Georgia Proposes Rules Updating Requirements for Personal Care Homes and Assisted Living Communities | Arnall Golden Gregory LLP

Georgia’s Department of Community Health (DCH) announced to the public on June 10, 2021 its intention to revise the rules for Personal Care Homes (PCH) and Assisted Living Communities (ALC). The proposed changes are intended to implement portions of Bill 987, which was enacted on June 30, 2020. The proposed revisions affect the Personal Care Home Regulations found at Ga. Comp. Rules & Regs., R. 111-8-62 and Rules & Regulations for Assisted Living Communities found at Ga. Comp. Rules and regulations, R. 111-8-63. The following is a summary of the main changes proposed.

Certification required from memory care centers

PCHs and ANSs that operate memory care centers must now obtain certification from DCH. The term “memory care center” has replaced “memory care unit” throughout the regulation, and is now defined as a stand-alone or incorporated specialized unit which (i) purports to provide additional or specialized care to people diagnosed with probable Alzheimer’s disease or other dementias or with cognitive deficits that could put the resident at risk; or (ii) charges higher rates for the care of residents with Alzheimer’s disease or other dementias than for the care of other residents. Previous requirements for memory care services remain in regulation, but are now identified as precautions for residents at risk of leakage. The regulation also emphasizes the role of the family in memory care, adding that the resident’s family should be involved in developing written individual care plans where possible, incorporating family and personal history to support a person-centered approach to care.

Staff requirements

The proposed rules include changes to the general staffing requirements for PCH and ANS as well as changes to staffing in PCH and ANS memory care centers. Qualifications for full-time administrators now require the administrator of an ANS or PCH licensed for twenty-five (25) beds or more to hold a valid license from the State Board of Long-Term Care Facility Administrators with an effective date no later than 60 days from the rental date.

Staff-to-resident ratios have also increased under the proposed regulation. Below is a summary of the proposed staffing requirements. Average monthly minimum staffing levels will be calculated and documented using methods and forms specified by DCH. In accordance with previous DCH requirements, all facilities must have staff in excess of these minimum staff ratios on site to meet residents’ ongoing health, safety and care needs.

Assisted Living Communities (ALC):
  • At least two (2) staff members 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) staff member on each occupied floor.
  • A minimum of two (2) on-site direct care staff must be on-site 24 hours a day to provide supervision when residents are present, with at least one (1) staff member on each occupied floor.
  • Maintain a minimum average monthly ratio of on-site staff to residents of one direct care staff awake for every 15 residents during waking hours and one direct care staff awake for 20 residents during non-hours awake where residents have minimal care needs.
  • A Registered Professional Nurse or Licensed Practical Nurse is on-site to support the care and supervision of residents, as follows:
    • For communities of 1 to 30 inhabitants, a minimum of 8 hours per week;
    • For communities of 31 to 60 residents, a minimum of 16 hours per week;
    • For communities of 61 to 90 residents, a minimum of 24 hours per week;
    • For communities with more than 90 residents, a minimum of 40 hours per week;
Personal Care Homes (PCH)
  • An authorized PCH for less than 25 beds must maintain a minimum ratio of on-site staff per resident of one direct care staff awake for every 15 residents during waking hours, and one direct care staff awake for 25 residents during awake hours when the residents have minimal care needs.
  • At least one administrator, on-site manager or responsible staff member must be on-site 24 hours a day and available to meet the needs of residents, with a minimum of one staff member per occupied floor.
Certified memory care centers (ALC and PCH)
  • At least one dementia-trained direct care staff member for every 12 on-site residents during all waking hours, or for every 15 on-site residents during all non-awake hours on a monthly average basis;
  • A licensed professional nurse, licensed practical nurse or certified medication aide on site at all times;
  • Two direct care staff must be on site at all times, with at least one on each floor occupied; and
  • A registered professional nurse or licensed practical nurse on site available in the building at all times as follows:
    • For memory care centers with 1 to 12 residents, a minimum of 8 hours per week;
    • For memory care centers with 13 to 30 residents, a minimum of 16 hours per week;
    • For memory care centers with 31 to 40 residents, a minimum of 24 hours per week; or
    • For memory care centers with more than 40 residents, a minimum of 40 hours per week.

Training requirements

Training requirements have also been changed for general staff as well as for memory care centers. The proposed PCH policy requires that all direct care personnel, including the administrator or on-site manager, satisfactorily complete continuing education (at least 16 hours) each year. For SLAs, all staff providing practical personal services to residents, including the on-site administrator or manager, must satisfactorily complete a total of at least twenty-four (24) hours of continuing education during the course of the first year of employment as a direct care worker, and sixteen (16) hours each following year. These courses should be relevant to the tasks of the individual, such as courses on working with residents with Alzheimer’s disease or other cognitive disorders, working with people with mental and developmental illnesses, social and recreational activities, legal matters, physical maintenance and fire safety, maintenance, or other matters as needed or determined by DCH.

Memory care centers have additional training requirements. All staff, regardless of their role, must meet orientation requirements. Direct care staff must follow a separate orientation and follow annual training requirements. For homes with memory care centers, direct care staff should complete a minimum of eight (8) hours of specialized training based on dementia care skills on an annual basis using the forms specified by the department.

Limited nursing services

Home care now includes the provision of limited nursing services. “Limited nursing services” is defined as “the assessment of physical, mental and emotional condition to determine the appropriate level of care for a person; performing health maintenance activities… and providing any nursing care within the scope of practice of direct care personnel that may be performed within seven days or intermittently.

License and change notice

The initial application for a license to practice as a PCH of twenty-five (25) or more beds, or as an NSA, now requires a financial stability affidavit from a CPA affirming the applicant’s ability to continue operating. over the next two years. In addition, a household or community must now notify residents, their family contacts and representatives, and the department in a timely manner whenever an emergency arises that disrupts the provision of accommodation. and meals to residents of the licensed location. Homeowners must provide the ministry with a 60-day notice of bankruptcy or property eviction. In the event of a change of ownership, owners must provide 30 days notice through a request.

For communities and homes licensed for twenty-five (25) or more beds, the rules contain other infection control requirements set out in the rules and regulations for disaster preparedness plans regarding plans, supplies and equipment. pandemic policies and procedures (chapter 111-8-16). Communities and homes licensed for twenty-five (25) or more beds must notify residents of outbreaks or incidents of infectious disease.

Changes Specific to Personal Care Homes

The proposed rules provide that each PCH must have its name displayed so that it is easily visible from the street. The rules also include new exceptions for aging in place. Under the aging in place exceptions, the PCH may allow up to three (3) non-ambulatory residents to remain in the PCH to support an aging in place strategy that is in the best interest of the resident, provided certain criteria are met. are followed to ensure the patient is properly cared for within the facility and emergency procedures remain sufficient along with safety compliance standards.

PCH’s proposed rules also include changes relating to the administration of drugs in memory care centers. Medication for residents living in the memory care center should be provided by an authorized caregiver, registered nurse, licensed practical nurse working under the supervision of a physician or registered nurse, or medication aide certified subject to a record, competence and observation. conditions. A certified medication aid can only administer medication as part of their authorized duties as a certified medication aid and must undergo an annual proficiency review. The home must record in the resident’s file any administration of liquid morphine by an approved medication assistant. Homes may offer certified training programs for medication aids, provided the program meets the appropriate skills and registry requirements. All controlled substances must be safely stored and inventoried daily. A home may only have a limited supply of liquid morphine on site to 50 ml for each palliative care patient in the home for whom there is a physician’s prescription for such medication.

A public comment opportunity will take place on July 14, 2021 at 10:00 a.m. EDT via WebEx audio. Comments on the proposed rule in writing can be submitted no later than July 16, 2021. DCH encourages individuals to send their comments electronically to Public.comment@dch.ga.gov. Public notices can be viewed here.

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