Estate PlanningNovember 22, 2011

Personal Care Home Summary

By: Hazen Law Group
  1. Applicable Code Sections.
    1. 55 Pa.Code Chapter 2600 Personal Care Homes
    2. 55 Pa.Code Chapter 2620 Personal Care Home Licensing
  2. Compliance. Profit and nonprofit personal care homes must comply with this rulemaking.
    1. There are 1689 licensed personal care homes in Pennsylvania (77% for profit and 23% nonprofit) with a resident capacity of 75,958.
    2. The rulemaking “supports resident-centered care, resident choice and resident privacy.”
    3. The definition of a personal care home is “A premise in which food, shelter and personal assistance or supervision are provided for a period exceeding 24 hours, for four or more adults who are not relatives of the operator, who do not require the services in or of a licensed long-term care facility, but who do require assistance or supervision in activities of daily living or instrumental activities of daily living. This term includes a premise that has held or presently holds itself out as a personal care home and provides food and shelter to four or more adults who need personal care services, but who are not receiving such services.”
  3. Exemptions. There are some exemptions for small personal care homes serving 8 or fewer residents. These exemptions are intended to provide fiscal relief for smaller facilities and support a more “home-like” setting.
    1. Administrator qualifications;
    2. Sewage System approval;
    3. Communication systems;
    4. Posting of emergency evacuation diagrams;
    5. Interconnected fire alarms; and
    6. Exit signs.
  4. Licensing requirements.
    1. The Department of Public Welfare (the “Department”) will conduct an on-site, unannounced inspection annually.
    2. The Department will issue a license after an investigation evidences requirements for licensure are met.
    3. After new a new home is licensed, the Department will re-inspect within 3 months of the original licensure.
  5. Fire Safety Approval
    1. Before a license will be issued, personal care homes must have a written fire safety plan approved by the Department of Health or the appropriate local building authority under the Pennsylvania Uniform Construction Code Act.
  6. Abuse reporting
    1. Allegations of suspected abuse must be immediately reported in accordance with the Older Adult Protective Services Act.
    2. The home must immediately submit to the Department a plan of supervision or notice of suspension of the affected staff person. The home must also notify the resident and the resident’s designated person of the report of suspected abuse or neglect.
  7. Reportable incidents and conditions
    1. Homes must develop and implement written policies and procedures on the prevention, reporting, notification, investigation and management of reportable incidents and conditions.
    2. The reports must be made within 24 hours of the incident or condition.
    3. The following is a list of incidents and conditions that must be reported.
      1. Death of a resident due to accident, abuse, neglect, homicide, suicide, malnutrition or other unusual circumstances;
      2. A physical act by a resident to commit suicide;
      3. Serious bodily injury or trauma;
      4. A violation of a resident’s rights;
      5. An unexplained absence for more than 24 hours or an absence from a secured dementia unit;
      6. Misuse of a resident’s funds;
      7. Outbreak of a serious communicable disease;
      8. Food poisoning of residents;
      9. Physical or sexual assault;
      10. Fire or structural damage;
      11. An incident requiring the services of an emergency management team;
      12. A complaint of resident abuse or suspected abuse;
      13. A prescription medication error;
      14. An emergency situation;
      15. An unscheduled closure of the home;
      16. A bankruptcy filed by the home;
      17. A criminal conviction against the legal entity, its administrator or staff;
      18. A termination notice from a utility; and
      19. A violation of health and safety laws.
  8. Waivers. Requests for a waiver of a specific requirement may be submitted to the Department. The home shall discuss the waiver request with affected residents.
  9. Admission requirements.
    1. Preadmission screening completed prior to admission on a form specified by the Department;
    2. Medical evaluation completed 60 days prior or within 30 days after admission on a form specified by the Department;
    3. Personal care home assessment within 15 days after admission;
    4. Support plan developed and implemented within 30 days after admission; and
    5. Resident-home contract completed prior to admission or within 24 hours after admission.
  10. Resident Rights. Residents shall be afforded the following rights:
    1. To not be discriminated against on the basis of race, color, religious creed, disability, handicap, ancestry, sexual orientation, national origin, sex or race;
    2. To not be neglected, intimidated or abused;
    3. To be treated with dignity and respect;
    4. To be provided 30 days notice of any rule changes within the home;
    5. To have access to a private telephone without tolls for local calls;
    6. To privately receive and send mail;
    7. To privately communicate with the Ombudsman;
    8. To have religious choice;
    9. To have assistance in accessing health services;
    10. To have assistance in obtaining and keeping clean seasonal clothing;
    11. To access, review and request modification of the resident’s record;
    12. To have personal furnishings and possessions;
    13. To have the freedom to leave and return to the home
    14. To relocate and to request assistance in relocating;
    15. To associate, organize and communicate with others privately;
    16. To receive compensation for labor provided to the home. Residents may voluntarily and without coercion perform tasks;
    17. To receive visitors for a minimum of 12 hours a day, 7 days per week;
    18. To have privacy of self and possessions;
    19. To file complaints without the threat of discharge or retaliation;
    20. To receive the services contracted for in the resident-home contract;
    21. To use the home’s procedures to appeal involuntary discharge;
    22. To a system to safeguard the resident’s money or property; and
    23. To choose healthcare providers.
  11. Complaint procedures.
    1. Residents must be informed of complaint procedures prior to admission.
    2. The home must ensure investigation and resolution of all complaints.
    3. Within 2 business days of receipt of the complaint, the home shall provide the complainant with a written status report.
    4. Within 7 days after submission of a complaint, the home shall provide a written decision.
  12. Staff Training and Qualifications. The regulations provide specific requirements for staff and administrator qualifications and training in Sections 2600.53 through 2600.68.
  13. Physical Site. The regulations provide specific requirements for the physical site in Sections 2600.81 through 2600.109.
  14. Resident Health.
    1. Residents shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner 60 days prior to admission or within 30 days after admission.
    2. Residents shall have medical evaluations at least annually and more frequently if the medical condition of the resident changes.
    3. The home shall assist the resident in securing medical care if the resident’s health declines.
    4. The home shall assist the resident in securing preventative medical, dental, vision and behavioral care.
    5. The home shall have a written emergency medical plan as outlined in Section 2600.143.
    6. Smoking may be permitted in a smoking room to be established in accordance with the regulations.
    7. Meals:
      1. At least three nutritionally well-balanced meals shall be offered daily.
      2. There shall not be more than 6 hours between breakfast and lunch, and between lunch and dinner.
      3. Adaptive eating equipment or utensils shall be made available to meet the needs of the residents.
      4. Menus shall be prepared a week in advance and shall be followed.
      5. A resident’s physician and designated person shall be notified if the resident refuses to eat or drink continuously during a 24 hour period.
    8. A home may not be required to provide transportation.
    9. Medications.
      1. A home shall provide assistance, as needed, with medication prescribed for the resident’s self-administration. This includes reminding the resident to take the medication, storing the medication in a secure place and offering the resident the medication at the prescribed times.
      2. A resident who desires to self-administer shall be assessed by his or her medical provider regarding the ability to self administer.
      3. If the resident is able to self-administer, medication may be stored in the resident’s room if it is kept locked in a safe and secure location.
      4. A home may provide medication administration services for a resident who is assessed to need such services. It must be administered by a physician, dentist, physician’s assistant, RN, CRNP, LPN or licensed paramedic. Medications can also be administered by a graduate of an approved nursing program under the direct supervision of a professional nurse. A student nurse may administer medications under the direct supervision of a member of the nursing school staff. Other staff members may administer medications if they have completer the medication administration training as specified in Section 2600.190.
    10. Mechanical restraints are prohibited.
    11. Support plan.
      1. The home shall have a written support plan developed and implemented within 30 days of admission.
      2. The plan of support shall be modified within 30 days of the annual assessment or upon changes in the resident’s needs.
      3. A resident may participate in development of the support plan.
  15. Discharge by the facility.
    1. The resident must be provided with 30 days advance notice.
    2. The Department must be provided at least 60 days advance notice of an anticipated closing of the home.
    3. The only grounds for discharge by the home are:
      1. If the resident is a danger to himself or others.
      2. If the legal entity chooses to voluntarily close the home or a portion thereof.
      3. If a home determines that a resident’s functional level has advanced or declined so that the resident’s needs cannot be met in the home. If the resident disagrees, consultation shall be made with the resident’s physician.
      4. If meeting the resident’s needs would require a fundamental alteration in the home’s program or building site.
      5. If the resident has failed to pay after reasonable documented efforts by the home to obtain payment.
      6. If closure of the home is initiated by the Department
      7. Documented, repeated violation of the home rules.
  16. Dementia Care Units. Provisions for Dementia Care Units can be found in Sections 2600.231 through 2600.241.
  17. Effective date.
    1. Most of the changes take effect six months from the April 22, 2005 publication date in the PA Bulletin.
    2. Direct care of staff person training and orientation provisions take effect 6 months from the effective date of the final regulation.
    3. Waiver provisions take effect 12 months from the effective date of the final regulation.
    4. Provisions relating to exits, smoke detectors, fire alarms and medication administration shall take effect 18 months from the effective date of the final regulation.
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