Title: Section 488.4 - Admission and retention standards.
488.4 Admission and retention standards. (a) An operator may admit, retain and care for only those individuals who require the services the operator is certified to provide.
(b) An operator shall not exclude an individual on the basis of an individual’s mobility impairment, and shall make reasonable accommodations to the extent necessary to admit such individuals, consistent with federal, state, and local laws.
(c) An operator must not accept nor retain any person who:
(1) needs continual medical or nursing care or supervision as provided by an acute care facility or a residential health care facility certified by the Department of Health;
(2) suffers from a serious and persistent mental disability sufficient to warrant placement in an acute care or residential treatment facility operated or certified by an office of the Department of Mental Hygiene;
(3) requires health, mental health, or other services which cannot be provided by local service agencies;
(4) causes, or is likely to cause, a danger to himself/herself or others;
(5) repeatedly behaves in a manner which directly impairs the well-being, care, or safety of the resident or other residents or which substantially interferes with the orderly operation of the enriched housing program;
(6) requires continual skilled observation of symptoms and reactions or accurate recording of such skilled observations for the purpose of reporting on a medical condition to the resident's physician;
(7) refuses or is unable to comply with a prescribed treatment program, including but not limited to a prescribed medications regimen when such refusal or inability causes, or is likely to cause, in the judgment of a physician, life-threatening danger to the resident or others;
(8) is chronically bedfast;
(9) has chronic unmanaged urinary or bowel incontinence;
(10) suffers from a communicable disease or health condition which constitutes a danger to other residents and staff;
(11) is dependent on medical equipment unless it has been demonstrated that:
(i) the equipment presents no safety hazard;
(ii) use of the equipment does not restrict the individual to his/her room, impede the individual in the event of evacuation, or inhibit participation in the routine activities of the home;
(iii) use of the equipment does not restrict or impede the activities of other residents;
(iv) the individual is able to use and maintain the equipment with only intermittent or occasional assistance from medical personnel;
(v) assistance in the use or maintenance of the equipment, if needed, is available from local social services agencies or approved community resources;
(vi) each required medical evaluation attests to the individual's ability to use and maintain the equipment;
(12) has chronic personal care needs which cannot be met by enriched housing staff or approved community providers;
(13) is not self-directing; i.e., requires continuous supervision and is not capable of making choices about his/her activities of daily living; or
(14) engages in alcohol or drug use which results in aggressive or destructive behavior.
(d) An operator must not admit nor retain persons in excess of the capacity specified on the operating certificate.
(e) An operator must not admit nor retain an individual without a determination being made that the enriched housing program can support the physical and social needs of the resident. Such determination must be based upon:
(1) a medical evaluation (DSS-3122 or an approved substitute) written and signed by a physician, physician assistant or nurse practitioner, which includes:
(i) the date of examination, significant medical history and current conditions, known allergies, the prescribed medication regimen, including information on the applicant's ability to self-administer medications, recommendations for diet, exercise, recreation, frequency of medical examinations and assistance needed in the activities of daily living;
(ii) a statement that a resident is medically or mentally suited for care in the enriched housing program;
(iii) a statement that the resident does not require placement in a hospital or residential health care facility; and
(iv) a dated statement indicating that the physician, physician assistant or nurse practitioner has physically examined the resident within 30 days prior to the date of admission, or for required annual evaluations within 30 days prior to the date of the report.
(2) an interview between the enriched housing program coordinator, or a designee responsible for admission and retention decisions and the resident and his/her representative(s), if any. Each applicant interview must:
(i) include an explanation of the conditions of residency including, but not limited to, the admission agreement, resident rights and responsibilities, enriched housing program rules and regulations and the personal allowance protections available to Supplemental Security Income or Home Relief recipients;
(ii) ascertain that the enriched housing program can:
(a) meet the physical needs and personal care needs of the resident, including dietary needs occasioned by cultural or religious practice or preference or medical prescription; and
(b) meet the psycho-social needs of the resident.
(iii) be summarized in writing, including the date of the interview and identification of those present.
(3) a mental health evaluation if a proposed resident has a known history of chronic mental disability, or the medical evaluation or resident interview suggests the existence of such a disability. Such evaluation must be a written and signed report from a psychiatrist, physician, registered nurse, certified psychologist or certified social worker who has experience in the assessment and treatment of mental illness. Such report shall be documented on a form prescribed by the Department and developed in consultation with the Office of Mental Health and shall include:
(i) a significant mental health history and current conditions;
(ii) a statement that the resident or prospective resident is mentally suited for care in the enriched housing program;
(iii) a statement that the resident or prospective resident does not evidence need for placement in a hospital or residential treatment facility; and
(iv) a dated statement indicating that the person signing the report has conducted a face-to-face examination of the resident or prospective resident which, for prospective residents, shall be dated within 30 days prior to admission.
(4) a functional assessment completed on a form prescribed or approved by the department. Each functional assessment must be a written report prepared by the program coordinator, case manager, or consultant registered nurse and must address:
(i) personal activities of daily living;
(ii) instrumental activities of daily living;
(iii) sensory impairments;
(iv) behavioral characteristics;
(v) personality characteristics; and
(vi) daily habits.
(f) The following assessments must be conducted whenever a change in a resident's condition warrants and no less than once every 12 months:
(1) a medical assessment;
(2) a mental health evaluation, if needed; and
(3) a functional assessment.
(g) The operator must assist an applicant in obtaining any required evaluations.
(h) The operator must assist a resident who cannot be retained because of the presence of one or more of the conditions set forth in subdivision (c) of this section to find an alternative placement and must document such assistance.
(i) Notwithstanding subdivision (e) of this section, medical evaluations need not be required of a competent adult who relies upon or is being furnished treatment by spiritual means through prayer, in lieu of medical treatment, in accordance with the tenets and practices of a recognized church or religious denomination of which the resident is a member or a bona fide adherent. In such cases the operator must:
(1) require documentation of the resident's standing as a member; and
(2) adhere to the admission and retention standards set forth in subdivision (c) of this section.
(j) The operator must not admit nor accept for return an individual directly from a general or special hospital, psychiatric center, developmental center, skilled nursing or health-related facility without a signed statement from the referral source which details significant medical conditions, prescribed health or mental health regimens and such psycho-social information as may be available to help the operator plan an adequate level of care for the resident. This statement may substitute for the medical and mental health evaluations or functional assessment if the requirements of subdivision (e)(1), (3) and (4) of this section are met.
(k) The operator must give each applicant at or prior to the admissions interview copies of:
(1) the admission agreement;
(2) the statement of resident rights;
(3) the enriched housing program rules, if any, relating to resident activities, office and visiting hours and other pertinent information concerning the operation of the program;
(4) a fact sheet about the Long-Term Ombudsman Program, if made available by the program; and
(5) the listing of legal services or advocacy agencies made available to the program by the department.
(l) The operator must provide to each applicant for admission and to the applicant's representative, if any, an opportunity to review the most recent inspection report issued by the department to the enriched housing program.
(1) If the applicant or resident is sight-impaired or hearing-impaired or otherwise unable to comprehend English or printed matter, the operator must arrange for the conduct of the required admission interview and transmission of the contents of the admission agreement, the statement of rights and responsibilities and enriched housing information in a manner comprehensible to the applicant.
VOLUME B-1 (Title 18)