Understanding Continued Residency Exceptions for Non-Hospice Residents in Assisted Living Facilities

Understanding Continued Residency Exceptions for Non-Hospice Residents in Assisted Living Facilities
Understanding Continued Residency Exceptions for Non-Hospice Residents in Assisted Living Facilities

Assisted living facilities (ALFs) in Florida must follow strict regulations to ensure residents receive appropriate care while maintaining a home-like environment. One important rule, 59A-36.006(4)(b), outlines specific conditions under which a non-hospice resident with a Stage 2 pressure sore may continue to reside in the facility.

Regulation Breakdown: Continued Residency for Residents with a Stage 2 Pressure Sore

According to 59A-36.006(4)(b), an assisted living resident who develops a Stage 2 pressure sore may continue to reside in the facility only if the following conditions are met:

  1. Proper Care is Secured:
    • The resident must contract directly with a licensed home health agency or a nurse to provide wound care.
  2. Condition is Properly Documented:
    • The presence of the pressure sore must be documented in the resident’s record to ensure proper monitoring and compliance.
  3. Resident’s Condition Must Improve Within 30 Days:
    • If the pressure sore does not show improvement within 30 days, as documented by a healthcare practitioner, the resident must be discharged from the facility.

Key Takeaways for ALF Operators

  • This regulation applies only to non-hospice residents. If a resident is under hospice care, different rules may apply.
  • ALFs cannot provide wound care themselves; the resident must contract outside nursing services.
  • Strict 30-day monitoring is required. If improvement is not documented, the resident must be discharged.
  • Facilities should maintain clear documentation to demonstrate compliance and avoid citations during inspections.

What is a Stage 2 Pressure Sore?

A Stage 2 pressure sore (also known as a Stage 2 pressure ulcer or bed sore) is a type of skin injury that occurs due to prolonged pressure on an area of the body. It is more severe than a Stage 1 sore but still treatable with proper care. These sores most commonly develop in areas where bones are close to the skin, such as the hips, heels, elbows, tailbone, and back of the head.

Characteristics of a Stage 2 Pressure Sore

  • Partial-thickness skin loss: Unlike a Stage 1 sore, which only affects the outermost layer of skin, a Stage 2 sore involves damage to both the epidermis (outer layer) and dermis (deeper layer of skin).
  • Open wound or blister: The sore may appear as a shallow open ulcer with a red or pink wound bed, or it may look like a fluid-filled or ruptured blister.
  • Pain and tenderness: The area is typically painful, swollen, and may feel warm to the touch.
  • No dead tissue (eschar or slough): At this stage, there is no presence of necrotic (dead) tissue, which is characteristic of more severe pressure ulcers.

Common Causes of Stage 2 Pressure Sores

  • Prolonged pressure: Staying in one position for too long (e.g., in a wheelchair or bed) reduces blood flow, leading to tissue damage.
  • Shear and friction: When the skin rubs against a surface, such as bedsheets or a chair, it can break down more easily.
  • Moisture: Excessive moisture from sweat, urine, or wound drainage can weaken the skin and make it more vulnerable to breakdown.

Treatment & Management of Stage 2 Pressure Sores

For assisted living residents, the goal is to prevent worsening of the wound while promoting healing. Treatment generally includes:

1. Pressure Relief

  • Encourage frequent repositioning (every 1-2 hours for bed-bound residents, every 15 minutes for those in wheelchairs).
  • Use specialty cushions or mattresses to distribute pressure evenly.

2. Wound Care

  • Clean the wound with saline or prescribed wound care solutions.
  • Apply appropriate dressings (e.g., hydrocolloid, foam, or silicone-based dressings) to protect the sore and keep it moist for healing.
  • Avoid harsh antiseptics, which can delay healing.

3. Nutrition & Hydration

  • Protein-rich diets and proper hydration help with skin repair.
  • Supplements such as vitamin C and zinc may aid in wound healing.

4. Infection Prevention

  • Monitor for signs of infection (increased redness, swelling, warmth, pus, or foul odor).
  • If infection develops, antibiotics may be needed.

5. Professional Care

  • In an ALF setting, licensed home health agencies or nurses must be involved in treatment.
  • If the wound does not show improvement within 30 days, continued residency in the ALF is no longer allowed under Florida regulation 59A-36.006(4)(b).

Prevention Strategies for Assisted Living Facilities

  • Frequent repositioning of residents to reduce prolonged pressure.
  • Use of pressure-relieving mattresses, cushions, and heel protectors.
  • Proper skincare routines to keep skin clean and dry.
  • Regular skin assessments to detect early signs of breakdown.
  • Encouraging mobility and physical activity to promote circulation.

By understanding and managing Stage 2 pressure sores, ALF operators can ensure compliance with Florida regulations while improving resident care and quality of life.

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