Current through Register Vol. 51, No. 19, September 20, 2024
A. A licensee
may provide:
(1) The level of care for which
the assisted living program has been approved; and
(2) Any lower level of care.
B. At the time of initial
licensure and each subsequent renewal, an applicant shall request approval to
provide services at one of the three levels of care set forth in §G of
this regulation. An applicant or licensee shall demonstrate that it has the
capacity to provide the level of care requested either directly or through the
coordination of community services.
C. If, at any time, a licensee wants to
provide a higher level of care than that for which it is licensed, the licensee
shall request authority from the Department to change its licensed level of
care.
D. The Department shall
determine if an applicant or licensee has the capacity to provide and ensure
the requested level of care.
E. The
Department may approve or deny the request. If an applicant or licensee is
aggrieved by the Department's decision, the applicant or licensee may appeal by
filing a request for a hearing consistent with Regulation .64 of this
chapter.
F. As provided in
Regulation .14C of this chapter, the resident's care needs shall determine the
need, amount, frequency of nursing overview by the registered nurse, and the
need for on-site nursing services as well as when awake overnight staff is not
required. The Department may approve a waiver of the requirement for awake
overnight staff when the facility has demonstrated to the Department its use of
an effective electronic monitoring system. The licensee shall comply with
applicable requirements of COMAR 10.27.09.
G. Levels of Care.
(1) The applicant or licensee shall request
one of the levels of care listed in §G(2)-(4) of this regulation. Program
staff shall have the abilities necessary to provide the level of care and the
abilities to provide the services listed for the level of care selected by the
applicant or licensee.
(2) Level 1:
Low Level of Care.
(a) An assisted living
program that accepts a resident who requires a low level of care shall have
staff with the abilities to provide the services listed in §G(2)(b)-(g) of
this regulation, and the program shall provide those services.
(b) Health and Wellness. Staff shall have the
ability to:
(i) Recognize the causes and risks
associated with a resident's current health condition once these factors are
identified by a health care practitioner; and
(ii) Provide occasional assistance in
accessing and coordinating health services and interventions.
(c) Functional Condition. Staff
shall have the ability to provide occasional supervision, assistance, support,
setup, or reminders with two or more activities of daily living.
(d) Medication and Treatment. Staff shall
have the ability to assist a resident with taking medication or to coordinate
access to necessary medication and treatment.
(e) Behavioral Condition. Staff shall have
the ability to monitor and provide uncomplicated intervention to manage
occasional behaviors that are likely to disrupt or harm the resident or
others.
(f) Psychological or
Psychiatric Condition. Staff shall have the ability to monitor and manage
occasional psychological or psychiatric episodes or fluctuations that require
uncomplicated intervention or support.
(g) Social and Recreational Interests. Staff
shall have the ability to provide occasional assistance in accessing social and
recreational services.
(3) Level 2: Moderate Level of Care.
(a) An assisted living program that accepts a
resident who requires a moderate level of care shall have staff with the
abilities to provide the services listed in §G(3)(b)-(g) of this
regulation, and the program shall provide those services.
(b) Health and Wellness. Staff shall have the
ability to:
(i) Recognize and accurately
describe and define a resident's health condition and identify likely causes
and risks associated with the resident's condition; and
(ii) Provide or ensure access to necessary
health services and interventions.
(c) Functional Condition. Staff shall have
the ability to provide or ensure:
(i)
Substantial support with two or more activities of daily living; or
(ii) Minimal support with any number of
activities of daily living.
(d) Medication and Treatment. Staff shall
have the ability to:
(i) Provide or ensure
assistance with taking medication; or
(ii) Administer necessary medication and
treatment, including monitoring the effects of the medication and
treatment.
(e)
Behavioral Condition. Staff shall have the ability to monitor and provide or
ensure intervention to manage frequent behaviors which are likely to disrupt or
harm the resident or others.
(f)
Psychological or Psychiatric Condition. Staff shall have the ability to monitor
and manage frequent psychological or psychiatric episodes that may require
limited skilled interpretation, or prompt intervention or support.
(g) Social and Recreational Interests. Staff
shall have the ability to provide or ensure ongoing assistance in accessing
social and recreational services.
(4) Level 3: High Level of Care.
(a) An assisted living program that accepts a
resident who requires a high level of care shall have staff with the abilities
to provide the services listed in §G(4)(b)-(g) of this regulation, and the
program shall provide those services.
(b) Health and Wellness. Staff shall have the
ability to:
(i) Recognize and accurately
describe and define a resident's health condition and identify likely causes
and risks associated with the residents' condition; and
(ii) Provide or ensure ongoing access to and
coordination of comprehensive health services and interventions including
nursing overview.
(c)
Functional Condition. Staff shall have the ability to provide or ensure
comprehensive support as frequently as needed to compensate for any number of
activities of daily living deficits.
(d) Medication and Treatment. Staff shall
have the ability to:
(i) Provide or ensure
assistance with taking medication; and
(ii) Administer necessary medication and
treatment, including monitoring or arranging for monitoring of the effects of
complex medication and treatment regimens.
(e) Behavioral Condition. Staff shall have
the ability to monitor and provide or ensure ongoing therapeutic intervention
or intensive supervision to manage chronic behaviors which are likely to
disrupt or harm the resident or others.
(f) Psychological or Psychiatric Condition.
Staff shall have the ability to monitor and manage a variety of psychological
or psychiatric episodes involving active symptoms, condition changes, or
significant risks that may require skilled interpretation or immediate
interventions.
(g) Social and
Recreational Interests. Staff shall have the ability to provide or ensure
ongoing access to comprehensive social and recreational services.
