Immediate Transfers of Residents

As we continue to age, we will undoubtedly need more help with activities of daily living due to new clinical issues that arise. The same is true for your residents. While you may have conducted an initial assessment in conjunction with the resident’s medical provider things certainly will change for the resident over time. Thankfully the ADPH has given ALFs guidelines as to how we can maintain the clinical care of residents as they age.

420-5-4-.06 Care of Residents

(3) Health Supervision

(a) Initial Assessment. No more than 30 days prior to admission, the facility shall assess prospective residents for facility eligibility. This assessment shall document identified care needs and serve as a baseline for future assessments.

(b) Monthly Assessments. The facility shall assess each resident monthly and more often when necessary to identify changes in resident’s status. In addition to other items that may be required by the facility’s own policies and procedures, the monthly assessment shall:

  1. Assess the resident’s ability to safely self-manage medications or safely self-administer medications with assistance.
  2. Accurately weigh and record the weight of each resident. A significant weight loss is defined as a five percent or greater weight loss in a period of one month or less, or a seven and a half or greater weight loss in a period of three months or less, or a ten percent or greater weight loss in a period of 6 months or less. Any weight loss shall be considered to be an unplanned weight loss unless the affected resident has been placed on a restricted-calorie diet specifically for the purpose of reducing the resident’s weight, and such diet has been approved by the resident’s attending physician.
  3. The document identified changes in resident status.
  4. Assess the appropriateness of each resident’s plan of care. Any decline in resident status requires immediate implementation and documentation of interventions or reassessment of existing interventions.

(c) Observation. Each assisted living facility shall provide a general observation and health supervision of the residents to identify changes in all residents’ health conditions and physical abilities, and awareness of the need for medical attention or nursing services as the changes develop. Whenever a resident requires medical attention, nursing services, or changes in personal care and assistance with activities of daily living provided by the facility, the facility shall arrange for or assist the residents in obtaining necessary services.

(d) Services Beyond Capability of Assisted Living Facility. Whenever a resident requires hospitalization, medical, nursing, or other care beyond the capabilities and facilities of the assisted living facility, arrangements shall be made to discharge the resident to an appropriate setting, or to transfer the resident promptly to a hospital or other health care facility able to provide the appropriate level of care.

(e) Care During Emergency or Illness. The resident’s attending physician, or a backup physician, if the attending physician is unavailable, shall be promptly called at the onset of an illness or in case of an accident or injury to a resident. In case of a medical emergency that could result in death, serious medical impairment, or disability to a resident, the local EMS system shall be 7 activated by calling 911 or another emergency local telephone numbers.

(f) All assisted living facilities shall maintain the following telephone numbers, properly identified, and posted in a prominent location readily accessible and known to all staff members:

  1. Each resident’s attending physician, and the facility’s backup physician or physicians.
  2. 911, or the local emergency telephone number if the community is not served by a 911 telephone service.

(g) Mechanical Restraint and Seclusion. No form of physical restraint or seclusion shall be applied to residents of an assisted living facility except in extreme emergency situations when the resident presents a danger of harm to himself or herself or to other residents. In such an event, the facility shall use the least restrictive intervention that will be effective to protect residents, immediately notify the resident’s physician and sponsor, and appropriate treatment, transfer to an appropriate health care facility, or both shall be provided without any avoidable delay. In no event shall emergency behavioral symptoms of residents be treated with sedative medications, anti-psychotic medications, anti-anxiety medications, or other psychoactive medications in an assisted living facility.

(h) Resident Abuse, Neglect, and Exploitation. Each facility shall develop and implement a policy and procedure to protect each resident of the facility from abuse, neglect, and exploitation. The facility shall ensure that all staff can demonstrate an understanding of what constitutes abuse, neglect, and exploitation, and shall ensure that all staff understands his or her responsibility to immediately report suspected, alleged, confessed, witnessed, or actual incidents of abuse, neglect, or exploitation of a resident to the administrator. When abuse, neglect, or exploitation is suspected, alleged, confessed, witnessed, or actual the facility shall conduct and document a thorough investigation and take appropriate action to prevent further abuse. All allegations, suspicions, confessions, witnessed, or actual incidents shall be reported to the Assisted Living Unit of the Alabama Department of Public Health and to the victim’s sponsor or responsible family member within 24 hours. Suspected, alleged, confessed, witnessed, or actual abuse, neglect, or exploitation of a resident shall be reported to the Department of Human Resources or law enforcement in accordance with Code of Ala. 1975, Section 38-9-8. At any time that a resident has been the victim of sexual assault or sexual abuse perpetrated by a staff member or visitor, local law enforcement authorities shall be immediately notified.

(i) Laboratory Tests. Any facility conducting or offering laboratory tests for its residents, including routine blood glucose monitoring, shall comply with federal law, and specifically with the applicable requirements of the federal Clinical Laboratory Improvement Act (CLIA) as well as with applicable federal regulations. This requirement in some cases would require the facility to obtain a CLIA certificate, and in other cases would require the facility to obtain a CLIA waiver. For more information about CLIA requirements, a facility may contact the Department, Bureau of Health Provider Standards. For testing or monitoring requiring blood, either the resident must draw his or her own blood or the blood must be drawn by a physician, an RN or LPN, or a phlebotomist from a licensed Independent Clinical Laboratory. Blood and blood products, needles, sharps, and other paraphernalia involved in collecting blood must be handled in a manner consistent with the requirements of the federal occupational safety and health administration (OSHA). Personnel handling such materials must be vaccinated against blood-borne diseases if such vaccinations are required by OSHA. Blood, blood products, needles, sharps, and other paraphernalia involved in collecting blood shall be treated as medical waste and shall be disposed of in a manner compliant with the requirements of the State of Alabama Department of Environmental Management.


  • Create a tickler system to track residents who need their monthly assessment. Assign this task to the same team monthly to ensure consistency and accuracy.