On August 12, 2021, the Georgia Department of Community Health (DCH) passed final rules to revise the regulations for personal care homes (PCH (s)) and assisted living communities (ALC (s)). The final rules implement the changes made under House Bill 987, the “Act for the Protection of Adults and Older Persons with Disabilities,” which came into force on June 30, 2020 and came into effect on July 1, 2021 became. The final rules concern the rules for personal care homes found at Ga. Comp. Rules & Regs., R. 111-8-62 and the Rules and Regulations for Assisted Living Communities at Ga. Comp. Rules and Regulations, R. 111-8-63. Below is a summary of the major changes.
Required certification from Memory Care Centers
PCHs and ALCs running Memory Care Centers must now obtain certification issued by the DCH. The term “memory care center” replaces “memory care unit” throughout the regulations and is defined as a freestanding or integrated specialized facility that can either (i) provide additional or specialized care for people diagnosed with more likely Alzheimer’s disease or other people with dementia or with cognitive deficits that can endanger the resident; or (ii) higher rates are charged for caring for residents with Alzheimer’s disease or other dementias than for caring for other residents. The previous requirements for “Memory Care Services” remain in the regulations, but are now identified as “Precautions for residents at risk of elopement”. To support a person-centered care approach, the regulations also require the family to participate in the development of an individual, written care plan, if possible including family and life history.
Manpower requirements
The final rules include changes to both general staffing requirements for PCHs and ALCs and changes to the staffing of PCH and ALC memory care centers. The administrator of a PCH licensed for 25 beds or more or an ALC must now be in possession of a valid State Board of Long-Term Care Facility Administrator license with a validity date no later than 60 days from the date of recruitment.
The final rules also increase the staff-to-residents ratio. The average monthly minimum staffing is calculated and documented using the methods and forms specified by DCH. In accordance with previous DCH requirements, all facilities must have these minimum staffing quotas on-site to meet the ongoing health, safety and care needs of their respective residents. Below is a summary of the final staffing requirements for PCHs and ALCs.
Nursing homes
- A PCH licensed for fewer than 25 beds must maintain a minimum on-site staff-to-resident ratio of one awake direct caregiver per 15 residents during awake hours and one awake direct caregiver per 25 residents during non-awake hours, with residents having one minimal maintenance requirements.
- A PCH licensed for 25 or more beds must maintain an average monthly minimum staff-to-resident ratio of one awake direct caregiver per 15 residents during waking hours and one awake direct caregiver per 20 residents during non-awake hours.
- At least one administrator, on-site manager or responsible employee must be on site 24 hours a day and respond to the needs of the residents, with at least one employee per occupied floor.
Supervised shared apartments
- At least two employees who have completed the minimum training requirements must be present at all times when residents are present in the assisted living community, with at least one employee per occupied floor.
- At least two direct caregivers on site must be present on the premises around the clock and supervise when residents are present, with at least one person on each occupied floor.
- Maintain an average monthly minimum staff-to-resident ratio of one awake direct caregiver per 15 residents during awake hours and one awake direct caregiver per 20 residents during non-awake hours when the residents have minimal care needs.
- A registered professional nurse or licensed practical nurse is on-site to assist with the care and supervision of residents in the following ways:
- For municipalities with one to 30 inhabitants, at least eight hours per week;
- For municipalities with 31 to 60 inhabitants, at least 16 hours per week;
- For communities with 61 to 90 inhabitants at least 24 hours a week; and
- For communities with more than 90 inhabitants, at least 40 hours per week
Certified memory care centers
- For every 12 residents on site during all awake times and for every 15 residents on site during all non-awake times, one direct nurse with dementia training based on a monthly average;
- A registered professional nurse, licensed practical nurse, or certified medication assistant on-site at all times;
- There must always be two direct caregivers on site, at least one on each occupied floor; and
- A nationally recognized nurse or licensed practical nurse available on site or in the building at any time as follows:
- For memory care centers with one to 12 residents, at least eight hours per week;
- For memory centers with 13 to 30 residents, at least 16 hours per week;
- For memory care centers with 31 to 40 residents, at least 24 hours per week; or
- For memory care centers with more than 40 residents, at least 40 hours per week.
Training requirements
The final rules change training requirements for both general staff and memory care centers. The final PCH rules require all direct caregivers, including the administrator or on-site manager, to complete at least 16 hours of satisfactory training each year. At ALCs, all employees providing practical personal services to residents, including the administrator or on-site manager, must complete at least 24 hours of continuing education within the first year of direct caregiver employment and satisfactorily 16 hours thereafter. The further training must be professionally relevant, e.g. B. Courses on first aid certifications, adequate medication, work with the elderly, work with residents with Alzheimer’s or other cognitive impairments, work with the mentally ill and developmentally disabled, social and recreational activities, legal issues, physical maintenance and fire protection, housekeeping, identifying and reporting Abuse or other issues as needed or as determined by DCH.
Memory maintenance centers have additional training requirements. All employees, regardless of their function, must meet orientation requirements. Direct nursing staff must receive separate training and meet annual training requirements. For homes and communities with memory centers, direct care personnel must complete at least 8 hours of specialist training in dementia care annually.
Limited care services
Assisted living now also includes the provision of limited care services. “Restricted care services” are defined as “the assessment of the physical, psychological and emotional state in order to determine the appropriate level of care for an individual; the conduct of health maintenance activities … and the provision of all care within the direct caregiver”. Area of activity of the person that can be completed within seven days or temporarily. “
Admission and notification requirements
The initial application for approval as a PCH with 25 beds or more or as an ALC now requires a financial stability statement from an auditor, which confirms the applicant’s ability to continue for the next two years. In addition, a home or a community must now inform the residents, their family contacts and representatives as well as the office of the relocation address in good time if an emergency situation arises that disrupts the provision of accommodation and food to the residents at the approved location. Owners must give DCH and all residents at least 60 days’ notice of bankruptcy or property eviction. In the event of a change of ownership, the owners must inform DCH and all residents 30 days in advance. Notification to the DCH must be in the form of an application, which must be approved before approval is given to the new owners.
For PCHs licensed for 25 or more beds and ALCs, the rules implement additional infection control requirements set out in the Disaster Risk Reduction Plan Rules and Regulations (Chapters 111-8-16) relating to pandemic plans, deliveries, and policies and procedures. Homes licensed for 25 or more beds and communities must notify residents of outbreaks or incidents of infectious diseases.
Specific changes for nursing homes
The final rules are that the name of each PCH must be displayed so that it is easily visible from the street. The rules also include new exemptions for on-site aging. As part of these exemptions, the PCH may allow up to three non-ambulatory residents to stay in the PCH to support an aging strategy in the area that is in the best interests of the resident, provided certain criteria are met to ensure that the resident receive adequate care at home and the emergency procedures meet safety standards.
The final PCH rules also include changes to drug delivery in memory centers. Medication for residents of the memory care center must be provided by a trained assistant caregiver, a licensed registered nurse, a licensed general practitioner who works under the supervision of a doctor or registered nurse, or a certified medication assistant who meets the registration, proficiency and observation requirements. A certified medication assistant can only perform certain authorized tasks related to drug administration and must undergo an annual competency review. The staff of the PCH must observe every administration of liquid morphine by a certified medication assistant and document it in the resident’s file. PCHs can offer certified medication worker training programs, provided the program meets the appropriate competency and registration requirements. All controlled substances must be securely stored and inventoried on a daily basis. The on-site supply of liquid morphine must be limited to 50 ml for every hospice patient in the home for whom a doctor’s prescription is available.
The final rules can be found here.