Idaho Assisted Living Admitting Policy (in part)

Assisted Living vs. Skilled Nursing

Admittance

We often take phone calls inquiring who Assisted Living can admit.  With a growing desire for our aging population and their families to live at the highest quality of life, Assisted Living has become a popular choice.  Offering dignity, entertainment, independence, assistance with ADL's (activities of daily life) and comfort in a residential or often times retreat-like environment Assisted Living is changing the dynamics of senior living. 

Assisted Living (if a facility is staffed with 24/7 Registered Nurses trained to handle the care needed of each resident) is now an option even for those who previously were not viable residents.  A list of polices and procedures provided in part by Idaho Health & Welfare follows:

1.       Describe the facilities conditions for admitting and retaining residents at the facility.  The following items should be included:

a.       A resident will be admitted or retained only when the facility has the capability, capacity, and services to provide appropriate care, or the resident does not require a type of service for which the facility is not licensed to provide or which the facility does not provide or arrange for, or if the facility does not have the personnel, appropriate in numbers and with appropriate knowledge and skills to provide such services.

b.      No resident will be admitted or retained who requires ongoing skilled nursing or care not within the legally licensed authority of the facility.  Such residents include:

i.                     A resident who has a gastrostomy tube, arterial-venous (AV) shunt, or suprapubic catheter inserted within the previous twenty-one (21) days

ii.                   A resident who is receiving continuous total parenteral nutrition (TPN) or intravenous (IV) therapy

iii.                  A resident who requires physical restraints, including bed rails, an exception is a chair with locking wheels or chair in which the resident cannot get out of

iv.                 A resident who is comatose, except for a resident who has been assessed by a physician or authorized provider who has determined that death is likely to occur with fourteen (14) to thirty (30) days (Note: The physician’s determination should be documented in the resident record)

v.                   A resident who is on a mechanically supported breathing system, except for residents who use CPAP (continuous positive airway pressure)

vi.                 A resident who has a tracheotomy who is unable to care for the tracheotomy independently

vii.                A resident who is fed by a syringe

viii.              A resident with open, draining wounds for which the drainage cannot be contained

ix.                 A resident with a Stage III or IV pressure ulcer

x.                   A resident with any type of pressure ulcer or open wound that is not improving bi-weekly

xi.                 A resident who has MRSA (methicillin-resistant staphylococcus aureus) in an active stage (infective stage)

xii.                For any resident who has needs requiring a nurse, the facility must assure a licensed nurse is available to meet the needs of the resident

xiii.              A resident will not be admitted or retained who has physical, emotional, or social needs that are not compatible with the other residents in the facility

xiv.              A resident that is violent or a danger to himself or others

xv.               Any resident requiring assistance in ambulation must reside on the first story unless the facility complies with 16.03.22.401 and 16.03.22.401 which is related to the fire extinguishing system

xvi.              Residents who are not capable of self-evacuation must not be admitted or retained by a facility which does not comply with the NFPA Standard #101, “Life Safety Code, 2000 Edition, Chapter 33, Existing Residential Board and Care Impracticable Evacuation Capability: (fire extinguishing system)

C.    Residents at risk for wandering.  A facility that accepts or retains residents with cognitive impairments must provide a secured interior environment and a secured exterior yard.  If the facility does not provide these, the policy must specify how the facility will ensure no residents

In speaking with the Department of Health and Welfare, I was informed that although "Skilled Nursing Facilities" are regulated by both Federal and State, Assisted Living is only regulated by the State.  When an Assisted living facility applies for license, and provides the mountains of necessary documentation with application fees and application, the State sends a surveyor to come out and approve or deny the facilities ability to follow and provide all necessary policies and procedures, thereafter a survey is conducted each 3rd year thereafter, unless a complaint is filed, then the State will come in and survey each incident.  Skilled Nursing Facilities are surveyed routinely every 15 months unless a complaint is filed.  Both entities are subject to following strict guidelines and regulations and subject to penalties, fines and other consequences.