§ 2800.231. Admission.
(a) Special care units. This section and §§ 2800.232—2800.239 apply to special care units. These provisions are in addition to the other provisions of this
chapter. A special care unit is a residence or portion of a residence that provides one or both of the following:
(1) Specialized care and services for residents with Alzheimer’s disease or dementia in the least restrictive manner consistent with the resident’s support
plan to ensure the safety of the resident and others in the residence while maintaining the resident’s ability to age in place.
(i) Admission of a resident shall be in consultation with the resident’s family or designated person.
(ii) Prior to admission other service options that may be available to a resident shall be considered.
(2) Intense neurobehavioral rehabilitation for residents with severely disruptive and potentially dangerous behaviors as a result of brain injury in the
least restrictive manner consistent with the resident’s rehabilitation and support plan to ensure the safety of the resident and others in the residence.
(i) Each resident of a special care unit for INRBI shall have a rehabilitation and support plan that supports independence and promotes recovery
and thereby discharge to a less restrictive setting.
(ii) Special care units for INRBI shall provide for each resident to age in place.
(iii) Admission of a resident shall be in consultation with the resident or potential resident and, when appropriate, the resident’s designated person or
the resident’s family, or both.
(iv) Prior to admission other less restrictive service options that may be available to a resident or potential resident shall be considered.
(b) Medical evaluation. A resident or potential resident shall have a medical
evaluation by a physician, physician’s assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior
to admission.
(1) Documentation for a special care unit for residents with Alzheimer’s
disease or dementia must include the resident’s diagnosis of Alzheimer’s disease or dementia and the need for the resident to be served in a special care unit.
(2) Documentation for a special care unit for INRBI must include the resident’s or potential resident’s diagnosis of brain injury and need for residential
services to be provided in a special care unit for INRBI. The evaluation must
include visual function, hearing, swallowing, mobility and hand function.
(c) Preadmission screening.
(1) Special care unit for residents with Alzheimer’s disease or dementia.
(i) A written cognitive preadmission screening completed in collaboration with a physician or a geriatric assessment team and documented on the
Department’s cognitive preadmission screening form shall be completed for
each resident within 72 hours prior to admission to a special care unit.
(ii) A geriatric assessment team is a group of multidisciplinary specialists in the care of adults who are older that conducts a multidimensional
evaluation of a resident and assists in developing a support plan by working with the resident’s physician, designated person and the resident’s family to coordinate the resident’s care.
(2) Special care unit for INRBI.
(i) A written CPB preadmission screening completed in collaboration
with a physician, neuropsychologist or cognitive, physical, behavioral assessment team and documented on the Department’s CPB preadmission screening form
shall be completed for each resident or potential resident within 72 hours prior to admission to a special care unit for INRBI.
(ii) A cognitive, physical, behavioral specialist with brain injury experience shall assist in developing a rehabilitation and support plan by working
with the resident’s physician, neuropsychologist and, when appropriate, the resident’s designated person or the resident’s family, or both to develop the
resident’s rehabilitation and support plan. This plan must include a high level of nursing and behavioral supervision, medication management, occupational
therapy, cognitive therapy, behavioral therapy, vocational services, support for social reentry, and a personalized treatment plan.
(d) Resident admission to special care unit. Each resident record must have documentation that the resident or potential resident and, when appropriate, the
resident’s designated person or the resident’s family have agreed to the resident’s admission or transfer to the special care unit.
(e) Additional assessments.
(1) In addition to the requirements in § 2800.225 (relating to additional assessments), residents of a special care unit for Alzheimer’s disease or dementia
shall also be assessed quarterly for the continuing need for the special care unit for Alzheimer’s disease or dementia.
(2) In addition to the requirements in § 2800.225, residents of a special
care unit for INRBI shall also be assessed at least semiannually or more frequently as necessary to assure the continuing need for residence in the special care unit for INRBI.
(f) Additional resident in special care unit. A spouse, friend or family member who does not have a primary diagnosis of Alzheimer’s disease or dementia
or brain injury may reside in the special care unit if desired by the resident or his designated person.
(1) The spouse, friend or family member shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner,
documented on a form provided by the Department within 60 days prior to admission to the residence or 15 days after admission to the residence.
(2) The spouse, friend or family member shall have access to and be able to follow directions for the operation of the key pads or other lock-releasing
devices to exit the special care unit.
(g) Disclosure of services. The resident-residence contract specified in § 2800.25 (relating to resident-residence contract) must also include a disclosure
of services, admission and discharge criteria, change in condition policies, special programming and costs and fees.
(h) Alzheimer’s disease or dementia. When the residence holds itself out to
the public as providing services or housing for individuals with Alzheimer’s disease or dementia, the residence shall disclose to individuals and provide materials that include the following:
(1) The residence’s written statement of its philosophy and mission which reflects the needs of individuals with Alzheimer’s disease or dementia.
(2) A description of the residence’s physical environment and design features to support the functioning of individuals with Alzheimer’s disease or dementia.
(3) A description of the frequency and types of individual and group activities designed specifically to meet the needs of individuals with Alzheimer’s disease or dementia.
(4) A description of the security measures provided by the residence.
(5) A description of the training provided to staff regarding provision of
care to individuals with Alzheimer’s disease or dementia.
(6) A description of availability of family support programs and family involvement.
(7) The process used for assessment and establishment of a plan of services for the individual, including methods by which the plan of services will remain
responsive to changes in the individual’s condition.
(i) Special care unit for INRBI. When an assisted living residence holds itself out to the public as a special care unit for INRBI, the residence shall disclose and
provide materials to individuals and, when appropriate, the individual’s designated person or the individual’s family, or both, that include the following information:
(1) The residence’s written statement of its philosophy and mission which reflects the needs of individuals with brain injury for intense neurobehavioral
rehabilitation and support.
(2) A description of the residence’s physical environment and design features that support and promote the functioning and rehabilitation of individuals
who need INRBI.
(3) A description of the types of individual and group activities that have been designed specifically to meet the requirements of the rehabilitation and
support plans of specific residents with brain injury.
(4) A description of the security measures provided by the residence.
(5) A description of the credentials and experience required and the training provided to staff regarding the provision of rehabilitation and support for
individuals who require INRBI.
(6) A description of availability of family support programs, family education programs, and family involvement.
(7) The process used for assessment and establishment of a plan of services for the resident, including methods by which the plan of services will remain
responsive to progress in the resident’s recovery.
(j) Residents who wander. The residence shall identify measures to address individuals with Alzheimer’s disease or dementia or with INRBI who have tendencies to wander.
(k) Individuals with INRBI. The residence with a special care unit for INRBI shall identify measures to address individuals who require INRBI who have
problems that may actually impede rehabilitation such as:
(1) Anger.
(2) Self-control.
(3) Aggression toward others.
(4) Self-injury.
(5) Deficient judgment and problem solving due to cognitive deficits.
(6) Frequent agitation.
(7) Prolonged confusional state.
(8) Seizure disorders and related behavioral problems.
(9) Significant memory and learning problems.
(10) Disruption of sleep and wake cycles.
(11) Problems with attention.
(12) Filtering and focusing.
(13) Emergence of mental health problems or exacerbation of preexisting mental health issues.
(14) Emergence of substance abuse problems or exacerbation of preexisting
substance abuse issues.
(15) Other cognitive and behavioral problems which have or would prevent
successful completion of traditional rehabilitation programs.
(l) Professionals caring for individuals requiring INRBI. The residence with
a special care unit for INRBI shall identify at a minimum the following professionals with expertise in providing care for individuals requiring INRBI.
(1) Onsite behavioral specialist.
(2) Onsite cognitive rehabilitation therapist.
(3) A consulting physiatrist; a consulting neuro-psychologist.
(4) A consulting neuropsychiatrist or psychiatrist for prescribing and monitoring the psychiatric medications that may be needed for residents with behavioral health issues.
Cross References
This section cited in 55 Pa. Code § 2800.202 (relating to prohibitions).
§ 2800.232. Environmental protection.
(a) The residence shall provide exercise space, both indoor and outdoor.
(b) No more than two residents may occupy a living unit regardless of its size. A living unit must meet the requirement in § 2800.101 (relating to resident
living units), as applicable. Kitchen facilities may not be included in a living unit located in a special care unit for INRBI.
(c) The residence shall provide space for dining, group and individual activities and visits.
(d) The residence shall provide a full description of the measures implemented to enhance environmental awareness, minimize environmental stimulation
and maximize independence of the residents in public and private spaces
based on the needs of the individuals being served.
(e) The residence with a special care unit for INRBI shall identify the process used to assure conformity of the individual resident’s living unit to the
ongoing rehabilitation recommendations of the neuropsychologist and the cognitive physical, emotional behavioral assessment team as expressed in the current
rehabilitation and support plan.
Cross References
This section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.233. Doors, locks and alarms.
(a) Doors equipped with key-locking devices, electronic card operated systems or other devices that prevent immediate egress are permitted only if there is
written approval from the Department of Labor and Industry, Department of Health or appropriate local building authority permitting the use of the specific
locking system.
(b) A residence shall have a statement from the manufacturer, specific to that residence, verifying that the electronic or magnetic locking system will shut
down, and that all doors will open easily and immediately when one or more of the following occurs:
(1) Upon a signal from an activated fire alarm system, heat or smoke detector.
(2) Power failure to the residence.
(3) Overriding the electronic or magnetic locking system by use of a key pad or other lock-releasing device.
(c) If key-locking devices, electronic card systems or other devices that prevent immediate egress are used to lock and unlock exits, directions for their
operation shall be conspicuously posted near the device.
(d) Doors that open onto areas such as parking lots, or other potentially unsafe areas, shall be locked by an electronic or magnetic system.
(e) Fire alarm systems must be interconnected to the local fire department,
when available, or a 24-hour monitoring service approved by the local fire
department.
§ 2800.234. Resident care.
(a) Support or rehabilitation plan.
(1) Within 72 hours of the admission, or within 72 hours prior to the resident’s admission to the special care unit, a support plan shall be developed,
implemented and documented in each resident’s record.
(2) For individuals being admitted into a special care unit for INRBI, a the rehabilitation plan shall be developed, implemented and documented in the
resident record. This rehabilitation plan and the individual’s support plan shall be based on the CPB preadmission assessment and other available records and
information.
(b) Plan requirements.
(1) The support plan and if applicable, the rehabilitation plan must identify the resident’s physical, medical, social, cognitive and safety needs.
(2) The rehabilitation and support plan for residents of a special care unit
for INRBI must identify the residents’ emotional and behavioral needs.
(c) Responsible individual. The support plan and if applicable, the rehabilitation plan must identify the individual responsible to address the resident’s needs.
(d) Review of plans.
(1) The support plan for a resident of a special care unit for residents with Alzheimer’s disease or dementia shall be reviewed, and if necessary, revised at
least quarterly and as the resident’s condition changes.
(2) The support plan and rehabilitation plan for a resident of a special care unit for INRBI shall be reviewed, and if necessary, revised at least monthly and
as the resident’s condition changes.
(e) Resident involvement in development of plan. The resident, the resident’s designated person or the resident’s family shall be involved in the development
and the revisions of the support plan and if applicable, the rehabilitation plan.
Cross References
This section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.235. Discharge.
(a) If the residence initiates a discharge or transfer of a resident, or the legal entity chooses to close the residence, the administrator shall give a 30-day
advance written notice to the resident, the resident’s designated person and the referral agent citing the reasons for the discharge or transfer. This requirement
shall be stipulated in the resident-residence contract signed prior to admission to the special care unit.
(b) If a resident of a special care unit for INRBI, or when appropriate, the resident’s designated person or the resident’s family, request discharge to another
facility, another assisted living residence or an independent living arrangement, transition services shall be provided by the special care unit.
Cross References
This section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.236. Training.
(a) Each direct care staff person working in a special care unit for residents with Alzheimer’s disease or dementia shall have 8 hours of initial training within
the first 30 days of the date of hire and a minimum of 8 hours of annual training related to dementia care and services, in addition to the 16 hours of annual
training specified in § 2800.65 (relating to staff orientation and direct care staff person training and orientation).
(b) The training for each direct care staff person working in a special care unit for residents with Alzheimer’s disease or dementia at a minimum must
include the following topics:
(1) An overview of Alzheimer’s disease and related dementias.
(2) Managing challenging behaviors.
(3) Effective communications.
(4) Assistance with ADLs.
(5) Creating a safe environment.
(c) Each direct care staff person working in a special care unit for INRBI shall have 8 hours of initial training within the first 30 days of the date of hire
and a minimum of 8 hours of annual training related to brain injury, in addition to the 16 hours of annual training specified in § 2800.65 and any continuing
education required for professional licensing.
(d) The training for each direct care staff person working in a special care unit for INRBI in addition to subsection (b)(3), (4) and (5), must at a minimum
include the following topics:
(1) An overview of brain injury including the common cognitive, physical and behavioral effects.
(2) Understanding and managing challenging behaviors that follow from the cognitive, physical and behavioral effects of brain injury.
(3) Tailoring activities and interactions to provide individualized rehabilitation and support in accordance with the resident’s rehabilitation and support plan.
(4) Coaching and cueing, interactive problem solving, promoting the initiation of self-soothing activities, and timing the fading of supports.
Cross References
This section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.237. Program.
(a) The following types of activities shall be offered at least weekly to residents of a special care unit for residents with Alzheimer’s disease or dementia:
(1) Gross motor activities, such as dancing, stretching and another exercise.
(2) Self-care activities, such as personal hygiene.
(3) Social activities, such as games, music, and holiday and seasonal celebrations.
(4) Crafts, such as sewing, decorations, and pictures.
(5) Sensory and memory enhancement activities, such as review of current
events, movies, storytelling, picture albums, cooking, pet therapy, and reminiscing.
(6) Outdoor activities, as weather permits, such as walking, gardening, and field trips.
(b) Resident participation for residents of a special care unit for residents with Alzheimer’s disease or dementia in general activity programming shall:
(1) Be voluntary.
(2) Respect the resident’s age and cognitive abilities.
(3) Support the retention of the resident’s abilities.
(c) The rehabilitation and support plans of the residents in a special care unit for INRBI will determine the types and frequency of the individual and group
activities to be offered.
Cross ReferencesThis section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.238. Staffing.
Each resident in a special care unit shall be considered to be a resident with mobility needs under § 2800.57(c) (relating to direct care staffing).
Cross References This section cited in 55 Pa. Code § 2800.231 (relating to admission).
§ 2800.239. Application to Department.
(a) The legal entity shall submit an application to the Department at least 60 days prior to the following:
(1) Opening a special care unit.
(2) Adding a special care unit to an existing residence.
(3) Increasing the maximum capacity in an existing unit.
(4) Changing the locking system, exit doors or floor plan of an existing unit.
(b) The Department will inspect and approve the special care unit prior to operation or change. The requirements of this chapter shall be met prior to operation.
(c) The following documents shall be included in the application specified in subsection (a):
(1) The name, address and legal entity of the residence.
(2) The name of the administrator of the residence.
(3) The maximum capacity of the residence.
(4) The requested resident population of the special care unit.
(5) A building description.
(6) A unit description.
(7) The type of locking system.
(8) Policy and procedures to be implemented for emergency egress and resident elopement.
(9) A sample of a 2-week staffing schedule.
(10) Verification of completion of additional training requirements.
(11) The operational description of the special care unit locking system of the doors.
(12) The manufacturer’s statement regarding the special care unit locking system.
(13) A written approval or a variance permitting locked exit doors from the Department of Labor and Industry, the Department of Health or the appropriate
local building authority.
(14) The name of the municipality or 24-hour monitoring service maintaining the interconnection with the residence’s fire alarm system.
(15) A sample plan of care and service for the resident addressing the resident’s physical, medical, social, cognitive and safety needs for the residents.
(16) The activity standards.
(17) The complete medical and cognitive preadmission assessment that is completed upon admission and reviewed and updated annually.
(18) A consent form agreeing to the resident’s placement in the special care unit, to be signed by the resident or the resident’s designated person.
(19) A written agreement containing full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming, costs and fees.
(20) A description of environmental cues being utilized.
(21) A general floor plan of the entire residence.
(22) A specific floor plan of the special care unit, outside enclosed area and exercise space.