Admission criteria for Virginia ALFs | VA

One of the biggest struggles that Assisted Living Facilities have is 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 Virginia DOSS provides strict guidelines on who can be accepted into an ALF in the state. Take a look below:

22VAC40-73-310. Admission and retention of residents.

1. No resident shall be admitted or retained:
2. For whom the facility cannot provide or secure appropriate care;
3. Who requires a level of care or service or type of service for which the facility is not licensed or which the facility does not provide; or
4. If the facility does not have staff appropriate in numbers and with appropriate skill to provide the care and services needed by the resident.
5. Assisted living facilities shall not admit an individual before a determination has been made that the facility can meet the needs of the individual. The facility shall make the determination based upon the following information at a minimum:
6. The completed UAI.
7. The physical examination report.
8. A documented interview between the administrator or a designee responsible for admission and retention decisions, the individual, and his legal representative, if any. In some cases, conditions may create special circumstances that make it necessary to hold the interview on the date of admission.
9. A mental health screening in accordance with 22VAC40-73-330 A.
10. An assisted living facility shall only admit or retain individuals as permitted by its use and occupancy classification and certificate of occupancy. The ambulatory or nonambulatory status, as defined in 22VAC40-73-10, of an individual is based upon:
11. Information contained in the physical examination report; and
12. Information contained in the most recent UAI.
13. Based upon review of the UAI prior to admission of a resident, the assisted living facility administrator shall provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. Copies of the written assurance shall be given to the legal representative and case manager, if any, and a copy signed by the resident or his legal representative shall be kept in the resident’s record.
14. All residents shall be 18 years of age or older.
15. No person shall be admitted without his consent and agreement, or that of his legal representative with demonstrated legal authority to give such consent on his behalf.
16. The facility shall not require a person to relinquish the rights specified in § 63.2-1808 of the Code of Virginia as a condition of admission or retention.
17. In accordance with § 63.2-1805 D of the Code of Virginia, assisted living facilities shall not admit or retain individuals with any of the following conditions or care needs:
18. Ventilator dependency;
19. Dermal ulcers III and IV except those stage III ulcers that are determined by an independent physician to be healing;
20. Intravenous therapy or injections directly into the vein, except for intermittent intravenous therapy managed by a health care professional licensed in Virginia or as permitted in subsection K of this section;
21. Airborne infectious disease in a communicable state that requires isolation of the individual or requires special precautions by the caretaker to prevent transmission of the disease, including diseases such as tuberculosis and excluding infections such as the common cold;
22. Psychotropic medications without appropriate diagnosis and treatment plans;
23. Nasogastric tubes;
24. Gastric tubes except when the individual is capable of independently feeding himself and caring for the tube or as permitted in subsection K of this section;
25. Individuals presenting an imminent physical threat or danger to self or others;
26. Individuals requiring continuous licensed nursing care;
27. Individuals whose physician certifies that placement is no longer appropriate;
28. Unless the individual’s independent physician determines otherwise, individuals who require maximum physical assistance as documented by the UAI and meet Medicaid nursing facility level of care criteria as defined in the State Plan for Medical Assistance Program (12VAC30-10); or
29. Individuals whose physical or mental health care needs cannot be met in the specific assisted living facility as determined by the facility.
30. When a resident has a stage III dermal ulcer that has been determined by an independent physician to be healing, periodic observation and any necessary dressing changes shall be performed by a licensed health care professional under a physician’s or other prescriber’s treatment plan.
31. Intermittent intravenous therapy may be provided to a resident for a limited period of time on a daily or periodic basis by a licensed health care professional under a physician’s or other prescriber’s treatment plan. When a course of treatment is expected to be ongoing and extends beyond a two-week period, evaluation is required at two-week intervals by the licensed health care professional.
32. At the request of the resident in an assisted living facility and when his independent physician determines that it is appropriate, care for the conditions or care needs (i) specified in subdivisions H 3 and H 7 of this section may be provided to the resident by a physician licensed in Virginia, a nurse licensed in Virginia or a nurse holding a multistate licensure privilege under a physician’s treatment plan, or a home care organization licensed in Virginia or (ii) specified in subdivision H 7 of this section may also be provided to the resident by facility staff if the care is delivered in accordance with the regulations of the Board of Nursing for delegation by a registered nurse, 18VAC90-19-240 through 18VAC90- 19-280, and 22VAC40-73-470 E. This standard does not apply to recipients of auxiliary grants.
33. When care for a resident’s special medical needs is provided by the licensed staff of a home care agency, the assisted living facility direct care staff may receive training from the home care agency staff in appropriate treatment monitoring techniques regarding safety precautions and actions to take in case of emergency. This training is required prior to direct care staff assuming such duties. Updated training shall be provided as needed. The training shall include content based on the resident’s specific needs. The training shall be documented and maintained in the staff record.
34. Notwithstanding § 63.2-1805 of the Code of Virginia, at the request of the resident, hospice care may be provided in an assisted living facility under the same requirements for hospice programs provided in Article 7 (§ 32.1-162.1 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia if the hospice program determines that such program is appropriate for the resident. However, to the extent allowed by federal law, no assisted living facility shall be required to provide or allow hospice care if such hospice care restrictions are included in a disclosure statement that is signed by the resident prior to admission. If hospice care is provided, there shall be a written agreement between the assisted living facility and any hospice program that provides care in the facility. The agreement shall include:
35. Policies and procedures to ensure appropriate communication and coordination between the facility and the hospice program;
36. Specification of the roles and responsibilities of each entity, including a listing of the services that will generally be provided by the facility and the services that will generally be provided by the hospice program;
37. Acknowledgment that the services provided to each resident shall be reflected on the individualized service plan as required in 22VAC40-73-450 D; and
38. Signatures of an authorized representative of the facility and an authorized representative of the hospice program.

Top Takeaways:

• Assisted living facilities shall not admit an individual before a determination has been made that the facility can meet the needs of the individual. The facility shall make the determination based upon the following information at a minimum:

Census is low…should you take a chance on a resident who is on the borderline of acceptance? Absolutely not. If you take a resident that you cannot meet the needs of you are opening the facility up to many potential violations with DOSS, not to mention possible litigation if there happens to be an adverse situation down the road.

• In accordance with § 63.2-1805 D of the Code of Virginia, assisted living facilities shall not admit or retain individuals with any of the following conditions or care needs: 1-12

Your clinical and marketing team needs to be on the same page and understand the regulation as to what absolute NON-ADMISSIONS into your community are. Avoiding potential issues by communicating your clinical capabilities is key here.