Current through Register Vol. 46, No. 12, March 20, 2024
(a) The operator
shall be responsible for the provision or arrangement of resident services, which
shall include, at a minimum, housing, 24-hour on-site monitoring, daily food
service, case management services, development of an individualized service plan,
personal care and/or home care services.
(b) Unless conflicted or contradicted by
subdivision (a) of this section, the operator shall be responsible for the
provision or arrangement of resident services pursuant to the facility's
certification as either an adult home or enriched housing program as prescribed
in 18 NYCRR Part 487 or 488, respectively.
(c) The services to be provided to the resident
shall be delineated in the signed residency agreement executed pursuant to
section
1001.8(f)
of this Part and shall be consistent with the resident's individualized service
plan developed pursuant to section
1001.7(k)
of this Part.
(d) Additional
services, supplies or amenities may be available from the operator directly or
through arrangements with the operator and may be subject to additional charges,
provided the provision of such services, supplies or amenities and charges for
such are specified in the residency agreement executed pursuant to section
1001.8(f)
of this Part.
(e) Residents shall
have the ability to receive services from service providers with whom the
operator does not have an arrangement. The operator shall assist the resident in
arranging such services, if necessary, and, as part of the operator's case
management responsibility, shall be responsible for coordinating the care the
operator provides or arranges with the care provided by such other service
providers.
(f) Residents shall have
the right to choose their health care providers, notwithstanding any other
agreement to the contrary.
(g)
Monitoring.
(1) The operator shall designate
sufficient staff who shall be responsible for monitoring residents
on-site.
(2) Monitoring shall be
provided at any hour of the day or night of the week, and shall include but not
be limited to the ability:
(i) to respond to
urgent or emergency needs or requests for assistance with appropriate staff;
and
(ii) to identify abrupt or
progressive changes in behavior, appearance, or in performing basic activities of
daily living which may signify the need for re-assessment and changes in service
as reflected on the individualized service plan.
(h) Daily food service.
(1) Unless otherwise stated in the resident's
residency agreement, the provision of food service shall be dictated by and in
compliance with the facility's certification as either an adult home or enriched
housing program and provided pursuant to 18 NYCRR Part 487 or Part 488.
(2) All food purchasing, storage, preparation
and service shall be in compliance with the New York State Sanitary Code Part 14
of this Title and other applicable county and local health codes and the
standards for such practices as dictated by the facility's certification as
either an adult home or enriched housing program pursuant to 18 NYCRR Part 487 or
Part 488.
(3) Food services shall be
provided in a manner that respects the dietary needs of the residents in relation
to health conditions, food allergies and dietary intolerances, religious and
ethnic mandates, and that allows for a reasonable variation in taste
preferences.
(i) Case
management services. In addition to the case management services provided
pursuant to 18 NYCRR section 487.7(g) or 488.7(e), the residence shall:
(1) identify and evaluate the resident's needs,
interests, and strengths and the capability of the facility to meet those needs,
prior to admission and then at least once every 12 months, using the personal
data and resident evaluation form prescribed by the department;
(2) oversee and coordinate a written
individualized service plan for each resident, as per the conditions of this
paragraph;
(3) provide information
upon admission including meeting with prospective residents and residents and
their representatives and legal representatives, if any, to discuss whether and
how the residence can meet the needs of such prospective resident or residents,
and to explain the various levels of care and services available in a basic
assisted living residence, an enhanced assisted living residence and a special
needs assisted living residence;
(4)
meet with prospective residents and residents, and their representatives and
legal representatives to discuss matters described in the residency agreement and
disclosures required under article 46-B of the Public Health Law and this Part,
including the services that the residence can provide to meet the needs of the
prospective resident or residents;
(5) provide information and referral on an
ongoing basis;
(6) coordinate with
service providers selected by the residents and with other available resources on
an ongoing basis to best address the resident's identified needs and
interests;
(7) develop a formal
mechanism between the case manager and facility staff who serve the resident to
identify abrupt or progressive changes in behavior or appearance, which may
signify the need for assessment and service; and
(8) maintain a complete and accurate personal
record for each resident as specified in section
1001.12 of this
Part.
(j) Personal care.
(1) Each resident shall be provided such
personal care as is necessary to enable the resident to maintain good personal
hygiene, to carry out the activities of daily living, to maintain good health,
and to participate in the ongoing activities of the residence, as per the
resident's individualized service plan developed pursuant to section
1001.7(h)
of this Part.
(2) Unless otherwise
stated in the resident's residency agreement, the provision of personal care
shall be dictated by and in compliance with the facility's certification as
either an adult home or enriched housing program and provided pursuant to 18
NYCRR Part 487 or Part 488.
(3)
Personal care service tasks shall be performed by staff, hereafter referred to as
resident aides, appropriately trained to perform such tasks pursuant to section
1001.11(c)(2)
of this Part.
(k) Health
care services.
(1) Pursuant to section
1001.7(k)
of this Part, the resident's individualized service plan shall specify any
necessary health care services to be provided to the resident, including those
provided by a home care services agency licensed pursuant to article 36 of the
Public Health Law.
(2) Unless
approved by the commissioner to provide enhanced or special needs assisted
living, the residence shall arrange for any needed health care services to be
provided by a home care services agency approved pursuant to article 36 of the
Public Health Law. For purposes of this Part, such services shall include:
nursing, home health aide services, physical therapy, occupational therapy,
speech therapy, respiratory therapy, social work, nutrition, and medical
supplies, equipment and appliances.
(3) A home care services agency shall not
provide in a residence those basic services required to be provided by an adult
home or enriched housing program certified pursuant to 18 NYCRR Part 487 or Part
488, including personal care services, unless an assisted living residence
operator has contracted with a home care services agency approved pursuant to
article 36 of the Public Health Law for the provision of such required services
on its behalf, and such services are included in the resident's basic rate. If
such home care services agency fails to provide services in compliance with the
requirements for the residence as an adult home or enriched housing program,
pursuant to such contract, the assisted living residence operator shall continue
to be responsible for assuring that such services are provided in accordance with
applicable regulations.
(4) The
receipt of hospice services by a resident of an assisted living residence shall
be permitted, and additional certification for enhanced assisted living shall not
be required for the resident to receive hospice services within the residence, so
long as the following conditions are met:
(i)
the ALR, the resident's physician and the hospice determine that, with the
provision of hospice services, the resident can be safely cared for in the
assisted living residence;
(ii)
service responsibilities of the residence and the hospice are specified on the
individualized service plan; and
(iii) the operator agrees to retain the
resident and to coordinate the care provided by the operator with the
hospice.
(l)
Medication management.
(1) Medication
acquisition, storage and disposal, and assistance with self-administration of
medication shall be performed in conformance with the standards for such practice
dictated by the facility's certification as either an adult home or enriched
housing program, pursuant to 18 NYCRR section 487.7(f) or 488.7(d) respectively,
and consistent with any and all operative guidance documents relating to
medication services provided to facility residents issued by the
department.
(2) The operator shall
develop policies and procedures for medication management in compliance with the
requirements of 8 NYCRR section 29.7(a)(21)(ii)(b), sections
80.5 and
80.6
of this Title, 18 NYCRR section 487.7(f) or 488.7(d) (depending on facility
certification).
(3) A medication
assistance record shall be maintained for each resident to include, at a minimum,
the diagnoses of the resident, all medications used by the resident, including
both prescribed and over-the-counter medications, the indication for the
medications prescribed, labels for medications that are dispensed as generic
drugs labeled as such, any special directions for taking or storing medications,
known allergies, and a picture of the resident or other electronic means to
identify the resident.
(4) Medication
orders received from the physician of a resident prescribed as PRN shall be
reviewed with the physician in terms of the resident's ability to identify the
need for medication.
(5) The
physician's order for all PRN medications, including prescriptions and over-the
counter, shall identify those resident behaviors or symptoms warranting
consideration of need for the medication(s).
(6) Unless at the time that a medication order
is issued, the resident's physician has indicated that the resident is able to
identify the need for the medication, a resident may not be assisted with any PRN
medication, whether prescription or over-the-counter, without observation by or
consultation with appropriate licensed nursing or medical providers. The record
of assistance with such medications shall include the behavior or symptoms
observed as well as the nature of such observation by or consultation with such
licensed staff.
(7) The use of
prescription PRN medications for persons with dementia shall be limited to only
those instances where the physician has determined after review with residence
staff that there is no alternative to the order.
(m) Enhanced assisted living.
(1) In addition to the services of the assisted
living residence provided pursuant to an executed residency agreement, a resident
of enhanced assisted living within a residence granted an enhanced assisted
living certificate pursuant to section
1001.4
of this Part may receive health care services provided by staff directly employed
by the enhanced assisted living residence. The operator may, but is not required
to, obtain licensure or certification pursuant to article 36 of the Public Health
Law, to provide such health care service.
(2) If an enhanced assisted living residence
provides health care services that would ordinarily be provided by a home care
services agency licensed pursuant to article 36 of the Public Health Law, then
the operator of the enhanced assisted living residence shall develop appropriate
policies and procedures related to such health care services, to include but not
be limited to:
(i) service specific delivery
standards consistent with current professional standards of practice, including
staff supervision, which are reviewed and revised as necessary;
(ii) documentation of service
delivery;
(iii) storage, cleaning and
disinfection of medical supplies, equipment and appliances;
(iv) provision of nursing or therapeutic
service, procedure or treatment not previously provided by the enhanced assisted
living residence;
(v) resident
discharge which assures a timely, safe and appropriate transition; and
(vi) appropriate quality assurance and
improvement activities.
(3) Personal care tasks that exceed the
approved scope of tasks in which the resident aide is trained, shall be performed
by home health aides trained in such tasks pursuant to section
700.2(b)
of this Title.
(4) An enhanced
assisted living residence shall provide or arrange for nursing services for its
residents as necessary. Such services shall include but not be limited to:
assessment and evaluations of residents; supervision of aides; and nursing care
and treatments.
(5) If a resident
reaches the point where he or she is in need of 24-hour skilled nursing care or
medical care required to be provided by facilities licensed pursuant to article
28 of the Public Health Law or article 19, 31 or 32 of the Mental Hygiene Law,
then the resident must be discharged from the residence and the operator shall
initiate proceeding for the termination of such residency agreement of such
resident in accordance with the provisions of section
461-h of the Social Services Law. Provided,
however, a resident may remain at the enhanced assisted living residence if each
of the following conditions are met:
(i) the
resident in need of 24-hour skilled nursing care or medical care hires
appropriate nursing, medical or hospice staff to care for his or her increased
needs;
(ii) the resident's physician,
home care agency and/or hospice determine that, with the provision of such
additional services, the resident can be safely cared for in the residence, and
would not require placement in a hospital, nursing home or other health or mental
health facility;
(iii) the operator
agrees to retain the resident and to coordinate the care provided by the operator
and the additional nursing, medical and/or hospice services; and
(iv) the resident is otherwise eligible to
reside at the residence.
(n) Special needs assisted living.
(1) In addition to the services of the assisted
living residence provided pursuant to an executed residency agreement, a resident
of special needs assisted living within a residence granted a special needs
assisted living certificate pursuant to section
1001.4
of this Part is entitled to receive the services approved to be offered by the
special needs assisted living residence pursuant to the operator's approved
special needs plan and consistent with the resident's individualized service plan
developed pursuant to section
1001.7(h)
of this Part.
(2) The operator shall
provide a comprehensive and coordinated program to regularly observe and assess
the need for services in a professional, respectful, competent, and timely
manner.
(3) Services provided to a
resident of special needs assisted living shall be provided by individuals
appropriately trained, experienced and licensed or certified, if applicable,
pursuant to section
1001.11 of this
Part.
(4) The operator shall ensure
initial and on-going efforts to establish community-based individual and agency
linkages and contacts, specific to serving a special needs population.
(5) Supervision in special needs assisted
living.
(i) The operator shall maintain
knowledge of the general whereabouts of each resident.
(ii) In the event a resident is absent from the
residence and the resident's whereabouts are unknown, immediate efforts shall be
undertaken to locate the resident, including immediate notification to the
appropriate law enforcement agency and the department's regional office.
Notification shall also be made immediately to the resident's family and
representative, unless a different time frame has been agreed upon pursuant to
the residency agreement executed pursuant to section
1001.8(e)
of this Part.
(iii) Sufficient staff
to supervise residents and respond to their needs must be available on all
shifts.
(6) Medication
assistance in special needs assisted living. When disruptive or aggressive
behaviors are exhibited, the operator shall evaluate the special needs assisted
living resident, determine precipitating factors, make staff aware of
precipitating factors that need to be avoided, and develop a plan to include
successful interventions and to promote the highest level of resident
function.
(7) Case management in
special needs assisted living.
(i) In addition
to the case management services required by subdivision (i) of this section, the
operator shall assist the special needs assisted living resident to maintain
family ties by assisting residents' family members and representatives to:
(a) adjust to and remain involved with the
resident's initial placement and continued residence in the special needs
assisted living residence;
(b)
establish, operate, and maintain individual and collective methods or
recommendations for change or improvement in residence operations and programs,
regarding both individual and congregate resident-related issues;
(c) remain active in the care planning process
for the resident; and remain informed in a timely manner about significant issues
regarding the resident's care and supervision needs and changes made to the care
plan.
(ii) Individualized
service plans and case management records shall identify when a resident is
periodically resistant to the provision of personal care services by staff of the
special needs assisted living residence and include a plan for addressing such
services.
(8) Activities
in special needs assisted living.
(i) The
operator shall provide frequent individual and group activities which are geared
towards individuals with special needs and which are meaningful to the residents.
This programming shall be based on initial and on-going, historical and current,
interests, assessments, and observations.
(ii) There shall be sufficient staff to ensure
that activities programs are available throughout every day and
evening.
(iii) Weather permitting,
residents of special needs assisted living residences shall have the opportunity
and be encouraged to be outdoors, each day, with appropriate and sufficient
supervision.
(9) Food
service in special needs assisted living.
(i)
Food should be offered outside of the usual meal times in a manner acceptable to
the special needs assisted living resident and mindful of the resident's
functional abilities, preferences and needs. The resident's care plan should
reflect these needs and preferences.
(ii) To ensure optimal intake at mealtimes,
unless contrary to the physician's orders, prescribed nutritional supplements
shall be provided between and not at the same time as scheduled meals.