LTCCC PROPOSES CHANGES TO CURRENT ADULT HOME RULES TO PROMOTE RESIDENT AUTONOMY, CHOICE AND INDEPENDENCE

Since the 2004 assisted living licensure law requires all assisted living residences to follow current adult home regulations, LTCCC makes the following suggestions for changes in the current adult home regulations.  See http://www.health.state.ny.us/nysdoh/phforum/nycrr18.htm to find the current adult home rules.

(1) Section 487.4.  Admission and Retention Standards

In order to ensure that people living in adult homes are afforded an opportunity to move into more independent housing if they are able to and want to, we suggest removing the crossed off word and add the bolded language to the following section: (n) In facilities with a significant number of mentally disabled persons, the mental health organization or agency with which the operator has executed the agreement required by section 487.7(b) of this Part shall be afforded reasonable opportunity to participate in the admission or retention assessment of persons who require a mental health evaluation or who would be eligible for the mental health organization's services by reason of residency in the adult home. Such participation shall be solely for the purpose of assisting the operator to determine if the operator and available mental health services can meet the needs of the resident or if the resident would like to and is able to move into a alternative housing.

(2) 487.5 Resident Protections

(b) (2) (ii) Resident Organizations – We suggest adding the bolded:  “appoint a staff person, with residents’ permission, to act as an advisor to the residents’ organization, who shall serve as a liaison ….”

(f) (7) (ii) – We suggest adding the bolded: “In the event that a resident’s behavior poses a realistic imminent risk of death or imminent risk of serious physical harm to himself or others, the operator will document this, give written notice with an opportunity to dispute the allegations and the operator will arrange for transfer of the individual, with participation of the resident and the family in the selection, to an appropriate facility.  ” In addition, the operator must make clear to the resident and family why the new facility is more appropriate.

(f) In order to make sure that resident choice is promoted when a resident is involuntarily transferred to a hospital, the following languages should be added to state clearly that it is the hospital (or nursing home) which makes the determination of when the resident is able to return, not the adult homeUnless the resident’s admission agreement has been terminated in accordance with this section and with Section 461-h of the Social Services Law, and during the pendency of any proceeding to terminate the admission agreement, when the hospital, nursing home or residential health care facility to which the resident was removed deems the resident appropriate for return to the facility, the operator shall accept the resident for return immediately.  The operator’s obligation to accept the resident shall apply whether the transfer to a hospital, nursing home or residential health care facility was voluntary or involuntary.  In addition, the regulations should be amended to require notification to residents of their right to return to the facility and require adult homes to report transfers to the DOH where the resident does not return.

(3) 487.7 Resident Services

(e) (6) (ii). We suggest changing to: “Residents, who choose to, may be provided in-room tray services, in addition to when it is necessary for a short-term illness.”

(g) (1) (iii). Please remove and add a new iii: “assist staff to understand and accommodate the basic routines of the resident.”

(h) (1). Please add the bolded “The operator shall develop and maintain, with the participation and input of residents and, if appropriate, family members, an organized and diversified program of individual and ….”

(h) We suggest adding a new section (13): “On-going evaluations of the activities program will be conducted collecting information on how many residents are attending which activities, resident satisfaction with activities. Modification of activities programs will be made based upon the evaluations.”

(4) 487.8. Food Service

(d) (1). Please add the bolded: “Menus for regular and modified diets and snacks are to be planned, with the participation and input of the residents and family members, to furnish sufficient nutrients and calories to meet the recommended dietary allowances of the Food and Nutrition Board of the National Academy of Science, National Research Council, adjusted for age, sex and activity.”

 (d). Add a new section (16): On-going evaluations of the menus will be conducted collecting information on percentages of food eaten at meals and resident satisfaction. Modification of menus programs will be made based upon the evaluations.”

(d). Add a new section (17): “Food services shall be provided in a manner that respects the dietary needs of the residents in relation to health conditions, food allergies and dietary intolerances, religious and ethnic mandates, and that allows for a reasonable variation in taste preferences.” (Note: this is language that passed in the Budget Bill – Article 7 – Language for Adult Home Initiatives – S2108-C/A4308-C).

(d). Add a new section (18): “Resident food committees in each facility, assembled from among the residents, shall have the freedom to meet and evaluate the food service available to them without interference, and shall advise the operators as to issues of dietary needs, preferences, food quality and safety. (Note: this is language that passed in the Budget Bill – Article 7 – Language for Adult Home Initiatives – S2108-C/A4308-C).

Add anew section: “The commissioner of health shall review existing adult care facility regulations and amend existing regulations or  promulgate new regulations if  appropriate, to determine those food service personnel in adult care facilities that should undergo training appropriate for the level of food service which they may perform, including but not limited to sanitation in the food preparation and service areas; refrigeration and preservation;  principles of a balanced meal; and ordering with an emphasis on fresh foods.”  (Note: this is language that passed in the Budget Bill – Article 7 – Language for Adult Home Initiatives – S2108-C/A4308-C).

 (d) (8) (i). Add the bolded:  “planned a minimum of three weeks in advance unless evaluations of resident satisfaction or resident participation require less of a lead in time.”

(5) 487.9. Personnel

(3). Add a new section (vii). How to communicate with residents and family members.

Add a new section that states that “No adult care facility shall furnish payment to any party as compensation for referring a resident for admission, nor may staff members receive commissions for admission of new residents to the facility.”   This will help stop the practice of paying “headhunters” to recruit residents from psychiatric units of hospitals in order to fill beds.  This practice provides a monetary incentive to steer residents with mental disabilities toward specific adult homes, rather than to provide them with alternatives. 

(6) 487.11. Environmental Standards

(i). (2). Please add the bolded: “All resident areas shall be decorated, painted and appropriately furnished. Resident and family members will participate in such plans.  Add a new section: (i) (5): Residents may bring their own furniture.

(l) (1).  Please add bolded: “Space in a facility must be used exclusively for the purposes set forth in this Part.  An operator may request prior permission, in writing, to utilize space for other activities. The operator must document the participation of the residents in the decision to use the space differently, demonstrate that the proposed use is not incompatible with the facility program,….”

Add a new part that states:”The Department of Health should establish a reasonable schedule of charges for the use of air conditioners and prohibit operators from charging more than the fee schedule.”

Please change the language in 15 (3) as follows

When the outside temperature exceeds 85 degrees Fahrenheit (30 degrees Celsius) and the inside temperature exceeds 72 degrees at any time day or night the operator shall:
(i) turn on air conditioners in public areas and in resident rooms when available.

LTCCC will work with the State Department of Health and the State Task Force to implement these changes.