16 Del. Admin. Code § 3225-13.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 3225-13.0 - Service Agreements

13.1 A service agreement based on the needs identified in the UAI shall be completed prior to or no later than the day of admission. The resident shall participate in the development of the agreement. The resident and the facility shall sign the agreement and each shall receive a copy of the signed agreement. All persons who sign the agreement must be able to comprehend and perform their obligations under the agreement.

13.2 The service agreement or contract shall address the physical, medical, and psychosocial services that the resident requires as follows:

13.2.1 Assistance with activities of daily living and instrumental activities of daily living;

13.2.2 Services provided by licensed nurses;

13.2.3 Food, nutrition, and hydration services;

13.2.4 Environmental services including housekeeping, laundry, safety, trash removal;

13.2.5 Psychosocial/emotional services including those related to memory impairment and other cognitive deficits;

13.2.6 Banking, record keeping, and personal spending services;

13.2.7 Transportation services;

13.2.8 Individual living unit furnishings;

13.2.9 Notification procedures when an incident occurs or there is a change in the health status of the resident;

13.2.10 Assistive technology and durable medical equipment;

13.2.11 Rehabilitation services;

13.2.12 Qualified interpreters for people who have a hearing impairment or do not speak English; and

13.2.13 Reasonable accommodations for persons with disabilities as defined by applicable state and federal law.

13.3 The resident's personal attending physician(s) shall be identified in the service agreement by name, address, and telephone number.

13.4 The facility shall be responsible for appropriate documentation in the service agreement for services provided or arranged by the facility.

13.5 The service agreement shall be developed and followed for each resident consistent with that person's unique physical and psychosocial needs with recognition of his/her capabilities and preferences.

13.6 The service agreement shall be reviewed when the needs of the resident have changed and, minimally, in conjunction with each UAI. Within 10 days of such assessment, the resident and the assisted living facility shall execute a revised service agreement, if indicated.

13.7 The service agreement shall be based on the concepts of shared responsibility and resident choice. To participate fully in shared responsibility, residents shall be provided with clear and understandable information about the possible consequences of their decision-making. If a resident's preference or decision places the resident or others at risk or is likely to lead to adverse consequences, a managed/negotiated risk agreement section may be included in the service agreement.

13.8 The following are criteria for a managed/ negotiated risk agreement:

13.8.1 The risks are tolerable to all parties participating in the development of the managed/negotiated risk agreement;

13.8.2 Mutually agreeable action is negotiated to provide the greatest amount of resident autonomy with the least amount of risk; and

13.8.3 The resident living in the facility is capable of making choices and decisions and understanding consequences.

13.9 If a managed/negotiated risk agreement is made a part of the service agreement, it shall:

13.9.1 Clearly describe the problem, issue or service that is the subject of the managed/negotiated risk agreement;

13.9.2 Describe the choices available to the resident as well as the risks and benefits associated with each choice, the assisted living facility's recommendations or desired outcome, and the resident's desired preference;

13.9.3 Indicate the agreed-upon option;

13.9.4 Describe the agreed upon responsibilities of the assisted living facility, the resident, and any third parties;

13.9.5 Become a part of the service agreement, be signed separately by the resident, the assisted living facility, and any third party with obligations under the managed/ negotiated risk agreement that the third party is able to fully comprehend and perform; and

13.9.6 Include a time frame for review.

13.10 The assisted living facility shall have sufficient staff to meet its responsibilities under the managed/negotiated risk agreement.

13.11 The assisted living facility shall not use managed/negotiated risk agreements to provide care to residents with needs beyond the capability of the facility. A managed/negotiated risk agreement shall not be used to supersede any requirements of these regulations.

13.12 The assisted living facility shall make no attempt to use the managed/negotiated risk portion of the service agreement to abridge a resident's rights or to avoid liability for harm caused to a resident by the negligence of the assisted living facility and any such abridgement or disclaimer shall be void.

16 Del. Admin. Code § 3225-13.0