16 Del. Admin. Code § 3305-III-6.0

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

Section 3305-III-6.0 - Admission and Discharge

Admission

6.1 The purpose of a group home is to provide a supportive and rehabilitative environment for consumers of mental health services who are unable to live independently at a given time, who demonstrate a willingness to develop the skills for independent living, and who would benefit from group living as an alternative to their existing living situation.

6.2 A service provider shall ensure that no applicant is denied any benefits or services or is subject to illegal discrimination based on age, sex, race, nationality, religion, sexual orientation or disability.

6.3 Unless otherwise authorized by statute, admission to a group home shall be limited to adults with a psychiatric disability who apply for admission to the group home, meet the criteria contained in Section 6.4, and require intensive home and community-based support services as a result of the degree of their psychiatric disability.

6.4 In order to be accepted as a resident of a group home, the following criteria must be met:

6.4.1 Be eighteen (18) years of age or older;

6.4.2 Require a twenty-four (24) hour supervised community residence because of a primary diagnosis of serious mental illness and not require the services of a psychiatric hospital;

6.4.3 Agree to abide by the rules and regulations of the program;

6.4.4 Be assessed not likely to be dangerous consistent with the following standard:

6.4.4.1 Individuals shall not be eligible for group home admission if their residency, even with reasonable accommodation, would either constitute a direct threat to the health or safety of self or others, or result in substantial physical damage to the property of others. Such determination shall be made on an individualized basis by a multi-disciplinary team of the group home, which shall include a psychiatrist.

6.4.4.2 Individuals shall agree to comply with treatment plans.

6.4.5 Not be a current user of illegal drugs during the assessment period. A drug-screening test may be required to demonstrate the remission or current nonuse of illegal drugs at the time of admission.

6.5 Prior to admission, the service provider shall provide the applicant or legal representative an admission agreement, including the following:

6.5.1 An itemized statement of services, equipment, and supplies expected to be furnished to the applicant during the period of residency;

6.5.2 The cost and expected source of funding for each item, highlighting any items chargeable to the applicant's personal funds;

6.5.3 Discharge standards;

6.5.4 By attachment, the Patients' Bill of Rights Act (16Del.C., § 1121). Receipt shall be acknowledged by signature of the applicant or legal representative and retained in the service provider's file; and

6.5.5 Each provider shall adopt a reasonable fee schedule, which shall be shared with an applicant in writing prior to admission and at such intervals thereafter as prescribed by the Department. Fees charged residents receiving state and/or federal financial assistance shall not exceed amounts available to such persons under law. Residents of all group homes shall be given thirty (30) days written notice of any increase in fees.

6.6 The service provider shall complete an assessment, using a format approved by the Division of Substance Abuse and Mental Health, prior to each resident's admission to the group home with the assistance of the group home's psychiatrist.

A written summary of the assessment completed by the applicant's primary clinician must be clearly explained to the applicant. The summary of the assessment shall address, at a minimum, the following:

6.6.1 Current psychiatric or behavioral health symptomatology and mental status;

6.6.2 Compliance with and response to prescribed medical/psychiatric treatment;

6.6.3 Medical, dental, and visual needs;

6.6.4 Recent key life events and current social functioning;

6.6.5 Vocational and educational functioning;

6.6.6 Accommodations and supports to facilitate activities of daily living;

6.6.7 Recommendations pertaining to limitations on the applicant's diet or activities, if any, signed by a licensed physician; and

6.6.8 Drug and alcohol history and history of assaultive behavior up to five (5) years prior to institutionalization.

6.7 Based on the results of the assessment, the service provider and resident shall develop an initial individualized treatment plan no later than the date of the resident's admission to the group home. The service provider shall comply with the provisions of such plan. Copies of such plan and all amendments shall promptly be provided to the resident. In addition, copies of such plans shall be maintained for each resident at the resident's group home and shall be available for inspection by the Department upon request.

6.8 Discharge. Consistent with 16Del.C.,Section 1121, a provider may seek discharge of a resident for good cause. Prior to discharge, the provider shall ensure the development of a written discharge plan in consultation with the resident; his guardian or legal representative, if any; anticipated post-discharge providers; and a multidisciplinary team which shall include a psychiatrist.

6.8.1 Content of a Discharge Plan

At a minimum, the discharge plan shall include:

6.8.1.1 A realistic assessment of the resident's post discharge social financial, vocational, housing, and treatment needs;

6.8.1.2 Identification of available support services and provider linkages necessary to meet the assessed needs; and

6.8.1.3 Identification and a timetable of discrete, predischarge activities necessary to promote the resident's successful transition to the post-discharge setting.

6.8.2 Good Cause

Good cause for discharge includes the following:

6.8.2.1 The resident has demonstrated the ability and willingness to live in a less restrictive setting;

6.8.2.2 The resident, even with reasonable accommodation, poses either a direct threat to the health or safety of self or others; or direct threat of substantial physical damage to the property of others;

6.8.2.3 The resident requires a level of care beyond the scope of that reasonably available within the group home; or

6.8.2.4 The resident has materially violated essential rules of operation of the group home and such violation seriously affects the welfare of the resident or other residents of the group home.

6.9 A resident to be discharged shall be given thirty (30) days prior notice of the discharge and the reasons therefore, and shall be entitled to an impartial hearing to challenge the discharge. In emergency situations, a resident may be discharged without notice and a hearing, provided that as soon as practical a resident will be provided an opportunity to challenge the discharge through a hearing after the discharge has occurred, and further provided that no resident may be discharged before the service provider develops and implements an emergency discharge plan adequate to protect the resident's safety and welfare until the discharge hearing.

The emergency plan shall address the resident's need for housing. For purposes of this subsection, a situation is an emergency when the behavior of a resident is causing or threatens to imminently cause physical injury or death to the resident, other residents, staff, or others.

No resident shall be discharged on an emergency basis without prompt notification to the Division of Substance Abuse and mental Health.

6.10 Short-term transfer to a medical treatment setting, including a psychiatric hospital, shall not result in discharge.

16 Del. Admin. Code § 3305-III-6.0