Coordinating services for ALR residents

One of the most common reasons why a person may move into an assisted living residence is the fact that they need assistance with their activities of daily living. These ADL’s may include tasks such as assistance with using the restroom, brushing their teeth, getting dressed for the day or even being tucked in for a night’s sleep. That is where we come in- our job is to make our residents feel as independent as possible while providing this delicate care for things they either do not want to do or tasks they cannot perform. For more information on what services the state of Massachusetts expects your residence to perform check out the following regulation:

12.04: General Requirements for an Assisted Living Residence

(2) Service and Service Coordination Requirements.

(a) Each Assisted Living Residence shall designate at least one Service Coordinator. The Service Coordinator shall be qualified by training and experience and shall be responsible for the following:

  1. Reviewing with the Resident the assessment and service options available to address needs and preferences identified under 651 CMR 12.04(6) and (7);
  2. Implementation of the service plan developed under 651 CMR 12.04(7);
  3. Monitoring the Resident’s needs and the services provided by the Residence to address those needs;
  4. Coordinating with and participating in the Quality Improvement and Assurance program, as set forth under 651 CMR 12.04(10); and
  5. Maintaining complete and accurate records of service plans.

(b) The Sponsor of the Assisted Living Residence shall provide or arrange for the provision of the following services by personnel meeting standards for professional qualifications and training set forth in 651 CMR 12.05, 12.07, and 12.08:

  1. For all Residents whose service plans so specify, supervision of and assistance with Activities of Daily Living, including at a minimum bathing, dressing, and ambulation and similar tasks; and supervision or assistance with Instrumental Activities of Daily Living including at a minimum laundry, housekeeping, socialization and similar tasks;
  2. Self-administered Medication Management (SAMM) of prescription or over-the counter medication, if specified by a Resident’s service plan. When assisting a Resident to self-administer medication the individual performing SAMM must:
  3. remind the Resident to take the medication;
  4. check the package to ensure that the name on the package is that of the Resident;
  5. observe the Resident take the medication; and
  6. document in writing the observation of the Resident’s actions regarding the medication (e.g., whether the Resident took or refused the medication, the date and time).

If requested by the Resident, the individual performing SAMM may open prepackaged medication or open containers, read the name of the medication and the directions on the label to the Resident, and respond to any questions the Resident may have regarding those directions.

The Residence may assist a Resident with SAMM from a medication container that has been removed from its original pharmacy-labeled packaging or container by another person (e.g., by the Resident’s family). Such assistance is not required of the Residence. If this service is to be provided, the Residence and Resident shall have a full written disclosure of the risks involved and consent by the Resident.

SAMM shall only be performed by an individual who has completed Personal Care Service Training as set forth in 651 CMR 12.07(4) or (8); a practitioner, as defined in M.G.L. c. 94C; or a nurse registered or licensed under the provisions of M.G.L. c. 112, § 74 or 74A to the extent allowed by laws, regulations and standards governing nursing practice in Massachusetts. Central storage of Residents’ medications in an area outside of a Resident’s Unit is prohibited. Residences shall provide a refrigerator to store medication in the Resident’s Unit if refrigeration is required, and may employ a locked location in which to safely store medications within a Unit.

  1. Timely assistance to Residents and prompt response to urgent or emergency needs:
  2. By the presence of 24 hour per day on-site staff;
  3. By the provision of personal emergency response systems for each Resident if the service plan requires or other means for the purpose of signaling such staff; and
  4. Any additional response systems EOEA may require in accordance with the service needs of the Residents.
  5. Up to three regularly scheduled meals daily (minimum of one meal per day). All Assisted Living Residences shall use daily recommended dietary allowances as established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences set forth in the Title III of the Older Americans Act as amended (42 USC 3030g) as a minimum dietary standard. In addition to the foregoing, at a minimum an Assisted Living Residence shall provide or arrange for the availability of food selections that would permit a Resident to adhere to a diet consistent with the most recent edition of Dietary Guidelines for Americans and dietary plans that do not require complex calculations of nutrients or preparation of special food items. These dietary plans shall include sodium restricted, sugar restricted and low fat. The Residence shall have a qualified dietitian review the Residence’s dietary plans at least every six months.

Top Takeaways:

  • (a) Each Assisted Living Residence shall designate at least one Service Coordinator. The Service Coordinator shall be qualified by training and experience and shall be responsible for the following: 1-5

You must have a designated person responsible for the coordination and implementation of a resident’s service plan. Many communities refer to this person as the Director of Health and Wellness, Director of Nursing or something of the sort. This is the point person for all resident healthcare needs.

  • Self-administered Medication Management (SAMM) of prescription or over-the counter medication, if specified by a Resident’s service plan. When assisting a Resident to self-administer medication the individual performing SAMM must:

Perhaps one of the most important elements of a resident’s care is the proper distribution of their medication. Think about it- these people are entrusting us with their life. The medication that often keeps them functioning and at times even alive rests in our care. It is necessary for your entire clinical team to be well versed in the regulation that is applicable to their position. The Nursing Director or their designee should hold frequent refresher trainings and have processes put into place for all matters related to the SAMM process.

  • remind the Resident to take the medication;
  1. check the package to ensure that the name on the package is that of the Resident;
  2. observe the Resident take the medication; and
  3. document in writing the observation of the Resident’s actions regarding the medication (e.g., whether the Resident took or refused the medication, the date and time).

These are integral parts of the SAMM process and will be reviewed by the EOEA inspectors to ensure the residences staff is compliant with all aspects of self-administered medication management.

 

 

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