The Georgia Department of Community Health (DCH) publicly announced its intention to revise the rules for personal care homes (PCHs) and assisted living communities (ALCs) on June 10, 2021. The proposed changes are intended to implement parts of House Bill 987, which came into force on June 30, 2020. The proposed changes affect the body care home regulations 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. The following is a summary of the main proposed changes.
Required certification from Memory Care Centers
PCHs and ALCs that operate Memory Care Centers must now receive certification issued by the DCH. The term “memory care center” replaced “memory care unit” throughout the regulations and is now defined as a free-standing or integrated special unit that either (i) offers itself as additional or specialized care for people with a probable Alzheimer’s diagnosis or other dementias 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 precautionary measures for residents at risk of elopement. The regulations also emphasize the role of the family in memory maintenance and add that the resident’s family should, if possible, be involved in the development of individual written care plans, taking into account family and personal history, in order to support person-centered care.
The proposed rules include changes to both general staffing requirements for PCHs and ALCs and changes to the staffing of PCH and ALC memory care centers. Full-time Administrator qualifications now require that the administrator of an ALC or PCH with a license for twenty-five (25) or more beds have a valid State Board of Long-Term Care Facility Administrator license with an expiration date no later than 60 days from the date of rental.
The ratio of staff to residents has also increased under the proposed regulations. Below is a summary of the proposed staffing needs. 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.
Assisted living communities (ALCs):
- At least two (2) employees who have completed the minimum training requirements must be present in the assisted living community at all times when residents are present, with at least one (1) employee on each occupied floor.
- At least two (2) direct on-site nursing staff must be on site 24 hours a day to supervise when residents are present, with at least one (1) staff on each occupied floor.
- The average monthly minimum on-site staff-to-resident ratio is 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 between one and 30 inhabitants, at least 8 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;
- For communities with more than 90 inhabitants, at least 40 hours per week;
Nursing Homes (PCHs)
- A PCH licensed for fewer than 25 beds must maintain a minimum staff-to-resident ratio of one awake direct caregiver for every 15 residents during waking hours and one awake direct caregiver for every 25 residents during non-awake times that residents have a minimal need for maintenance.
- At least one administrator, on-site manager or responsible staff must be on site 24 hours a day and available for the needs of the residents, with at least one staff per occupied floor.
Certified Memory Care Centers (ALCs and PCHs)
- At least one dementia-trained direct caregiver per 12 residents on site during all awake times or per 15 residents on site during all non-awake times 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 on-site, available at all times in the building, as follows:
- For memory care centers with one to 12 residents, at least 8 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 have also changed for general staff and memory care centers. The proposed PCH regulations require all direct caregivers, including the administrator or on-site manager, to undergo satisfactory training annually (at least 16 hours). At ALCs, all employees providing practical personal services to residents, including the administrator or on-site manager, must have a total of at least twenty-four (24) hours of continuing education within the first year of employment as a direct caregiver and sixteen (16) hours each subsequent year. These courses must be relevant to the job in hand, such as: B. Courses on working with residents with Alzheimer’s disease or other cognitive impairments, working with the mentally ill and developmentally disabled, social and leisure activities, legal issues, personal hygiene and fire protection, housekeeping fire, or other topics as required or as determined by the DCH.
Memory maintenance centers have additional training requirements. All employees, regardless of their function, must meet orientation requirements. Direct nursing staff must undergo a separate briefing and keep pace with the annual training requirements. At homes with memory care centers, nursing staff must complete at least eight (8) hours of subject-related, competency-based training in dementia care using the forms provided by the department.
Limited care services
Assisted living now also includes the provision of limited care services. “Reduced care services” are defined as “the assessment of the physical, mental and emotional state in order to determine the appropriate level of care for an individual; the implementation of health maintenance activities … and the provision of care services within the scope of the direct caregiver’s field of activity, which can be completed within seven days or intermittently. “
License and change notification
The initial application for approval as a PCH with twenty-five (25) beds or more or as an ALC now requires a financial stability statement from a CPA confirming the applicant’s viability for the next two years. In addition, a home or community must now provide the residents, their family contacts and representatives, and the department with the relocation address in good time if an emergency situation arises that disrupts the provision of accommodation and food for the residents at the approved location. Owners must give the department 60 days notice of the bankruptcy or eviction of the property. In the event of a change of ownership, owners must submit a 30-day notice with an application.
For communities and homes licensed for twenty-five (25) or more beds, the rules include additional infection control requirements set out in the Disaster Risk Reduction Plan Rules and Regulations relating to pandemic plans, supplies, and policies and procedures (Chapters 111-8-16 ). Communities and homes approved for twenty-five (25) or more beds must notify residents of outbreaks or incidents of infectious diseases.
Specific changes for nursing homes
The proposed rules provide that the name of each PCH must be displayed in such a way that it is easily visible from the street. The rules also include new exemptions for on-site aging. As part of the Site Aging Exemptions, the PCH may allow up to three (3) non-ambulatory residents to remain in the PCH to support an on-site aging strategy that is in the best interests of the resident, provided that: certain criteria are met to ensure that the patient is properly cared for in the facility and that emergency procedures remain adequate in accordance with safety standards.
The proposed PCH rules also include changes to drug delivery in memory centers. Medication for residents of the memory care center must be provided by an assistant caregiver, a licensed nurse, a licensed general practitioner who works under the supervision of a doctor or registered nurse, or a certified medication assistant who is subject to registration, proficiency and observation requirements. A certified medication assistant may only administer medication within the scope of his authorized duties as a certified medication assistant and must undergo an annual competence check. The home must document every administration of liquid morphine by a certified medication assistant in the resident’s file. Homes may offer certified medication worker training programs provided the program meets the appropriate skill and registration requirements. All controlled substances must be securely stored and inventoried on a daily basis. A home may only have a supply of liquid morphine limited to 50 ml for each hospice patient in the home for whom a doctor’s prescription for such drugs is available.
An opportunity for public comment will be held on July 14, 2021 at 10:00 a.m. EDT via WebEx Audio. Written comments on the proposed regulation can be submitted until July 16, 2021. DCH encourages individuals to send comments electronically to Public.firstname.lastname@example.org. The public notices can be found here.