When providing care to residents there may be an adverse change in condition or an accident that causes the resident to become unresponsive. While this can be alarming, assisted living facilities in the state of Georgia to have a responsibility to their residents when they note a change in the condition of the resident’s health. Ensure you have a policy in place to address the following regulation provided by the Georgia Department of Community Health:
111-8-63-.26 Procedures for Change in Resident’s Condition
(1) In case of an accident or sudden adverse change in a resident’s condition or adjustment, an assisted living community must immediately take the actions appropriate to the specific circumstances to address the needs of the resident, including notifying the representative or legal surrogate, if any. The assisted living community must retain a record of all such adverse changes and the assisted living community’s response in the resident’s files.
(2) Where the sudden change in the resident’s condition causes the resident to become unresponsive, the assisted living community must immediately take one of the following actions:
(a) If the resident is enrolled in a licensed hospice and has a specific hospice plan of care, the assisted living community must contact the hospice for directions regarding the care to be provided. If the hospice staff is not available to provide direction, then the assisted living community must immediately contact the duly-appointed health care agent for direction. If no health care agent has been appointed or is not available, then the assisted living community must immediately contact emergency medical services to arrange for emergency transport and must initiate cardiopulmonary resuscitation if no DNR order has been written.
(b) If the resident has a valid Do Not Resuscitate (DNR) order readily available, the caregiver may effectuate the DNR order if done in good faith.
(c) If the resident has appointed a health care agent in a living will, durable power of attorney for health care or an advance directive for health care which complies with the requirements of O.C.G.A. § 31-32-1et seq., then the assisted living community must immediately contact the health care agent for directions regarding the care to be provided. Where the health care agent is not immediately available and there is no valid DNR order for the resident, the assisted living community must immediately contact emergency medical services to arrange for emergency transport and must initiate cardiopulmonary resuscitation.
(d) If the resident is not enrolled in hospice, and does not have either a DNR or an advance directive, then the staff of the assisted living community must immediately contact emergency medical services to arrange for emergency transport and must initiate cardiopulmonary resuscitation where it is not obvious from physical observation of the resident’s body (e.g. body is stiff, cool to the touch, blue or grayish in color, etc.) that such efforts would be futile and there is not a physician, or authorized registered nurse or physician’s assistant on-site to assess and provide other direction.
(2) The staff must have ready access to phone numbers for emergency medical personnel and the resident’s file or appropriate emergency medical and contact information for each resident, both at the assisted living community and when residents are being transported by the assisted living community for any reason.
(3) Immediate investigation of the cause of an accident, injury, or death involving a resident must be initiated by the administrator or on-site manager of the assisted living community and a report made to the representative or legal surrogate, if any, with a copy of the report maintained in the resident’s file and in a central file for quality assurance review.
Top three takeaways:
- Always communicate any change in condition to the appropriate personnel based on circumstance. This could be a healthcare surrogate, representative, emergency personnel, or hospice services. At times it may be necessary to contact all of those parties depending on the specific situation.
- Keep a record of ANY and ALL change of condition in the resident’s clinical file.
- Have a procedure in place for staff to be knowledgeable of and ready to perform when these potential life-threatening instances occur.