Standards of care in the ALF admission/discharge process
One of the biggest struggles that Assisted Living Facilities have is low census and the ability to find qualified prospective residents. This often leads to hasty decisions when it comes to who you accept as a resident into your community- remember, not everyone is a good fit, nor will you be able to provide the care that each potential resident may need. Not being equipped to care for a resident’s needs will ultimately lead to the discharge process. The West Virginia Office of Healthcare Facility Licensure and Certification provides strict guidelines on who can be accepted into an ALF in the state. Check out the following regulation for more information:
- 64-14-6. Health Care Standards.
6.1. Admission and Discharge.
6.1.1. The licensee shall not admit to the assisted living residence individuals requiring ongoing or extensive nursing care and shall not admit or retain individuals requiring a level of service that the residence is not licensed to provide or does not provide. (Class I)
6.1.2. A resident whose condition declines after admission and is receiving services coordinated by a licensed hospice or certified home health agency, may receive these services in the residence if the residence has a backup power generator for services using equipment that requires auxiliary electrical power in the event of a power failure. The licensee shall ensure that a resident who requires ongoing or extensive nursing care is provided the care and services necessary to meet his or her needs. The provision of services to the residence receiving nursing care or hospice care shall not interfere with the provision of services to other residents. (Class I)
6.1.3. If a resident exhibits symptoms of a mental or developmental disorder that pose a risk to self or others, and the resident is not receiving behavioral health services, the licensee shall advise the resident or his or her legal representative of the behavioral health service options within the community. The resident shall have 30 days to obtain necessary services. If the resident or his or her legal representative fails to seek treatment in a timely manner and the risk persists, then the licensee after consultation with the resident’s physician, shall refer the resident to a licensed behavioral health provider. (Class II)
6.1.4. The licensee shall seek immediate treatment for a resident or may refuse to admit or retain a resident if there is reason to believe that the resident may suffer serious harm, or is likely to cause serious harm to himself, herself or to others, if appropriate interventions are not provided in a timely manner. (Class I)
6.1.5. If a resident has care needs that exceed the level of care for which the residence is licensed or can provide, the licensee shall inform the resident, or his or her legal representative in writing, of the need to move to a health care facility that can provide the needed level of care. (Class III)
6.1.6. The licensee shall assist the resident, or his or her legal representative, to secure placement in another health care facility and shall document in the resident’s record the efforts made to obtain placement. (Class III)
6.1.7. Prior to transfer or discharge of a resident, the licensee shall prepare a summary to accompany the resident that includes the resident’s medical history, functional needs assessment and service plans, the current physician’s orders, the resident’s advanced directives, any allergies and pertinent progress notes. The licensee shall retain a copy of such documentation in the resident’s record. (Class II)
Top Takeaways:
- 1.2. A resident whose condition declines after admission and is receiving services coordinated by a licensed hospice or certified home health agency, may receive these services in the residence if the residence has a backup power generator for services using equipment that requires auxiliary electrical power in the event of a power failure. The licensee shall ensure that a resident who requires ongoing or extensive nursing care is provided the care and services necessary to meet his or her needs. The provision of services to the residents receiving nursing care or hospice care shall not interfere with the provision of services to other residents. (Class I)
If a resident in your facility begins to decline and you are able to contract with agencies such as hospice or HHC they will be able to remain in the facility. If you cannot provide the care or contract with third parties, they must be discharged to a higher level of care.
- 1.6. The licensee shall assist the resident, or his or her legal representative, to secure placement in another health care facility and shall document in the resident’s record the efforts made to obtain placement. (Class III)
If you do have to discharge a resident, you should make every effort to assist them in the search with finding a more appropriate facility. Ensure you document the process as it will likely be needed by inspectors if the DC is appealed.
Pro Tip:
- Clinical, administration and marketing need to be on the same page when it comes to the type of resident you are looking to admit into the community. Ensure you have a process on how to identify the proper fit for you. A red light, yellow light, green light system has proven to work for many facilities.