1. Governing admissions to assisted living facilities;
2. Requiring that each assisted living facility prepare and provide astatement, in a format prescribed by the Department, to any prospectiveresident and his legal representative, if any, prior to admission and uponrequest, that discloses information, fully and accurately in plain language,about the (i) services; (ii) fees, including clear information about whatservices are included in the base fee and any fees for additional services;(iii) admission, transfer, and discharge criteria, including criteria fortransfer to another level of care within the same facility or complex; (iv)general number and qualifications of staff on each shift; (v) range,frequency, and number of activities provided for residents; and (vi)ownership structure of the facility;
3. Establishing a process to ensure that each resident admitted or retainedin an assisted living facility receives appropriate services and periodicindependent reassessments and reassessments when there is a significantchange in the resident's condition in order to determine whether a resident'sneeds can continue to be met by the facility and whether continued placementin the facility is in the best interests of the resident;
4. Governing appropriate discharge planning for residents whose care needscan no longer be met by the facility;
5. Addressing the involuntary discharge of residents;
6. Requiring that residents are informed of their rights pursuant to §63.2-1808 at the time of admission;
7. Establishing a process to ensure that any resident temporarily detained ina facility pursuant to §§ 37.2-809 through 37.2-813 is accepted back in theassisted living facility if the resident is not involuntarily admittedpursuant to §§ 37.2-814 through 37.2-819; and
8. Requiring that each assisted living facility train all employees who aremandated to report adult abuse, neglect, or exploitation pursuant to §63.2-1606 on such reporting procedures and the consequences for failing tomake a required report.
B. If there are observed behaviors or patterns of behavior indicative ofmental illness, mental retardation, substance abuse, or behavioral disorders,as documented in the uniform assessment instrument completed pursuant to §63.2-1804, the facility administrator or designated staff member shall ensurethat an evaluation of the individual is or has been conducted by a qualifiedprofessional as defined in regulations. If the evaluation indicates a needfor mental health, mental retardation, substance abuse, or behavioraldisorder services, the facility shall provide (i) a notification of theresident's need for such services to the authorized contact person of recordwhen available and (ii) a notification of the resident's need for suchservices to the community services board or behavioral health authorityestablished pursuant to Title 37.2 that serves the city or county in whichthe facility is located, or other appropriate licensed provider. TheDepartment shall not take adverse action against a facility that hasdemonstrated and documented a continual good faith effort to meet therequirements of this subsection.
C. The Department shall not order the removal of a resident from an assistedliving facility if (i) the resident, the resident's family, the resident'sphysician, and the facility consent to the resident's continued stay in theassisted living facility and (ii) the facility is capable of providing,obtaining, or arranging for the provision of necessary services for theresident, including, but not limited to, home health care and/or hospice care.
D. Notwithstanding the provisions of subsection C above, assisted livingfacilities shall not admit or retain an individual with any of the followingconditions or care needs:
1. Ventilator dependency.
2. Dermal ulcers III and IV, except those stage III ulcers that aredetermined by an independent physician to be healing.
3. Intravenous therapy or injections directly into the vein except forintermittent intravenous therapy managed by a health care professionallicensed in Virginia or as permitted in subsection E.
4. Airborne infectious disease in a communicable state that requiresisolation of the individual or requires special precautions by the caretakerto prevent transmission of the disease, including diseases such astuberculosis and excluding infections such as the common cold.
5. Psychotropic medications without appropriate diagnosis and treatment plans.
6. Nasogastric tubes.
7. Gastric tubes except when the individual is capable of independentlyfeeding himself and caring for the tube or as permitted in subsection E.
8. An imminent physical threat or danger to self or others is presented bythe individual.
9. Continuous licensed nursing care (seven-days-a-week, 24-hours-a-day) isrequired by the individual.
10. Placement is no longer appropriate as certified by the individual'sphysician.
11. Maximum physical assistance is required by the individual as documentedby the uniform assessment instrument and the individual meets Medicaidnursing facility level-of-care criteria as defined in the State Plan forMedical Assistance, unless the individual's independent physician determinesotherwise. Maximum physical assistance means that an individual has a ratingof total dependence in four or more of the seven activities of daily livingas documented on the uniform assessment instrument.
12. The assisted living facility determines that it cannot meet theindividual's physical or mental health care needs.
13. Other medical and functional care needs that the Board determines cannotbe met properly in an assisted living facility.
E. Except for auxiliary grant recipients, at the request of the resident inan assisted living facility and when his independent physician determinesthat it is appropriate, (i) care for the conditions or care needs defined insubdivisions D 3 and D 7 may be provided to the resident by a licensedphysician, a licensed nurse or a nurse holding a multistate licensureprivilege under a physician's treatment plan, or a home care organizationlicensed in Virginia or (ii) care for the conditions or care needs defined insubdivision D 7 may also be provided to the resident by facility staff if thecare is delivered in accordance with the regulations of the Board of Nursingfor delegation by a registered nurse, 18 VAC 90-20-420 et seq.
The Board shall adopt regulations to implement the provisions of thissubsection.
F. In adopting regulations pursuant to subsections A, B, C, D, and E theBoard shall consult with the Departments of Health and Behavioral Health andDevelopmental Services.
(1993, cc. 957, 993, § 63.1-174.001; 1995, cc. 649, 844; 2000, c. 176; 2002,c. 747; 2004, c. 49; 2005, cc. 610, 716, 724, 924; 2007, c. 539; 2009, cc.813, 840.)
1. Governing admissions to assisted living facilities;
2. Requiring that each assisted living facility prepare and provide astatement, in a format prescribed by the Department, to any prospectiveresident and his legal representative, if any, prior to admission and uponrequest, that discloses information, fully and accurately in plain language,about the (i) services; (ii) fees, including clear information about whatservices are included in the base fee and any fees for additional services;(iii) admission, transfer, and discharge criteria, including criteria fortransfer to another level of care within the same facility or complex; (iv)general number and qualifications of staff on each shift; (v) range,frequency, and number of activities provided for residents; and (vi)ownership structure of the facility;
3. Establishing a process to ensure that each resident admitted or retainedin an assisted living facility receives appropriate services and periodicindependent reassessments and reassessments when there is a significantchange in the resident's condition in order to determine whether a resident'sneeds can continue to be met by the facility and whether continued placementin the facility is in the best interests of the resident;
4. Governing appropriate discharge planning for residents whose care needscan no longer be met by the facility;
5. Addressing the involuntary discharge of residents;
6. Requiring that residents are informed of their rights pursuant to §63.2-1808 at the time of admission;
7. Establishing a process to ensure that any resident temporarily detained ina facility pursuant to §§ 37.2-809 through 37.2-813 is accepted back in theassisted living facility if the resident is not involuntarily admittedpursuant to §§ 37.2-814 through 37.2-819; and
8. Requiring that each assisted living facility train all employees who aremandated to report adult abuse, neglect, or exploitation pursuant to §63.2-1606 on such reporting procedures and the consequences for failing tomake a required report.
B. If there are observed behaviors or patterns of behavior indicative ofmental illness, mental retardation, substance abuse, or behavioral disorders,as documented in the uniform assessment instrument completed pursuant to §63.2-1804, the facility administrator or designated staff member shall ensurethat an evaluation of the individual is or has been conducted by a qualifiedprofessional as defined in regulations. If the evaluation indicates a needfor mental health, mental retardation, substance abuse, or behavioraldisorder services, the facility shall provide (i) a notification of theresident's need for such services to the authorized contact person of recordwhen available and (ii) a notification of the resident's need for suchservices to the community services board or behavioral health authorityestablished pursuant to Title 37.2 that serves the city or county in whichthe facility is located, or other appropriate licensed provider. TheDepartment shall not take adverse action against a facility that hasdemonstrated and documented a continual good faith effort to meet therequirements of this subsection.
C. The Department shall not order the removal of a resident from an assistedliving facility if (i) the resident, the resident's family, the resident'sphysician, and the facility consent to the resident's continued stay in theassisted living facility and (ii) the facility is capable of providing,obtaining, or arranging for the provision of necessary services for theresident, including, but not limited to, home health care and/or hospice care.
D. Notwithstanding the provisions of subsection C above, assisted livingfacilities shall not admit or retain an individual with any of the followingconditions or care needs:
1. Ventilator dependency.
2. Dermal ulcers III and IV, except those stage III ulcers that aredetermined by an independent physician to be healing.
3. Intravenous therapy or injections directly into the vein except forintermittent intravenous therapy managed by a health care professionallicensed in Virginia or as permitted in subsection E.
4. Airborne infectious disease in a communicable state that requiresisolation of the individual or requires special precautions by the caretakerto prevent transmission of the disease, including diseases such astuberculosis and excluding infections such as the common cold.
5. Psychotropic medications without appropriate diagnosis and treatment plans.
6. Nasogastric tubes.
7. Gastric tubes except when the individual is capable of independentlyfeeding himself and caring for the tube or as permitted in subsection E.
8. An imminent physical threat or danger to self or others is presented bythe individual.
9. Continuous licensed nursing care (seven-days-a-week, 24-hours-a-day) isrequired by the individual.
10. Placement is no longer appropriate as certified by the individual'sphysician.
11. Maximum physical assistance is required by the individual as documentedby the uniform assessment instrument and the individual meets Medicaidnursing facility level-of-care criteria as defined in the State Plan forMedical Assistance, unless the individual's independent physician determinesotherwise. Maximum physical assistance means that an individual has a ratingof total dependence in four or more of the seven activities of daily livingas documented on the uniform assessment instrument.
12. The assisted living facility determines that it cannot meet theindividual's physical or mental health care needs.
13. Other medical and functional care needs that the Board determines cannotbe met properly in an assisted living facility.
E. Except for auxiliary grant recipients, at the request of the resident inan assisted living facility and when his independent physician determinesthat it is appropriate, (i) care for the conditions or care needs defined insubdivisions D 3 and D 7 may be provided to the resident by a licensedphysician, a licensed nurse or a nurse holding a multistate licensureprivilege under a physician's treatment plan, or a home care organizationlicensed in Virginia or (ii) care for the conditions or care needs defined insubdivision D 7 may also be provided to the resident by facility staff if thecare is delivered in accordance with the regulations of the Board of Nursingfor delegation by a registered nurse, 18 VAC 90-20-420 et seq.
The Board shall adopt regulations to implement the provisions of thissubsection.
F. In adopting regulations pursuant to subsections A, B, C, D, and E theBoard shall consult with the Departments of Health and Behavioral Health andDevelopmental Services.
(1993, cc. 957, 993, § 63.1-174.001; 1995, cc. 649, 844; 2000, c. 176; 2002,c. 747; 2004, c. 49; 2005, cc. 610, 716, 724, 924; 2007, c. 539; 2009, cc.813, 840.)
1. Governing admissions to assisted living facilities;
2. Requiring that each assisted living facility prepare and provide astatement, in a format prescribed by the Department, to any prospectiveresident and his legal representative, if any, prior to admission and uponrequest, that discloses information, fully and accurately in plain language,about the (i) services; (ii) fees, including clear information about whatservices are included in the base fee and any fees for additional services;(iii) admission, transfer, and discharge criteria, including criteria fortransfer to another level of care within the same facility or complex; (iv)general number and qualifications of staff on each shift; (v) range,frequency, and number of activities provided for residents; and (vi)ownership structure of the facility;
3. Establishing a process to ensure that each resident admitted or retainedin an assisted living facility receives appropriate services and periodicindependent reassessments and reassessments when there is a significantchange in the resident's condition in order to determine whether a resident'sneeds can continue to be met by the facility and whether continued placementin the facility is in the best interests of the resident;
4. Governing appropriate discharge planning for residents whose care needscan no longer be met by the facility;
5. Addressing the involuntary discharge of residents;
6. Requiring that residents are informed of their rights pursuant to §63.2-1808 at the time of admission;
7. Establishing a process to ensure that any resident temporarily detained ina facility pursuant to §§ 37.2-809 through 37.2-813 is accepted back in theassisted living facility if the resident is not involuntarily admittedpursuant to §§ 37.2-814 through 37.2-819; and
8. Requiring that each assisted living facility train all employees who aremandated to report adult abuse, neglect, or exploitation pursuant to §63.2-1606 on such reporting procedures and the consequences for failing tomake a required report.
B. If there are observed behaviors or patterns of behavior indicative ofmental illness, mental retardation, substance abuse, or behavioral disorders,as documented in the uniform assessment instrument completed pursuant to §63.2-1804, the facility administrator or designated staff member shall ensurethat an evaluation of the individual is or has been conducted by a qualifiedprofessional as defined in regulations. If the evaluation indicates a needfor mental health, mental retardation, substance abuse, or behavioraldisorder services, the facility shall provide (i) a notification of theresident's need for such services to the authorized contact person of recordwhen available and (ii) a notification of the resident's need for suchservices to the community services board or behavioral health authorityestablished pursuant to Title 37.2 that serves the city or county in whichthe facility is located, or other appropriate licensed provider. TheDepartment shall not take adverse action against a facility that hasdemonstrated and documented a continual good faith effort to meet therequirements of this subsection.
C. The Department shall not order the removal of a resident from an assistedliving facility if (i) the resident, the resident's family, the resident'sphysician, and the facility consent to the resident's continued stay in theassisted living facility and (ii) the facility is capable of providing,obtaining, or arranging for the provision of necessary services for theresident, including, but not limited to, home health care and/or hospice care.
D. Notwithstanding the provisions of subsection C above, assisted livingfacilities shall not admit or retain an individual with any of the followingconditions or care needs:
1. Ventilator dependency.
2. Dermal ulcers III and IV, except those stage III ulcers that aredetermined by an independent physician to be healing.
3. Intravenous therapy or injections directly into the vein except forintermittent intravenous therapy managed by a health care professionallicensed in Virginia or as permitted in subsection E.
4. Airborne infectious disease in a communicable state that requiresisolation of the individual or requires special precautions by the caretakerto prevent transmission of the disease, including diseases such astuberculosis and excluding infections such as the common cold.
5. Psychotropic medications without appropriate diagnosis and treatment plans.
6. Nasogastric tubes.
7. Gastric tubes except when the individual is capable of independentlyfeeding himself and caring for the tube or as permitted in subsection E.
8. An imminent physical threat or danger to self or others is presented bythe individual.
9. Continuous licensed nursing care (seven-days-a-week, 24-hours-a-day) isrequired by the individual.
10. Placement is no longer appropriate as certified by the individual'sphysician.
11. Maximum physical assistance is required by the individual as documentedby the uniform assessment instrument and the individual meets Medicaidnursing facility level-of-care criteria as defined in the State Plan forMedical Assistance, unless the individual's independent physician determinesotherwise. Maximum physical assistance means that an individual has a ratingof total dependence in four or more of the seven activities of daily livingas documented on the uniform assessment instrument.
12. The assisted living facility determines that it cannot meet theindividual's physical or mental health care needs.
13. Other medical and functional care needs that the Board determines cannotbe met properly in an assisted living facility.
E. Except for auxiliary grant recipients, at the request of the resident inan assisted living facility and when his independent physician determinesthat it is appropriate, (i) care for the conditions or care needs defined insubdivisions D 3 and D 7 may be provided to the resident by a licensedphysician, a licensed nurse or a nurse holding a multistate licensureprivilege under a physician's treatment plan, or a home care organizationlicensed in Virginia or (ii) care for the conditions or care needs defined insubdivision D 7 may also be provided to the resident by facility staff if thecare is delivered in accordance with the regulations of the Board of Nursingfor delegation by a registered nurse, 18 VAC 90-20-420 et seq.
The Board shall adopt regulations to implement the provisions of thissubsection.
F. In adopting regulations pursuant to subsections A, B, C, D, and E theBoard shall consult with the Departments of Health and Behavioral Health andDevelopmental Services.
(1993, cc. 957, 993, § 63.1-174.001; 1995, cc. 649, 844; 2000, c. 176; 2002,c. 747; 2004, c. 49; 2005, cc. 610, 716, 724, 924; 2007, c. 539; 2009, cc.813, 840.)
