MEMORY CARE UNITS:  An assisted living facility that provides a memory care unit to serve residents with dementia shall comply with the provisions of subsection A-J below in addition to the rules applicable to all assisted living facilities, 7.8.2 NMAC.

  1.             Additional definitions:  The following definitions, in addition to those in NMAC, shall apply.

                                (1)           “Alzheimer’s” means a brain disorder that destroys brain cells, causing problems with memory, thinking and behavior that are severe enough to affect work, lifelong hobbies or social life.  Alzheimer’s gets progressively worse and is fatal.

                                (2)           “Care coordination agreement requirement” means a written document that outlines the care and services that are provided by other outside agencies for assisted living residents that require additional care and services.

                                (3)           “Dementia” means loss of memory and other mental abilities severe enough to interfere with daily life.  It is caused by changes in the brain.

                                (4)           “Memory care unit” means an assisted living facility or part of or an assisted living facility that provides added security, enhanced programming and staffing appropriate for residents with a diagnosis of dementia, Alzheimer’s disease or other related disorders causing memory impairments and for residents whose functional needs require a specialized program.

                                (5)           “Secured environment” means locked (secured/monitored) doors/fences that restrict access to the public way for residents who require a secure unit.

  1.             Care coordination requirement. An assisted living facility that accepts residents with memory issues shall determine which additional services and care requirements are relevant to the resident and disease process.

                                (1)           The medical diagnosis and ISP shall be utilized in the determination of the need for additional services.

                                (2)           The assisted living facility shall ensure the coordination of services and shall have evidence of an agreement of care coordination for all services provided in the facility by an outside health care provider.

  1.             Employee training.  In addition to the training requirements for all assisted living facilities, pursuant to NMAC, all employees assisting in providing care for memory unit residents shall have a minimum of twelve (12) hours of training per year related to dementia, Alzheimer’s disease, or other pertinent information.
  2.             Individual service plan (ISP).  An assisted living facility that admits memory care unit residents shall create an ISP in coordination with the resident’s primary care practitioner, in compliance with the requirements outlined in “Individual Service Plan,” NMAC, pursuant to a team meeting as described in “Exceptions to admission, readmission and retention,” Subsection C of NMAC, and which ensures the following criteria:

                                (1)           identification of the resident’s needs specific to the memory care unit and the services that are provided; each memory unit resident shall receive the services necessary to meet the individual resident’s needs;

                                (2)           medications shall be self-administered, self-administered with assistance by an individual that has completed a state approved program in medication assistance or administered by the following individuals:

                                                (a)           a physician;

                                                (b)           a physician extender (PA or NP);

                                                (c)           a licensed nurse (RN or LPN);

                                                (d)           the resident if their PCP has approved it;

                                                (e)           family or family designee; and

                                                (f)            any other individual in accordance with applicable state and local laws.

  1.             Assessments and reevaluations.

                                (1)           An assessment shall be completed by a registered nurse or a physician extender within fifteen (15) days prior to admission.  When emergency placement is warranted the fifteen (15) day assessment shall be waived and the assessment shall be completed within five (5) days after admission.

                                                (a)           The resident shall have a medical evaluation and documentation by a physician, physician’s assistant or a nurse practitioner within six (6) months of admission.

                                                (b)           The pre-admission assessment shall include written findings, an evaluation of less restrictive alternatives and the basis for the admission to the secured environment.  The written documentation shall include a diagnosis from the resident’s PCP of Alzheimer’s disease or other dementia and the need for the resident to reside in a memory care unit.

                                                (c)           Only those residents who require a secured environment placement or whose needs can be met by the facility, as determined by the assessment prior to admission or on review of the individual service plan (ISP), shall be admitted.

                                (2)           A re-evaluation must be completed every six (6) months and when there is a significant change in the medical or physical condition of the resident that warrants intervention or different care needs, or when the resident becomes a danger to self or others, to determine whether the resident’s stay in the assisted living facility memory care unit is still appropriate.

  1.             Documentation in the resident’s record.  In addition to the required documentation pursuant to NMAC, the following information shall be documented in the resident’s record:

                                (1)           the physician’s diagnosis for admission to a secure environment or a memory care unit;

                                (2)           the pre-admission assessment; and

                                (3)           the re-evaluation(s).

  1.             Secured environment.

                                (1)           Memory care unit residents may require a secure environment for their safety.  A secured environment is any locked (secured/monitored) area in which doors and fences restrict access to the public way.  These include but are not limited to:

                                                (a)           double alarm systems;

                                                (b)           gates connected to the fire alarm; and

                                                (c)           tab alarms for residents at risk for elopement.

                                (2)           In addition to the interior common areas required by this rule, the facility shall provide a safe and secure outdoor area for the year round use by the residents.

                                                (a)           Fencing or other enclosures shall prevent elopement and protect the safety and security of the residents.

                                                (b)           Residents shall be able to independently access the outdoor areas.

                                (3)           Locked areas shall have an access code or key which facility employees shall have available on their person or on the locking unit itself at all times.

  1.             Resident rights.  In addition to the requirements pursuant to NMAC, the following shall apply:

                                (1)           the resident’s rights may be limited as required by their condition and as identified in the ISP;

                                (2)           the resident who believes that he or she has been inappropriately admitted to the secured environment may request the facility in contact the resident’s legal guardian, or an advocate such as the ombudsman or the primary care practitioner; upon request, the facility shall assist the resident in making such contact.

  1.              Disclosure to residents.  A facility that operates a secured environment shall disclose to the resident and the resident’s legal representative, if applicable and prior to the resident’s admission to the facility, that the facility operates a secured environment.

                                (1)           The disclosure shall include information about the types of resident diagnosis or behaviors that the facility provides services for and for which the staff are trained to provide care for.

                                (2)           The disclosure shall include information about the care, services and the type of secured environment that the facility and trained staff provide.

  1.              Staffing.  The facility shall provide the sufficient number of trained staff members to meet the additional needs of the residents in the secured environment.  There must be at least one (1) trained staff member awake and in attendance in the secured environment at all times.

[ NMAC – N, 1/15/2010]