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District of Columbia Official Code 2001 Edition. |
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Division VIII. General Laws. |
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Title 44. Charitable and Curative Institutions. |
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Subtitle I. Health Related Institutions. |
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Chapter 1. Assisted Living Residence Regulation. |
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Subchapter VI. Admissions; Residential Agreements; Quality of Care; Discharge; Transfer.
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(a) An ALR shall accept as residents only individuals for whom the ALR can provide appropriate services unless the ALR arranges for third party services or the resident does so with the agreement of the ALR.
(b) Prior to admission of a resident, the ALA or designee shall determine that the resident is appropriate for admission to the ALR and that the resident's needs can be met in addition to the needs of the other residents.
(c) An ALR may only admit individuals who are at least 18 years of age.
(d) No individual may be admitted who at the time of initial admission, and as established by the initial assessment:
(1) Is dangerous to him or herself or others or exhibits behavior that significantly and negatively impacts the lives of others, where the ALR would be unable to eliminate such danger or behavior through the use of appropriate treatment modalities; or
(2) Is at high risk for health or safety complications which cannot be adequately managed by the ALR and requires more than 35 hours per week of skilled nursing and home health aide services combined, provided on less than a daily basis, according to section 2113.1 of HCFA Pub. 75 and 42 CFR, sections 409.32, 409.33, and 409.44.
(e) An ALR shall not admit individuals who require the following:
(1) More than intermittent skilled nursing care;
(2) Treatment of stage 3 or 4 skin ulcers;
(3) Ventilator services; or
(4) Treatment for an active, infectious, and reportable disease or a disease or condition that requires more than contact isolation.
(f) The ALR shall maintain records of all denials of admission.
(g) Nothing in this section shall automatically exclude persons with primary or secondary mental health issues from admission.
(June 24, 2000, D.C. Law 13-127, § 601, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a) A written contract must be provided to the resident prior to admission and signed by the resident or surrogate, if necessary, and a representative of the ALR. The nonfinancial portions of the contract shall include the following:
(1) The ALR's organizational affiliations (including parent or subsidiary organizations, religious or charitable affiliation, and management company);
(2) The specific nature of any special care that it holds itself out to provide, such as specialty in Alzheimer's disease or Parkinson's disease;
(3) An identification of services to be included and excluded, part of which is the ISP;
(4) A list of resident rights including grievance procedures;
(5) Unit assignment and procedures if changes occur;
(6) Admission and discharge policies which include clear and specific criteria for admission, transfer, and discharge;
(7) A description of responsibility for provision or coordination of healthcare, if any;
(8) An arrangement for notification in case of the resident's death; and
(9) A disposition of the resident's property upon discharge, transfer, or death of the resident.
(June 24, 2000, D.C. Law 13-127, § 602, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a) The written resident agreement required by § 44-106.02 shall include financial provisions which indicate the following:
(1) The obligations of the ALR, the resident, or the resident's surrogate as to performance of the following:
(A) The handling of the finances of the resident;
(B) The purchasing or renting of essential or desired equipment and supplies;
(C) The coordinating and contracting for services not covered by the resident agreement; and
(D) The purchasing of medications and durable medical equipment;
(2) Separate and accurate records of all funds and personal property deposited with or managed by the ALR for the benefit of a resident which include a receipt stating the date, amount, and purpose of any transaction and the current balance;
(3) Rate structure and payment provisions covering all rates to be charged to the resident, including the following:
(A) Service packages;
(B) Fee for service rates; and
(C) Any other nonservice related charges;
(4) Payment arrangements and fees, if known, for third-party services not covered by the resident agreement, but arranged for by either the resident, the resident's surrogate, or the ALR;
(5) Identification of the persons responsible for payment of all fees and charges and a clear indication of whether the person's responsibility is or is not limited to the extent of the resident's funds;
(6) A provision which provides at least 45 days notice of any rate increase except if necessitated by a change in the resident's medical condition;
(7) The procedures the ALR will follow in the event the resident or surrogate can no longer pay for services provided for in the resident agreement or for additional services or care needed by the resident; and
(8) The terms governing the refund of any pre-paid fees or charges in the event of a resident's discharge from the ALR or termination of the resident agreement.
(b) The ALR shall establish billing, payment, and credit practices that are fair and reasonable.
(June 24, 2000, D.C. Law 13-127, § 603, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a)(1) An ISP shall be developed for each resident prior to admission.
(2) An ISP shall be developed following the completion of the "post move-in" assessment.
(3) The ISP shall be written by a healthcare practitioner using information from the assessment.
(4) The ISP shall be developed with the resident, or surrogate, as a full partner.
(5) The ISP shall be signed by the resident, or surrogate, and a representative of the ALR.
(6) The ISP shall include a shared responsibility agreement when necessary.
(7) The ISP shall be based on such factors as:
(A) The medical, rehabilitation, and psychosocial assessment of the resident;
(B) The functional assessment of the resident; and
(C) The reasonable accommodation of resident and, if necessary, surrogate preferences.
(b) The ISP shall include the services to be provided, when and how often the services will be provided, and how and by whom all services will be provided and accessed.
(c) During the ISP development process, the ALR shall confer with the prospective resident and, if necessary, the surrogate to arrive at a mutual agreement as to the responsibilities of each party in accessing care and achieving related outcomes.
(d) The ISP shall be reviewed 30 days after admission and at least every 6 months thereafter. The ISP shall be updated more frequently if there is a significant change in the resident's condition. The resident and, if necessary, the surrogate shall be invited to participate in each reassessment. The review shall be conducted by an interdisciplinary team that includes the resident's healthcare practitioner, the resident, the resident's surrogate, if necessary, and the ALR.
(e) An ALR shall facilitate aging in place to the best of its ability with the understanding that there may be a point reached where adequate and appropriate services can not be marshalled to support the resident safely, making transfer to another setting necessary.
(June 24, 2000, D.C. Law 13-127, § 604, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a) Whenever disagreements arise as to lifestyle, personal behavior, safety, and service plans the ALR staff, resident or surrogate, and other relevant service providers shall attempt to develop a shared responsibility agreement.
(b) A shared responsibility agreements represents a tool for ALRs to recognize an individual resident's right to autonomy by respecting his or her right to make individual decisions regarding lifestyle, personal behavior, and ISPs. In some cases, a resident's decision may involve increased risk of personal harm and therefore potentially increase the risk of liability by the ALR absent an agreement between the resident and ALR concerning such decisions or actions. In such instances the ALR shall:
(1) Explain to the resident, or surrogate, why the decision or action may pose risks and suggest alternatives to the resident; and
(2) Discuss with the resident, or surrogate, how the ALR might mitigate potential risks.
(c) If, after consultation with the ALR as required by subsection (b) of this section, a resident decides to pursue a course of action, such as refusal of services, that may involve increased risk of personal harm and conflict with the ALR's usual responsibilities, the ALR shall:
(1) Describe to the resident the action or range of actions subject to negotiation; and
(2) Negotiate a shared responsibility agreement, with the resident as a full partner, acceptable to the resident and the ALR that meets all reasonable requirements implicated. The shared responsibility agreement shall be signed by the resident or surrogate and the ALR.
(June 24, 2000, D.C. Law 13-127, § 605, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
A record shall be maintained for every resident and include the following:
(1) The resident agreement required by this subchapter, including the "Resident's Rights" statement and any additional agreements;
(2) The functional assessment of ADLs;
(3) A physician's statement, including medical orders and rehabilitation plans;
(4) The ISP and any revisions thereto;
(5) All shared responsibility agreements; and
(6) Any note and comments added to the record by the ALR.
(June 24, 2000, D.C. Law 13-127, § 606, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a) An ALR shall provide or ensure the provision of the following:
(1) Twenty-four hour supervision and oversight to ensure the well-being and safety of its residents;
(2) Three nutritious and attractive meals and additional snacks, modified to individual dietary needs as necessary, on a daily basis;
(3) A variety of fresh and seasonal foods, adapted to the food habits, preferences, and physical abilities of the residents;
(4) At minimum, some assistance with ADLs and IADLs to meet the scheduled and unscheduled service needs of the residents; and
(5) Laundry and housekeeping service not provided by the resident or surrogate.
(b) An ALR shall facilitate access for a resident to appropriate health and social services, including social work, home health agencies, nursing, rehabilitative, hospice, medical, dental, dietary, counseling, and psychiatric services.
(c) An ALR shall provide or coordinate scheduled transportation to community-based services.
(June 24, 2000, D.C. Law 13-127, § 607, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
(a) When a resident wishes to be discharged from an ALR, the resident or surrogate shall give 30 days written notice to the ALR.
(b) When a sudden, unexpected, and life-threatening medical emergency arises necessitating the immediate transfer of the resident to an acute care facility, the ALR shall immediately notify the surrogate and the resident's healthcare provider of the transfer. The ALR shall provide the surrogate and healthcare provider with information concerning cause of the transfer and the name and location of the acute care facility.
(c) After a resident is transferred pursuant to subsection (b) of this section, his or her return to the ALR shall be determined by the renegotiation of the ISP with the resident or surrogate, the resident's healthcare provider, and the ALR. If, in renegotiating the ISP, the interested parties determine that the resident can no longer safely reside at the ALR, discharge planning shall take place in consultation with the resident or surrogate, the resident's healthcare provider, and the ALR. Under these circumstances the ALR shall waive the 30 day notice requirement.
(d) Before a resident may be discharged on an involuntary basis, the ALR shall provide 30 days written notice to the resident and surrogate of the planned discharge, and make arrangements for the discharge in consultation with the resident, the surrogate, and the healthcare provider. Any involuntary discharge shall conform to the notice and process established in subchapter III of Chapter 10 of this title.
(e) Although an ALR shall make every effort to avoid discharge, grounds for involuntary discharge may include the following:
(1) Failure to pay all fees and costs as specified in the contract; and
(2) Inability of the ALR to meet the care needs of the resident as provided in the ISP.
(f) An involuntary discharge shall be canceled upon the occurrence of one of the following:
(1) The payment of all monies owed at any time prior to discharge; or
(2) The negotiation of a new ISP.
(June 24, 2000, D.C. Law 13-127, § 608, 47 DCR 2647.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 13-127, see notes following § 44-101.01.
