Admission and Resident Retention

One of the biggest struggles that Assisted Living Facilities have is a low census, which often leads to hasty decisions when it comes to who you accept as a resident into your community- remember not everyone is a fit nor will you be able to provide the care that each potential resident may need. The Georgia Department of Community Health provides strict guidelines on who can be accepted into an ALF in the state. Take a look below:

111-8-63-.15 Admission and Resident Retention

(1) Resident Profile for Admission. The assisted living community must determine that the potential resident must meet

all of the following criteria at the time of admission:

(a) The resident must be an adult who is at least 18 years of age.

(b) The resident must not have active tuberculosis or require continuous medical or nursing care and treatment or require physical or chemical restraints, isolation, or confinement for behavioral control.

(c) The resident’s physical condition must be such that the resident is capable of actively participating in transferring from place to place.

(d) The resident must be able to participate in the social and leisure activities provided in the assisted living community.

(2) Evaluation of Applicants for Admission. In determining whether the assisted living community will be able to meet the needs of the applicant for admission to the assisted living community, the administrator or on-site manager of an assisted living community must consider and maintain documentation of the following:

(a) the information provided in an interview with the applicant and/or representative or legal surrogate, if any, regarding the applicant’s care and social needs and behavioral issues that may require more watchful oversight;

(b) a physical examination conducted by a licensed physician, nurse practitioner, or physician’s assistant dated within  30 days prior to the date of admission which reflects that the resident does not require continuous medical or nursing care and services and is free of active tuberculosis. The report of the physical examination must be completed on forms made available by the Department;

(c) either the results of an inquiry of the National Sex Offender Registry website coordinated by the Federal Bureau of Investigation or a fingerprint records check;

(d) where the applicant for admission is a registered sex offender or has committed another violent crime, the assisted living community must document the additional safety measures that the assisted living community will employ to ensure the safety of all residents, such as additional monitoring, room, and roommate selection and in-servicing of staff; and

(e) whether the applicant for admission has retained the services of a designated proxy caregiver that complies with the requirements of the Rules and Regulations for Proxy Caregivers

Used In Licensed Healthcare Facilities, Chapter 111-8-100.

(3) Emergency Placement. Where the applicant for admission is being evaluated for admission pursuant to an emergency placement made at the request of the Adult Protective Services Section of the Division of Aging Services, Department of Human Services or another licensed facility that is requesting the placement pursuant to activation of its emergency preparedness plan for relocation of residents, the complete physical examination required by Rule 111-8-63-.16(2)(b) may be deferred for up to 14 days after the emergency admission if no record of a qualifying physical examination or a copy of a current clinical record is available at the time of admission.

(4) Community Admission Decisions. The assisted living community must not admit residents who either do not meet the admission profile or who meet the profile but whose care needs cannot be met by staff available to provide assistance. The assisted living community’s decision to admit a resident must reflect that it has taken into account the condition of the resident to be admitted, the needs of currently admitted residents, the assistance with self-preservation current residents require, and the construction of the building including whether such building meets the state fire safety requirements applicable to an existing health care occupancy.

(5) Community Retention Decisions. The assisted living community must require a resident to move out when any one of the following occurs:

(a) The resident requires continuous medical or nursing care.

(b) The resident’s specific care needs cannot be met by available staff in the community, e.g., the resident is not ambulatory and not capable of assisted self-preservation.

(c) The community is not able to evacuate all of the current residents to a point of safety within established fire safety standards.

(6) Change in Condition Requiring Reevaluation. In the event, a resident develops a significant change in physical or a mental condition, the assisted living community must obtain the medical information necessary to determine that the resident continues to meet the retention requirements and the assisted living community is capable of meeting the resident’s needs. Where the Department has reason to believe either that the assisted living community cannot meet the needs of the resident or the resident no longer meets the retention criteria for living in the licensed assisted living community, the governing body must provide to the Department, upon request, a current physical examination for the resident from a physician, advanced practice a registered nurse or physician’s assistant as properly authorized.

Upon your initial clinical assessment of the resident, I would suggest paying close attention to these important regulations:

(b) a physical examination conducted by a licensed physician, nurse practitioner, or physician’s assistant dated within  30 days prior to the date of admission which reflects that the resident does not require continuous medical or nursing care and services and is free of active tuberculosis. 

This must be the single most common tag that communities are faced with when being surveyed. It is imperative that every resident is given a physical exam at a minimum of 30 days prior to the resident being admitted into the community and documented on the form provided by the GA Department of Community Health. This document would also need to be revised with each change in condition while they are a resident in your community. You must also decide at that point whether the resident will be able to continue residency based upon their needs (Section 5 A-C). The biggest take away- Do not risk a tag for a potential resident whose needs cannot be met. 

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