MRS. MB
The continuing story of Susan's professional journey with an incredible elderly woman
Susan's California Seminar Tour "RAISING UP Your Parents"
Coming in October & November To Irvine, Huntington Beach, and Woodland Hills. Its Free For Adult Children, Caretakers and Seniors.
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This is the fourth part of my series
on Assisted Living. Hopefully the information about "Staffing Ratios" will give you a better
insight into the services that should be expected from an assisted living
facility.
Before I dive into this information,
I would like to address a question that I received from many of my readers
about inspection records.
Briefly, upon
request, a facility must show you the most recent copy of its latest
inspection report (Note: Inspections are only required every five years,
and annually if the facility is in non-compliance); and a copy of
any substantiated complaints within the past year.
The regulatory agency
does not post compliance information on its web site or make such information
available electronically to organizations like mymomnpop.com. The only
way to view the record to is go to one of the district offices of Community
Care Licensing and request to view the public record of the facility.
Remember, if you do not wish to read the entire newsletter, but would like to ask me any questions, call me at 1 (888) 422-6070 or email me, susan@mymomnpop.com
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Staffing Ratios
This week I received a call from a womanwho needed to place her mother into an
assisted living facility because
her mother's
dementia seemed to take a turn for the worse.
Her
mother is currently being cared for by three in-home care service
providers.
She asked very intelligent questions
about the staffing ratios at the various assisted living facilities that I recommended.
I explained that while assisted living facilities are required by state
law to provide residents with individualized services, there are NO
staffing ratio requirements.
Regulations
state that facility personnel shall at all times be sufficient in numbers,
and competency to provide the services necessary to meet resident needs.
In regards to night supervision, for facilities with 15 or fewer residents,
there has to be one "qualified" person on call and on the premises;
in facilities with 16-100 residents, there shall be one person awake
and on the premises, and another on call and capable of responding within
10 minutes.
Unlike assisted living facilities,
in California, skilled nursing facilities are required to provide a
minimum of 3.2 hours of nursing care per resident per day. If this staffing
level is not adequate to meet resident needs, the nursing home must
employ as many licensed nursing and certified nursing assistants as
are needed. In a clearly visible place, a facility must post daily,
for each shift, the current number of licensed and unlicensed nursing
staff directly responsible for resident care
What determines the
care that a particular resident should receive?
Assessments and care plans are
the tools used by facilities to determine the services to be provided
to a resident. As discussed in my last newsletter, prior to a resident's
admission, an assisted living facility must make a written assessment
of the resident's needs.
The assessment must include the resident's
medical condition, mental capacity, personal
preferences, and ability
to carry out routine
daily tasks. The facility may charge a fee to
perform
the assessment, but only if the facility
discloses the fee and refund
conditions in the
admission agreement.
(Most facilities that I work with
do not charge this fee. And, if they do, I can usually get them to back
down from it.)
Prior to, or within two weeks
of a resident's admission, a facility must then arrange a meeting
with the resident, the resident's representative, appropriate facility
staff, and a representative of the home health agency (if a home health
agency is involved in the resident's care).
During the meeting, the
meeting participants prepare a written record of the care that the resident
will receive in the facility, and the resident's preferences regarding
the services to be provided, e.g., Mr. Doe prefers to eat breakfast
in bed and bathe in the evening, and so will receive tray service in
the morning and three baths a week following dinner.
A similar meeting
must occur whenever there is a significant change in the resident's
condition, or at least once every twelve months, to ensure that the
written care plan is kept up-to-date.
If there is a change, be prepared
to pay extra for care. Recall, that in many, but not all facilities,
there is a base rate and then extra charges for assistance with activities
of daily living.
Regardless of the requirement to
conduct and annual assessment, an assisted living facility must be aware
of changes in a resident's physical, mental, or emotional condition.
Significant changes in a resident's health must be reported to the
resident's doctor and (if applicable) to a resident's close family
member or friend. Moreover, assessments must be updated frequently enough
to maintain their accuracy.
At a minimum, the updates must include physical
setbacks and emotional traumas (the death of a family member, for instance).
How comprehensive
must facility services be?
In general, an assisted living
facility must enable its residents to have lives that are as active
and satisfying as possible. Accordingly, a facility must assure that
its residents receive all of the services that they need, including
those services identified in the resident's care plan.
For example, a facility must provide
services that "continue and promote, to the extent possible, independence
and self direction for all persons accepted for care." At a minimum
the following services must be provided:
· Care, supervision, and observation
· Living accommodations
· Three meals daily and snacks
· Assistance with activities
of daily living (dressing, bathing, toileting, etc.)
· Social and recreational activities
· Assistance with obtaining,
and transportation to and from, medical and dental care
What health-related
services must a facility provide?
An assisted living facility must
assure that each
resident has access to needed medical or dental
services.
If necessary, the facility must provide
transportation to the nearest
office that will perform the needed services.
A facility also must assist a resident,
if necessary, in the resident's self administration of medications,
and must store a resident's medication if it requires refrigeration
and the resident has no private refrigerator. In addition, a facility
must provide a resident with necessary help in the use of hearing aids,
artificial limbs, and other medical devices.
Residents with certain health conditions
may be admitted to or remain in an assisted living facility only if (1) the
resident is capable of caring for the condition by herself, or (2) the
resident receives necessary health care services from an appropriately
skilled professional, e.g., a home health agency.
These conditions include:
need for oxygen administration or a breathing machine; a colostomy,
ileostomy or catheter; diabetes; incontinence; and pressure ulcers (Stage
1 and 2, only). The facility must provide necessary supportive care
and supervision for residents with these conditions.
A resident can receive in-facility
health care from an outside health care provider, such as a home health
agency.
What services must
a facility provide for incontinent residents?
An assisted living facility must
ensure that incontinent residents are kept clean and dry. The resident
must be evaluated regularly to ensure that skin breakdown is not occurring.
If appropriate, a bowel and bladder training program must be provided
to an incontinent resident. A facility must take residents to the bathroom
as necessary, and cannot use diapers or catheters for the facility's
convenience.
What services must
a facility provide to residents with dementia?
An assisted living facility can
admit or 
retain a resident with dementia only if
it complies with dementia-specific
regulations
regarding staffing, training, fire safety, and
other safety
measures. These regulations
require an annual medical assessment, adequate
supervision, enhanced physical plant safety, and an appropriate activity
program.
A facility may only use specialized
devices to prevent residents from leaving the building if certain requirements
are met. Delayed egress doors (doors that delay, but do not prevent
a resident's exit from the building) and locked doors/perimeters require
special fire clearances, and locking is only allowed with prior approval
from the Department of Social Services.
Unlike regular assisted living,
when the facility is caring individuals with dementia the facility must
provide an adequate number of staff to support the physical, social,
emotional, safety and health care needs of each resident with dementia.
The facility also must have an activity program that addresses the needs
and limitations of residents with dementia. If a facility advertises
or promotes specialized dementia care, it also must describe its special
dementia-related features in its plan of operation.
The admission agreement
must inform the resident or his legal representative that the special
features are described in the plan of operation, and that the plan of
operation is available for review on request. The facility also must
ensure that special training requirements are met by staff who provide
care to residents with dementia.
The terminally ill
Individuals who have been diagnosed
as terminally ill by his doctor may live in an assisted living facility,
but only if certain conditions are met.
1) The facility must have approval
from the Department of Social Services to care for terminally ill residents.
2) The resident must contract for hospice services to be provided to him
by a Medicare-certified hospice agency.
3) The facility must be able to
work with the hospice agency to provide necessary services to the resident.
4) The hospice agency and facility must prepare a plan for the resident's
care. Finally, any roommate of the resident must agree to allow hospice
caregivers into the room.
Look for Part Five of this nine part series on assisted living, "Daily Living" coming soon!
THE MAGNIFICENT MRS. MB
If you
want to join me on my elder care journey with the magnificent Mrs. MB, just click on http://mymomnpop.com
"Raising UP Your Parents & "The Successful Aging Tour"
Coming to Huntington Beach, Irvine and Woodland Hills, October and November, 2010.
"Click Here" to be taken to my web page for the seminar and you can register for free.
As gerontologist, elder law attorney, and a former elder law professor, I have put together a seminar that can help prepare you for what lies ahead for you or someone you are caring for.
Remember, if you have an urgent question, or just wish to speak to me directly, you can email or call, susan@mymomnpop.com or (310) 897-7434.
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