| (a) Admission policies and disclosure statement.
(1) A facility must not admit or retain a resident
whose needs cannot be met by the facility and who cannot secure the
necessary services from an outside resource. As part of the facility's
general supervision and oversight of the physical and mental well-being
of its residents, the facility remains responsible for all care provided
at the facility. If the individual is appropriate for placement in
a facility, then the decision that additional services are necessary
and can be secured is the responsibility of facility management with
written concurrence of the resident, resident's attending physician,
or legal representative. Regardless of the possibility of "aging in
place" or securing additional services, the facility must meet all
NFPA 101 and physical plant requirements in Subchapter D of this chapter
(relating to Facility Construction), and, as applicable, §553.311
(relating to Physical Plant Requirements for Alzheimer's Units), based
on each resident's evacuation capabilities, except as provided in
subsection (e) of this section.
(2) There must be a written admission agreement between
the facility and the resident. The agreement must specify such details
as services to be provided and the charges for the services. If the
facility provides services and supplies that could be a Medicare benefit,
the facility must provide the resident a statement that such services
and supplies could be a Medicare benefit.
(3) A facility must share a copy of the facility disclosure
statement, rate schedule, and individual resident service plan with
outside resources that provide any additional services to a resident.
Outside resources must provide facilities with a copy of their resident
care plans and must document, at the facility, any services provided,
on the day provided.
(4) In addition to the facility disclosure statement,
a facility that advertises, markets, or otherwise promotes that it
provides services, including memory care services, to residents with
Alzheimer's disease and related disorders, must provide to each resident
the Assisted Living Facility Memory Care Disclosure Statement. The
facility must disclose whether the facility is certified to provide
specialized care to residents with Alzheimer's disease or related
disorders.
(A) A facility that is Alzheimer's certified and provides
the Assisted Living Facility Memory Care Disclosure Statement to a
resident, must also provide HHSC Form 3641, Alzheimer's Assisted Living
Facility Disclosure Statement.
(B) A facility that is not Alzheimer's certified and
provides the Assisted Living Facility Memory Care Disclosure Statement,
to a resident does not need to provide HHSC form 3641, Alzheimer's
Assisted Living Disclosure Statement.
(5) Each resident must have a health examination by
a physician performed within 30 days before admission or 14 days after
admission, unless a transferring hospital or facility has a physical
examination in the medical record.
(6) The facility must secure at the time of admission
of a resident the following identifying information:
(A) full name of resident;
(B) social security number;
(C) usual residence (where resident lived before admission);
(D) sex;
(E) marital status;
(F) date of birth;
(G) place of birth;
(H) usual occupation (during most of working life);
(I) family, other persons named by the resident, and
physician for emergency notification;
(J) pharmacy preference; and
(K) Medicaid/Medicare number, if available.
(b) Resident assessment and service plan. Within 14
days of admission, a resident comprehensive assessment and an individual
service plan for providing care, which is based on the comprehensive
assessment, must be completed. The comprehensive assessment must be
completed by the appropriate staff and documented on a form developed
by the facility. When a facility is unable to obtain information required
for the comprehensive assessment, the facility should document its
attempts to obtain the information.
(1) The comprehensive assessment must include the following
items:
(A) the location from which the resident was admitted;
(B) primary language;
(C) sleep-cycle issues;
(D) behavioral symptoms;
(E) psychosocial issues (e.g., a psychosocial functioning
assessment that includes an assessment of mental or psychosocial adjustment
difficulty; a screening for signs of depression, such as withdrawal,
anger or sad mood; assessment of the resident's level of anxiety;
and determining if the resident has a history of psychiatric diagnosis
that required in-patient treatment);
(F) Alzheimer's disease/dementia history;
(G) activities of daily living patterns (e.g., wakened
to toilet all or most nights, bathed in morning/night, shower or bath);
(H) involvement patterns and preferred activity pursuits
(e.g., daily contact with relatives, friends, usually attended religious
services, involved in group activities, preferred activity settings,
general activity preferences);
(I) cognitive skills for daily decision-making (e.g.,
independent, modified independence, moderately impaired, severely
impaired);
(J) communication (e.g, ability to communicate with
others, communication devices);
(K) physical functioning (e.g, transfer status; ambulation
status; toilet use; personal hygiene; ability to dress, feed and groom
self);
(L) continence status;
(M) nutritional status (e.g., weight changes, nutritional
problems or approaches);
(N) oral/dental status;
(O) diagnoses;
(P) medications (e.g., administered, supervised, self-administers);
(Q) health conditions and possible medication side
effects;
(R) special treatments and procedures;
(S) hospital admissions within the past six months
or since last assessment; and
(T) preventive health needs (e.g., blood pressure monitoring,
hearing-vision assessment).
(2) The service plan must be approved and signed by
the resident or a person responsible for the resident's health care
decisions. The facility must provide care according to the service
plan. The service plan must be updated annually and upon a significant
change in condition, based upon an assessment of the resident.
(3) For respite clients, the facility may keep a service
plan for six months from the date on which it is developed. During
that period, the facility may admit the individual as frequently as
needed.
(4) Emergency admissions must be assessed and a service
plan developed for them.
(c) Resident policies.
(1) Before admitting a resident, facility staff must
explain and provide a copy of the disclosure statement to the resident,
family, or responsible party. A facility that provides brain injury
rehabilitation services must attach to its disclosure statement a
specific statement that licensure as an assisted living facility does
not indicate state review, approval, or endorsement of the facility's
rehabilitative services. The facility must document receipt of the
disclosure statement.
(2) The facility must provide residents with a copy
of the Resident's Bill of Rights.
(3) When a resident is admitted, the facility must
provide to the resident's immediate family, and document the family's
receipt of, the HHSC telephone hotline number to report suspected
abuse, neglect, or exploitation, as referenced in §553.273 of
this subchapter (relating to Abuse, Neglect, or Exploitation Reportable
to HHSC by Facilities).
(4) The facility must have written policies regarding
residents accepted, services provided, charges, refunds, responsibilities
of facility and residents, privileges of residents, and other rules
and regulations.
(5) The facility must make available copies of the
resident policies to staff and to residents or residents' responsible
parties at time of admission. Documented notification of any changes
to the policies must occur before the effective date of the changes.
(6) Before or upon admission of a resident, a facility
must notify the resident and, if applicable, the resident's legally
authorized representative, of HHSC rules and the facility's policies
related to restraint and seclusion.
(7) The facility must provide a resident and the resident's
legally authorized representative with a written copy of the facility's
emergency preparedness plan or an evacuation summary, as required
under §553.275(d) of this subchapter (relating to Emergency Preparedness
and Response).
(d) Advance directives.
Cont'd... |
