216 R.I. Code R. 216-RICR-40-10-2.6

Current through June 12, 2024

Section 216-RICR-40-10-2.6 - Limited Health Services License Requirements

2.6.1Applicability

A. Any assisted living residence that offers to provide or provides limited health services to residents shall be required to meet all requirements of §§ 2.4 and 2.6 of this Part.

2.6.2Specific Requirements

A. All limited health services provided by a licensed assisted living residence shall be ordered by the resident's physician, and provided by qualified licensed assisted living staff members.

B. Assisted living residences licensed to provide limited health services may provide any or all of the following services:

1. Stage I and stage II pressure ulcer treatment and prevention;

2. Simple wound care including postoperative suture care/removal and stasis ulcer care;

3. Ostomy care including appliance changes for residents with established stomas;

4. Urinary catheter care.

C. An assisted living residence licensed to provide limited health services and offers to provide services to residents receiving hospice services that are bed-bound or in need of assistance from more than one (1) staff person for ambulation is required to be licensed at the F1 licensure level as defined in § 2.4.2(A)(1)(a) of this Part.

D. When it is identified that a resident requires a limited health services as defined in § 2.6.2(B) of this Part, the residence must inform the resident in writing of his/her right to access a licensed home nursing care agency or hospice provider for the services needed.

E. Assisted living residences licensed to provide limited health services are required to disclose in writing all services offered.

F. The disclosure shall be made to the licensing agency and to any person seeking placement in an assisted living residence licensed to provide limited health services.

G. The information disclosed shall explain the care that is provided in each of the following areas:

1. Philosophy: Written statement of its overall philosophy and mission which reflects how the assisted living provides limited health services;

2. Pre-Occupancy, Occupancy, and Termination of Residence: The process and criteria for occupancy, transfer or termination of residency;

3. Assessment, Service Planning and Implementation: The process used for assessment and establishing the plan of services and its implementation, including the method by which the plan of services evolves and is responsive to changes in condition;

4. Family Role in Providing Support and Services: The involvement with families and family support programs;

5. Program Costs: The cost of care and any additional fees and the process used in the event that a resident can no longer afford the cost of care being provided.

H. Any significant changes in the disclosure information provided by the assisted living residence shall be reported to the Department at the time the changes are made.

I. An assisted living residence that determines to cease offering a limited health service(s) shall notify, in writing, the Department, all residents, their guardian, or relative so appointed or elected to be his/her decision maker, every resident's physician and to the Office of the Long-Term Care Ombudsman of its intent thirty (30) days or more before ceasing to offer a limited health service.

1. The written notification shall include, but is not limited to the following:

a. Letter of intent and/or determining factors/justification for stopping the service(s);

b. Proposed date that services would be discontinued;

c. Plan for ensuring that residents continue to receive services until other acceptable arrangements are made; and

d. Contact information of staff member responsible for implementing plan.

J. Based upon approval by the Department, an assisted living residence that that does not provide all limited health services, as defined in § 2.6.2(B) of this Part, may add additional service(s) under its license one (1) time per annual licensing period.

K. Assisted living residences licensed to provide limited health services are required to develop and maintain written policies and procedures that detail the services offered, including:

1. Admission and discharge criteria for residents requiring limited health services;

2. Stage I and stage II pressure ulcer treatment and prevention;

3. Simple wound care including postoperative suture care/removal and stasis ulcer care;

4. Ostomy care including appliance changes for residents with established stomas;

5. Urinary catheter care;

6. Chronic, non-pressure related ulcers, such as venous stasis ulcers;

7. In-dwelling Foley catheters;

8. If applicable, coordination of hospice services for residents who are bed-bound or in need of assistance from more than one (1) staff person for ambulation.

L. All written policies and procedures for limited health services shall be developed under the direction of a licensed physician which shall be reviewed and approved at intervals not to exceed twelve (12) months.

M. Assisted living residences licensed to provide limited health services are required to have a licensed physician, a certified nurse practitioner or a licensed physician assistant as a member of the Quality Improvement Committee as defined in § 2.4.3 of this Part.

N. All limited health services shall be delivered in accordance with the prevailing community standard of care.

O. Evidence of Pre-employment and Ongoing Health Screening

1. Upon hire and prior to delivering services, employment health screenings shall be required for each individual who has or may have direct contact with a resident receiving limited health services. Such health screening shall be conducted in accordance with Part 20-15-7 of this Title, Immunization, Testing, and Health Screening for Health Care Workers.

P. All staff providing direct care services to residents receiving limited health services and/or hospice services for residents who are bed-bound or in need of assistance from more than one (1) staff person for ambulation shall be qualified licensed assisted living staff members and may only perform duties and services as permitted by their respective license and/or certificate of registration.

Q. Assisted living residences licensed to provide limited health services are required to have on staff, at a minimum, a registered nurse(s). The nurse shall be on-site full-time (minimum of thirty-five (35) hours per week), and shall be available for consultation at all times.

R. Staff Training - Limited Health Services. All employees, including those who will assist residents with personal care must receive at least four (4) hours of orientation and training in the areas listed below prior to beginning work alone with a resident receiving limited health services. Staff will be provided no less than two (2) hours of continued education in the following areas at intervals not to exceed twelve (12) months.

1. Pressure ulcer treatment and prevention;

2. Simple wound care including postoperative suture care/removal and stasis ulcer care;

3. Ostomy care including appliance changes for residents with established stomas;

4. Urinary catheter care;

5. In-dwelling Foley catheters;

6. Reporting changes in condition;

7. Signs and symptoms of infection(s); and

8. Signs and symptoms of dehydration.

2.6.3Emergency Power

A. The residence shall provide an emergency source of electrical power necessary to protect the health and safety of residents in the event the normal electrical supply is interrupted.

1. Such emergency power system shall supply power adequate at least for:

a. Lighting all means of egress; and

b. Equipment to maintain detection, alarm and extinguishing systems.

216 R.I. Code R. 216-RICR-40-10-2.6

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 3/18/2024