Continued Residency

The pre-residency interview and assessment are perhaps one of the single most important elements of future success for an ARCP and the prospective resident. This is a time where everything is laid out on the table and a chance for both sides to see if it will be a good fit to move forward. Thankfully, the Louisiana DHH provides a thorough guideline as to what is required during this time in the following regulation:

  • 6833. Pre-Residency and Continued Residency
  1. Information to prospective residents. The ARCP shall provide to prospective residents written information regarding conditions for residency, services, costs, fees and policies/procedures. This written information shall include, but is not limited to the following:
  2. the application process and the possible reasons for rejection of an application;
  3. types of residents suitable to the ARCP;
  4. services offered and allowed in the ARCP;
  5. resident’s responsibilities;
  6. policy regarding smoking;
  7. policy regarding pets;
  8. fee structure, including but not limited to any additional costs for providing services to residents during natural disasters (e.g. tropical storms, hurricanes, floods, etc.):
  9. the ARCP shall develop and provide a formula with cost parameters for any additional charges incurred due to disasters; and
  10. criteria for termination of residency agreement.
  11. The ARCP shall complete and maintain a pre-residency screening of the prospective resident to assess the applicant’s needs and appropriateness for residency.
  12. The pre-residency screening shall include:
  13. the resident’s physical and mental status;
  14. the resident’s need for personal assistance;
  15. the resident’s need for assistance with activities of daily living and instrumental activities of daily living; and d. the resident’s ability to evacuate the ARCP in the event of an emergency.
  16. The pre-residency screening shall be completed and dated before the residency agreement is signed.
  17. Prohibited Health Conditions. There are individuals who are not eligible for residency in ARCPs because their conditions and care needs are beyond the scope of the ARCP’s capacity to deliver services and ensure residents’ health, safety, and welfare. ARCPs may not enter into agreements with residents with such conditions. These prohibited health conditions include:
  18. stage 3 or stage 4 pressure ulcers;
  19. nasogastric tubes;
  20. ventilator dependency;
  21. dependency on BiPap, CPAP or other positive airway pressure device without the ability to self-administer at all times:
  22. exception. The resident may remain in the ARCP when a third party is available at all times to administer the positive airway pressure device during the hours of use;
  23. coma;
  24. continuous IV/TPN therapy (TPN¾total parental nutrition, an intravenous form of complete nutritional sustenance);
  25. wound vac therapy (a system that uses controlled negative pressure, vacuum therapy, to help promote wound healing);
  26. active communicable tuberculosis; and
  27. any condition requiring chemical or physical restraints.
  28. ARCP residents with a prohibited condition may remain in residence on a time-limited basis provided that the conditions listed below are met. Time-limited is defined as 90 days.
  29. The resident, the resident’s representative, if applicable, the resident’s physician, and the provider shall agree that the resident’s continued residency is appropriate.
  30. The resident’s physician has certified that the condition is time-limited and not permanent.
  31. The ARCP is prepared to coordinate with providers who may enter the ARCP to meet time-limited needs. Level 4 ARCPs may deliver or contract for the additional services to meet time-limited needs pursuant to this Section.
  32. In accordance with the terms of the residency agreement, the resident or the resident’s representative, if applicable, shall provide for or contract with a third party provider for the delivery of services necessary to meet the residents’ increased health and service needs which are beyond the scope of the services of the ARCP.
  33. It is the responsibility of the ARCP to assure that needed services are provided, even if those services are provided by the resident’s family or by a third party or contracted provider. A copy of such third party contract shall be verifiable, in writing, and retained in the resident’s record. The ARCP retains responsibility for notifying the resident or the resident’s representative, if applicable, if services are not delivered or if the resident’s condition changes.
  34. The ARCP or an affiliated business owned in full or in part by the owner or any member of the board of directors shall not be the third party providing the services.
  35. The care provided, as allowed under this section, shall not interfere with ARCP operations or create a danger to others in the ARCP. E. In level 4 ARCPs, residents whose health needs increase may continue to reside in the ARCP and receive Title 48, Part I 451 Louisiana Administrative Code August 2018 intermittent nursing services from the ARCP in accordance with the PCSP if the services are within the scope provided for in these regulations.
  36. In accordance with the terms of the residency agreement, residents who are receiving hospice services may continue to reside in all levels of the ARCP as long as the resident’s physician, the ARCP, the resident, and/or resident’s legal representative, if applicable, deem that the resident’s needs can be met.
  37. Residency Agreement. The ARCP shall complete and maintain individual residency agreements with all persons who move into the ARCP or with the resident’s representative where appropriate.
  38. The ARCP residency agreement shall specify the following: a. clear and specific criteria for residency continued residency and termination of residency agreements and procedures for termination of residency agreements; b. basic services provided;
  39. optional services;
  40. payment provisions for both basic and optional services, including the following:
  41. service packages and any additional charges for services;
  42. regular/ordinary and extra fees;

iii. payer source;

  1. due dates; and
  2. deposits;
  3. procedures for the modification of the residency agreement, including provision of at least 30 days prior written notice to the resident of any rate change;
  4. requirements around notice before voluntarily terminating the residency agreement;
  5. refund policy;
  6. the delineation of responsibility among the following parties: the ARCP, the resident, the family, the resident’s representative and/or others;
  7. residents’ rights; and
  8. grievance procedures.
  9. The ARCP shall allow the review of the residency agreement by an attorney or other representative chosen by the resident.
  10. The residency agreement shall be signed by the director, or designee, and by the resident or the resident’s representative if applicable.
  11. The residency agreement shall conform to all relevant federal, state, and local laws and requirements.
  12. The residency agreement shall provide a process for involuntary termination of the residency agreement that includes, at a minimum, the following: a. written notice of any adverse action for violation(s) of the terms of the residency agreement that includes the following: i. notice shall allow the resident a minimum of 30 calendar days from date of delivery of the written notice to vacate the ARCP premises; however, the advance notice period may be shortened to 15 calendar days for nonpayment of a bill for a stay at the ARCP; and ii. the notice shall allow a minimum of 10 calendar days for the resident’s corrective action.
  13. The residency agreement shall include provisions for the opportunity for a formal appeal to the DAL for any involuntary termination of the residency agreement in accordance with §6837.B.2-4, including but not limited to, contact information for the DAL.
  14. A request for appeal shall be made within 30 calendar days of receipt of the written notice and the hearing shall be conducted by the DAL in accordance with the Administrative Procedure Act.
  15. When the resident moves in, the ARCP shall:
  16. obtain from the resident or if appropriate, the resident’s representative, the resident’s plan for both routine and emergency medical care which shall include:
  17. the name of the physician(s); and
  18. provisions and authorization for emergency medical care;
  19. provide the resident with a copy of the ARCP’s emergency and evacuation procedures

Top Takeaways:

  1. B. The ARCP shall complete and maintain a pre-residency screening of the prospective resident to assess the applicant’s needs and appropriateness for residency.
  2. The pre-residency screening shall include:
  3. the resident’s physical and mental status;
  4. the resident’s need for personal assistance;
  5. the resident’s need for assistance with activities of daily living and instrumental activities of daily living; and d. the resident’s ability to evacuate the ARCP in the event of an emergency.
  6. The pre-residency screening shall be completed and dated before the residency agreement is signed.

This pre-residency screening builds the most important part of the pre-residency interview; can you meet the needs of the resident? If you cannot provide the care this resident needs it is certainly not a good idea to admit them into your facility.

    1. Stage 3 or stage 4 pressure ulcers; nasogastric tubes; ventilator dependency; dependency on BiPap, CPAP, or other positive airway pressure device without the ability to self-administer at all times: (exception. The resident may remain in the ARCP when a third party is available at all times to administer the positive airway pressure device during the hours of use); coma; continuous IV/TPN therapy (TPN¾total parental nutrition, an intravenous form of complete nutritional sustenance); wound vac therapy (a system that uses controlled negative pressure, vacuum therapy, to help promote wound healing); active communicable tuberculosis; and any condition requiring chemical or physical restraints.

These diagnoses should set off immediate red flashing lights in your brain. No, if and or buts. Any person with these conditions shall not be admitted into your facility.

  1. Know the resident’s evacuation status and plans in case of emergency!!!!

 

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