Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59A - Health Facility and Agency Licensing
Chapter 59A-36 - ASSISTED LIVING FACILITY
Section 59A-36.021 - Extended Congregate Care Services
Universal Citation: FL Admin Code R 59A-36.021
Current through Reg. 50, No. 187; September 24, 2024
(1) LICENSING.
(a) Any facility intending to establish
extended congregate care services must obtain a license from the agency before
accepting residents needing extended congregate care services.
(b) Only the portion of a facility that meets
the physical requirements for extended congregate care in Chapter 4, Section
464 of the Florida Building Code as adopted in Rule
61G20-1.001, F.A.C., and is
staffed in accordance with subsection (3), is considered licensed to provide
extended congregate care services to residents who meet the admission and
continued residency requirements of this rule.
(2) EXTENDED CONGREGATE CARE POLICIES. Policies and procedures established through extended congregate care services must promote resident independence, dignity, choice, and decision-making. The facility must develop and implement specific written policies and procedures that address:
(a) Aging in place;
(b) The facility's residency criteria
developed in accordance with the admission and discharge requirements described
in subsection (4), and extended congregate care services listed in subsection
(7);
(c) The personal and
supportive services the facility intends to provide, how the services will be
provided, and the identification of staff positions to provide the services
including their relationship to the facility;
(d) The nursing services the facility intends
to provide, identification of staff positions to provide nursing services, and
the license status, duties, general working hours, and supervision of such
staff;
(e) Identifying potential
unscheduled resident service needs and mechanisms for meeting those needs
including the identification of resources to meet those needs;
(f) A process for mediating conflicts among
residents regarding choice of room or apartment and roommate; and,
(g) How to involve residents in decisions
concerning the resident. The services must provide opportunities and
encouragement for the resident to make personal choices and decisions. If a
resident needs assistance to make choices or decisions, a family member or
other resident representative must be consulted. Choices must include at a
minimum whether:
1. To participate in the
process of developing, implementing, reviewing, and revising the resident's
service plan,
2. To remain in the
same room in the facility, except that a current resident transferring into an
extended congregate care services may be required to move to the part of the
facility licensed for extended congregate care, if only part of the facility is
so licensed,
3. To select among
social and leisure activities,
4.
To participate in activities in the community. At a minimum the facility must
arrange transportation to such activities if requested by the resident; and,
5. To provide input with respect
to the adoption and amendment of facility policies and
procedures.
(3) STAFFING REQUIREMENTS. The following staffing requirements apply for extended congregate care services:
(a) Supervision by
an administrator who has a minimum of two years of managerial, nursing, social
work, therapeutic recreation, or counseling experience in a residential,
long-term care, or acute care setting or agency serving elderly or disabled
persons. If an administrator appoints a manager as the supervisor of an
extended congregate care facility, both the administrator and manager must
satisfy the requirements of subsection
59A-36.010(1),
F.A.C.
1. A baccalaureate degree may be
substituted for one year of the required experience.
2. A nursing home administrator licensed
under Chapter 468, F.S., is qualified under this paragraph.
(b) Provide staff or contract the services of
a nurse who must be available to provide nursing services, participate in the
development of resident service plans, and perform monthly nursing assessments
for extended congregate care residents.
(c) Provide enough qualified staff to meet
the needs of extended congregate care residents in accordance with Rule
59A-36.010, F.A.C., and to
provide the services established in each resident's service plan.
(d) Ensure that adequate staff is awake
during all hours to meet the scheduled and unscheduled needs of
residents.
(e) Immediately provide
additional or appropriately qualified staff, when the agency determines that
service plans are not being followed or that residents' needs are not being met
because insufficient staffing, in accordance with the staffing standards
established in Rule 59A-36.010, F.A.C.
(f) Ensure and document that staff receive
extended congregate care training as required in Rule
59A-36.011,
F.A.C.
(4) ADMISSION AND CONTINUED RESIDENCY.
(a) An individual must
meet the following minimum criteria in order to receive extended congregate
care services:
1. Be at least 18 years of
age;
2. Be free from signs and
symptoms of a communicable disease that is likely to be transmitted to other
residents or staff; however, an individual who has human immunodeficiency virus
(HIV) infection may be admitted to a facility, provided that he or she would
otherwise be eligible for admission according to this rule;
3. Be able to transfer, with assistance if
necessary. The assistance of more than one individual is permitted;
4. Not be a danger to self or others as
determined by a health care practitioner or mental health practitioner licensed
under chapter 490 or 491, F.S.;
5.
Not be bedridden, unless the resident is receiving licensed hospice services
pursuant to Section 429.26(1)(c),
F.S.;
6. Not have any stage 3 or 4
pressure sores;
7. Not require any
of the following nursing services:
a.
Artificial airway management of any kind except that of continuous positive
airway pressure may be provided through the use of a CPAP or bipap
machine,
b. Nasogastric tube
feeding,
c. Monitoring of blood
gases,
d. Management of
post-surgical drainage tubes or wound vacuums,
e. Skilled rehabilitative services as
described in Rule 59G-4.290, F.A.C., or
f. Treatment of a surgical incision, unless
the surgical incision and the condition that caused it have been stabilized and
a plan of care developed. The plan of care must be maintained in the resident's
record at the facility.
8. Not require 24-hour nursing supervision,
unless the resident is receiving licensed hospice services pursuant to Section
429.26(1)(c),
F.S.; and,
9. Have been determined
to be appropriate for admission to the facility by the facility administrator
or manager. The administrator or manager must base his or her decision on:
a. An assessment of the strengths, needs, and
preferences of the individual, the health assessment required by subsection (6)
of this rule, and the preliminary service plan developed in subsection
(7),
b. The facility's residency
criteria, and services offered or arranged for by the facility to meet resident
needs; and,
c. The ability of the
facility to meet the uniform fire safety standards for assisted living
facilities established in rule Chapter 69A-40, F.A.C.
10. Notwithstanding any other provision of
this rule, as individual enrolled and receiving licensed hospice services
pursuant to Section 429.26(1)(c),
F.S. may be admitted and receive extended congregate care
services.
(b) Criteria
for continued residency in an extended congregate care services must be the
same as the criteria for admission, except as specified below.
1. A resident may be bedridden for up to 14
consecutive days.
2. A terminally
ill resident who no longer meets the criteria for continued residency may
continue to reside in the facility if the following conditions are met:
a. The resident qualifies for, is admitted
to, and consents to the services of a licensed hospice that coordinates and
ensures the provision of any additional care and services that may be needed,
b. Continued residency is
agreeable to the resident and the facility,
c. An interdisciplinary care plan, which
specifies the services being provided by hospice and those being provided by
the facility, is developed and implemented by a licensed hospice in
consultation with the facility; and,
d. Documentation of the requirements of
subparagraph (5)(b)2., is maintained in the resident's
file.
3. The extended
congregate care administrator or manager is responsible for monitoring the
appropriateness of continued residency of a resident in extended congregate
care services at all times.
4. A
hospice resident that meets the qualifications of continued residency pursuant
to this rule may only receive services from the assisted living facility's
staff within the scope of the facility's license.
5. Staff may provide any nursing service
permitted under the facility's license and total help with the activities of
daily living for residents admitted to hospice. Staff may not exceed the scope
of their professional licensure or training in any licensed assisted living
facility.
(5) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care practitioner pursuant to Rule 59A-36.006, F.A.C. A health assessment conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once receiving services, a new health assessment must be obtained at least annually.
(6) SERVICE PLANS.
(a) Before receiving services, the extended
congregate care administrator or manager must develop a preliminary service
plan that includes an assessment of whether the resident meets the facility's
residency criteria, an appraisal of the resident's unique physical,
psychological and social needs and preferences, and an evaluation of the
facility's ability to meet the resident's needs.
(b) Within 14 days of receiving services, the
extended congregate care administrator or manager must coordinate the
development of a written service plan that takes into account the resident's
health assessment obtained pursuant to subsection (5); the resident's unique
physical, psychological and social needs and preferences; and how the facility
will meet the resident's needs including the following if required:
1. Health monitoring,
2. Assistance with personal care services,
3. Nursing services,
4. Supervision,
5. Special diets,
6. Ancillary services,
7. The provision of other services such as
transportation and supportive services; and,
8. The manner of service provision, and
identification of service providers, including family and friends, in keeping
with resident preferences.
(c) Pursuant to the definitions of "shared
responsibility" and "managed risk" as provided in Section
429.02, F.S., the service plan
must be developed and agreed upon by the resident or the resident's
representative or designee, surrogate, guardian, or attorney-in-fact, and must
reflect the responsibility and right of the resident to consider options and
assume risks when making choices pertaining to the resident's service needs and
preferences.
(d) The service plan
must be reviewed and updated quarterly to reflect any changes in the manner of
service provision, accommodate any changes in the resident's physical or mental
status, or pursuant to recommendations for modifications in the resident's care
as documented in the nursing assessment.
(7) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive environment, and in a manner that respects the resident's independence, privacy, and dignity.
(a) A facility providing extended congregate
care services may provide supportive services including social service needs,
counseling, emotional support, networking, assistance with securing social and
leisure services, shopping service, escort service, companionship, family
support, information and referral, assistance in developing and implementing
self-directed activities, and volunteer services. Family or friends must be
encouraged to provide supportive services for residents. The facility must
provide training for family or friends to enable them to provide supportive
services in accordance with the resident's service plan.
(b) A facility providing extended congregate
care services must make available the following additional services if required
by the resident's service plan:
1. Total help
with bathing, dressing, grooming and toileting,
2. Nursing assessments conducted more
frequently than monthly,
3.
Measurement and recording of basic vital functions and weight,
4. Dietary management including provision of
special diets, monitoring nutrition, and observing the resident's food and
fluid intake and output,
5.
Assistance with self-administered medications, or the administration of
medications and treatments pursuant to a health care practitioner's order. If
the individual needs assistance with self-administration the facility must
inform the resident of the qualifications of staff who will be providing this
assistance, and if unlicensed persons will be providing such assistance, obtain
the resident's or the resident's surrogate, guardian, or attorney-in-fact's
informed written consent to provide such assistance as required in Section
429.256, F.S.,
6. Supervision of residents with dementia and
cognitive impairments,
7. Health
education and counseling and the implementation of health-promoting programs
and preventive regimes,
8.
Provision or arrangement for rehabilitative services; and,
9. Provision of escort services to
health-related appointments.
(c) Nursing staff providing extended
congregate care services may provide any nursing service permitted within the
scope of their license consistent with the residency requirements of this rule
and the facility's written policies and procedures, provided the nursing
services are:
1. Authorized by a health care
practitioner's order and pursuant to a plan of care,
2. Medically necessary and appropriate for
treatment of the resident's condition,
3. In accordance with the prevailing standard
of practice in the nursing community,
4. A service that can be safely, effectively,
and efficiently provided in the facility,
5. Recorded in nursing progress notes; and,
6. In accordance with the
resident's service plan.
(d) At least monthly, or more frequently if
required by the resident's service plan, a nursing assessment of the resident
must be conducted.
(8) RECORDS. In addition to the records required in Rule 59A-36.015, F.A.C., a facility providing extended congregate care services must maintain the following:
(a) The service plans for each resident
receiving extended congregate care services;
(b) The nursing progress notes for each
resident receiving nursing services from the facility's staff;
(c) Nursing assessments; and,
(d) The facility's extended congregate care
policies and procedures.
(9) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility is unable to meet the resident's needs as identified in the service plan, or the resident no longer meets the criteria for continued residency, the resident must be discharged or relocated in accordance with Sections 429.26 and 429.28, F.S.
Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 429.41 FS.
New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-17-14, 5-10-18, Formerly 58A-5.030, Amended 9-9-21, 9-28-22.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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