2006 Spring Convention Presentation

1. 2006 Spring Convention Presentation Presenter Roy P. Kemp Licensure Bureau - QAD

2. National Assisted Living Statistics Licensure Bureau - QAD

3. National Assisted Living Statistics The average age of assisted living residents in 2000 was 80 years old. Over two-thirds (69%) of residents are women, (31%) are men and nearly all (96.7%) are White and non-Hispanic. 2 The typical assisted living resident is an 80 year old woman who is mobile, but needs assistance with approx. 2 ADLs.2 2 NCAL 2000 National Survey of Assisted Living Residents. .

4. National Assisted Living Statistics From 1991 to 1999, the number of properties providing assisted living services increased by 49.4 percent, while the number of properties offering skilled nursing services grew by only 22.2 percent. The rapid growth of assisted living has slowed, however, as an oversupply developed in some areas. Over 900,000 people nation wide live in approximately 36,000 Assisted living Facilities in 2000 NCAL 2000 National Survey of Assisted Living Residents.

5. National Assisted Living Statistics Most assisted living residents need fewer services than nursing home residents. In 1998, about 24% of assisted living residents need help with three or more Activities of Daily Living, compared to 83% of nursing home residents.

6. Table 1: Resident Care Needs and Characteristics Source: The Assisted Living Industry, An Overview - 1998.

7. National Assisted Living Statistics NCAL 2000 National Survey of Assisted Living Residents. Nationally The Average resident needs help with 2.25 ADLs. While 19% of residents need no help with ADLs.

8. Other Common Assisted Living Services • A full 93 % of residents needed or accepted help with housework • While 86% needed or accepted help with their daily medications

9. Where Residents Come From Source:Assisted Living Federation of America, 1998

10. National Assisted Living Statistics

11. Reasons For Resident Discharge Source: NCAL 2000 Survey of Assisted Living Facilities

12. Montana Assisted Living Statistics Licensure Bureau - QAD

13. Average Facility Size by Beds 9% 23% 2% 16% 59% Total 177 facilities

14. Facility Beds Profile

15. Assisted Living Draft Rules New Rules – Category C Licensure Bureau - QAD

16. Providers Feeling a Little Anxious?

17. MCA 50-5-226(4) – A Severe Cognitive Impairment: • (A) a sever cognitive impairment is one that renders the resident incapable of expressing needs or making basic care decisions • (B) the resident may be at risk for leaving the facility without regard for personal safety • (C) excluding (b) above, the resident may not be a risk to self or others • (D) the resident may not require physical or chemical restraint or placed in locked quarters

18. A.R.M. 37-106-2805(26)- Severe Cognitive Impairment • Means the loss of intellectual functions, such as thinking, remembering and reasoning, of sufficient severity to interfere with a persons daily functioning • Such a person is incapable of recognizing danger, self-evacuating, summoning assistance, expressing need and/or making basic care decisions

19. Rule I – Category C Facility Requirements • Must meet category A requirements • If secure unit – must be staffed at all times • Must have separate dining activities area • Staff must be awake, dressed, to provide care and supervision

20. Rule II – C Facility Administrator • Must hold a current MT. NH administrators license or a current out of state NH license • Enrolled w/ 6 month completion or have completed the self study ALFA modules

21. Rule II – C Facility Administrator • 16 contact hours of annual continuing education • 3 or more yrs experience in geriatrics or caring for disabled residents in a licensed setting • 8 hours of the required annual education shall pertain to caring for residents with severe cognitive impairment

22. Rule III – C Facility Direct Care Staff • Trained in the facility’s philosophy. • Must have skills to care for, intervene and direct residents. • Understand how to minimize challenging behaviors, wandering, hallucinations, illusions and delusions and impaired senses.

23. Rule III – C Facility Direct Care Staff • Trained in therapeutic programming to support the highest level of resident function including: • Large motor skills • Small motor skills • Appropriate level of cognitive tasks and • Social/emotional stimulation

24. Rule III – C Facility Direct Care Staff • Trained to: • Promote resident dignity, independence, individuality, privacy, and choice • Identify and alleviate safety risks, • Recognize common side effects and untoward reactions to medications, • Techniques to deal with bowel and bladder aberrant behaviors

25. Rule IV – C Facility Health Care Plan • Within 21 days of admission a resident certification must be conducted • A written health care plan must be developed • It must include a detailed assessment, therapeutic management, and intervention techniques for behaviors and resident needs

26. Rule IV – C Facility Health Care Plan • The plan shall include consideration of: • Memory • Judgment • Ability to care for self • Problem solving abilities • Mood and character changes • Behavioral patterns • Wandering • Dietary needs

27. Rule V – C Facility Resident Disclosure • The facility shall disclose in writing • The overall philosophy regarding meeting residents needs and the form of care or treatment provided • The process and criteria for move-in, transfer and discharge • The process used for resident assessment • The process to establish, implement, and update a health care plan • Staff training and continuing education practices

28. Rule V- C Facility Disclosure Continued • The facility shall disclose in writing: • The physical environment and design features to support the cognitively impaired • The frequency and types of activities • The level of family involvement expected • Any additional costs of care or fees • Written acknowledgement must be kept as part of resident permanent file

29. Feeling a Little Overwhelmed? Think about the guy who works here!

30. Assisted Living Rules Administrator Changes Licensure Bureau - QAD

31. Administrator Requirements – All Categories • The Alfa course or NH administrator license can be used for the 16 hours of continuing education in the year of issue • A qualified staff must be appointed in the administrators absence of longer than 30 continuous days; The department must be given written notice • The appointee may not be a resident and must be credentialed

32. Assisted Living -ResidentAssessment Must Be Done Prior to Move in. Why Is It So Important?

33. What you see! What you do not see!

34. Fundamental Principles Prior to Move-In Screening • Determines gross compatibility with: • State rules • Facility capabilities • Necessity to pay Assessment • Critical for all residents • Requires basic knowledge of aging & long term care • Licensed nurse critical at times • Becomes basis for initial service plan

35. Eating Walking Mobility Dressing Grooming Bathing Toileting Transferring “Activities of Daily Living”Tasks Usually Performed in the Course of a Normal Day in a Resident’s Life That Include:

36. Assisted Living Restraints A.R.M. 37-106-2901 Licensure Bureau - QAD

37. Assistive Devise • Any devise used to maximize the independence and maintenance of health for someone limited by: • Physical injury, illness, psychosocial dysfunction • Mental illness, developmental or learning disability • Aging, cognitive impairment,or adverse environmental condition • Any devise primarily used to restrict movement is considered a safety device or restraint not an assistive device

38. Safety Device • A safety device is used to maximize the independence and maintenance of health and safety by reducing the risk of falls and injuries associated with the residents medical condition • Safety devices can be: side rails, tray tables, seat belts, and other similar devices

39. Postural Support • An appliance or device used to achieve proper body position and balance • To improve residents’ mobility and independent function • To position rather than restrict movement • To prevent falling out of bed or chair • It does not include tying a residents hands or feet, or other wise depriving their use

40. Restraint • Any method of restricting a persons freedom of independent movement and purposeful function to include: • Seclusion, controlling physical activity or restricting normal access to a resident’s body that is not a usual and customary part of a medical diagnosis or treatment procedure

41. When Is a Restraint Considered a Safety Device? • When requested by the resident, the resident representative, or the physician to reduce the risk of falls and injuries associated with the residents medical condition • It may not be imposed for purposes of coercion, retaliation, discipline or staff convenience

42. Orthopedic Devices • Physician prescribed orthopedic devices used as postural supports are not considered safety devices or restraints • They are not subject to requirements for safety devices or restraints under this rule

43. Restraint Use Is Prohibited in Assisted Living Facilities • Single or 2 quarter rails that extend the entire length of the bed are prohibited from use as a safety or assistive device • A bed rail extending from the head to half the length of the bed and used as a safety or assistive device is allowed

44. Documentation Required in Residents Record for Safety Device Use • A signed consent form including a written explanation of the alternatives and any known risks associated with the use of the safety device • Written authorization from the physician that specifies the medical symptom the device is intended to address

45. Assisted Living Administrative Rule Clarifications Licensure Bureau - QAD

46. Assisted Living-Rule Clarifications • The Alfa basic course is all that is required or intended. Call Barbara shoemaker at 800-258-7030, who will reissue a basic course certificate with no expiration date if you choose • Any extended ALFA courses will be accepted for the annual 16 hours of continuing education

47. Assisted Living-Rule Clarifications • Bathroom doors must swing out unless: • The bathroom is ADA compliant with 6’ turning radius for wheel chairs • A bi- directional swing capability, not a bar room door • A pocket door, slides into the wall • A bi fold which does not impede the door opening width; Or • A Dutch door. Check wit building code if the bathroom opens into a corridor.

48. Assisted Living-rule Clarifications • Board of Nursing Medication Aide for Assisted Living Facilities • Aides will be permitted to administer insulin if there are predrawn syringes available • Medication aides are not required, by the Montana assisted living rules • They are considered to be a professional staff extender • Board of nursing can be reached at: 406-841-2341

49. What are we all looking For? Smooth Sailing

50. Assisted Living A.R.M. 37-106-313 Communicable Disease Control Licensure Bureau - QAD