What care services can ALFs provide? -AZ

What care services can ALFs provide

What care services can ALFs provide?

One of the most common reasons why a person may move into an Assisted Living Facility 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. The state of Arizona describes the different types of care services ALFs are prohibited to provide to residents. For more information on what the Bureau of Residential Facilities Licensing considers ‘direct’ or ‘personal care’ services check out the regulation below:

R9-10-815. Directed Care Services

  1. A manager shall ensure that a resident’s representative is designated for a resident who is unable to direct self-care.
  2. A manager of an assisted living facility authorized to provide directed care services shall not accept or retain a resident who, except as provided in R9-10-814(B)(2):
  3. Is confined to a bed or chair because of an inability to ambulate even with assistance; or
  4. Has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner.
  5. In addition to the requirements in R9-10-808(A)(3), a manager shall ensure that the service plan for a resident receiving directed care services includes:
  6. The requirements in R9-10-814(F)(1) through (3);
  7. If applicable, the determination in R9-10-814(B)(2)(b) R9-10-814(B)(2)(b)(iii);
  8. Cognitive stimulation and activities to maximize functioning;
  9. Strategies to ensure a resident’s personal safety;
  10. Encouragement to eat meals and snacks;
  11. Documentation:
  12. Of the resident’s weight, or
  13. From a medical practitioner stating that weighing the resident is contraindicated; and
  14. Coordination of communications with the resident’s representative, family members, and, if applicable, other individuals identified in the resident’s service plan.
  15. A manager shall ensure that an employee does not provide non-prescription medication to a resident receiving directed care services unless the resident has an order from a medical practitioner for the non-prescription medication.
  16. A manager shall ensure that:
  17. A bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies is available in a bedroom being used by a resident receiving directed care services; or
  18. An assisted living facility has implemented another means to alert a caregiver or assistant caregiver to a resident’s needs or emergencies.
  19. A manager of an assisted living facility authorized to provide directed care services shall ensure that:
  20. Policies and procedures are established, documented, and implemented that ensure the safety of a resident who may wander;
  21. There is a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend the increased physical effort that meets one of the following:
  22. Provides access to an outside area that:
  23. Allows the resident to be at least 30 feet away from the facility, and
  24. Controls or alerts employees of the egress of a resident from the facility;
  25. Provides access to an outside area:
  26. From which a resident may exit to a location at least 30 feet away from the facility, and
  27. Controls or alerts employees of the egress of a resident from the facility; or
  28. Uses a mechanism that meets the Special Egress-Control Devices provisions in the International Building Code incorporated by reference R9-10-104.01; and
  29. A caregiver or an assistant caregiver complies with the requirements for incidents in R9- 10-804 when a resident who is unable to direct self-care wanders into an area not designated by the governing authority for use by the resident.

R9-10-814. Personal Care Services

  1. A manager of an assisted living facility authorized to provide personal care services shall not accept or retain a resident who:
  2. Is unable to direct self-care;
  3. Except as specified in subsection (B), is confined to a bed or chair because of an inability to ambulate even with assistance; or
  4. Except as specified in subsection (C), has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner.
  5. A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who is confined to a bed or chair because of an inability to ambulate even with assistance if:
  6. The condition is a result of a short-term illness or injury; or
  7. The following requirements are met at the onset of the condition or when the resident is accepted by the assisted living facility:
  8. The resident or resident’s representative requests that the resident be accepted by or remain in the assisted living facility;
  9. The resident’s primary care provider or another medical practitioner:
  10. Examines the resident at the onset of the condition, or within 30 calendar days before acceptance, and at least once every six months throughout the duration of the resident’s condition;
  11. Reviews the assisted living facility’s scope of services; and

iii. Signs and dates a determination stating that the resident’s needs can be met by the assisted living facility within the assisted living facility’s scope of services and, for retention of a resident, are being met by the assisted living facility; and

  1. The resident’s service plan includes the resident’s increased need for personal care services.
  2. A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner, if the requirements in subsection (B)(2) are met.
  3. A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who:
  4. Is receiving nursing services from a home health agency or a hospice service agency; or
  5. Requires intermittent nursing services if:
  6. The resident’s condition for which nursing services are required is a result of a short-term illness or injury, and
  7. The requirements of subsection (B)(2) are met.
  8. A manager shall ensure that a bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies is available and accessible in a bedroom or residential unit being used by a resident receiving personal care services.
  9. In addition to the requirements in R9-10-808(A)(3), a manager shall ensure that the service plan for a resident receiving personal care services includes:
  10. Skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections;
  11. Offering sufficient fluids to maintain hydration;
  12. Incontinence care that ensures that a resident maintains the highest practicable level of independence when toileting; and
  13. If applicable, the determination in subsection (B)(2)(b)(iii).
  14. A manager shall ensure that an employee does not provide non-prescription medication to a resident receiving personal care services unless the resident has an order from the resident’s primary care provider or another medical practitioner for the non-prescription medication.

Top Takeaways:

  • Directed care servicesmean programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need, or making basic care decisions.
  • (Directed Care Services)
  1. A manager of an assisted living facility authorized to provide directed care services shall not accept or retain a resident who, except as provided in R9-10-814(B)(2):
  2. Is confined to a bed or chair because of an inability to ambulate even with assistance; or
  3. Has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner.

This is a regulation where there is absolutely zero grey area. You cannot accept or retain a resident who is confined to a bed or chair due to being non ambulatory nor can you have residents in your community with stage 3 or 4 wounds. If a state surveyor sees this in your community, you will absolutely be penalized. If you notice a current resident is beginning to display severe ambulatory issues or develop non healing wounds you need to begin the DC process.

  • Personal care services mean assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes coordination or provision of intermittent nursing services and the administration of medications and treatments by a licensed nurse.
  • A manager of an assisted living facility authorized to provide personal care services shall not accept or retain a resident who:
  1. Is unable to direct self-care;
  2. Except as specified in subsection (B), is confined to a bed or chair because of an inability to ambulate even with assistance; or
  3. Except as specified in subsection (C), has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner.

We have regulation with some wiggle room! If your facility is licensed to provide personal care services, you do have the ability to care for residents who are non-ambulatory or have stage 3/4 wounds if certain criteria is met. If a resident is determined to be non-ambulatory it must be due to a short-term illness or injury and the resident’s physician must be involved in the duration of the issue causing the inability to ambulate. Residents who have stage 3 or 4 wounds must also meet those requirements as well as having proper skin/wound maintenance as a part of their service plan.