Survey of State Assisted Living Regulations:

Transcription

1 Executive Summary Survey f State Assisted Living Regulatins: - Assisted Living & Licensing - Staffing and Staff Qualificatins NARA Adult Care Plicy Cmmittee Nvember 13, 2015 March 7, 2015 Natinal Assciatin fr Regulatry Administratin Page 1 f 10

2 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins Acknwledgements Several members f the NARA Adult Care Plicy Cmmittee Members have been invlved in sme manner leading up t and during the curse f this survey prject. These have included but may nt be limited t: Steven Eng - c-chair (BC, Canada) Margie Zelenak - c-chair (PA) Glria Merk - past cmmittee chair/retired (CA) Drthy Breen (AB, Canada) Wayne Curtin (KY) Eric Dwdy (CA) Terry Jarvis (NH) Jamie Simpsn (ID) Nancy Starr (FL) Jane Urbanvsky (AL) Tm van der Veen (OR) Sandi Wters (PA) Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 2 f 10

3 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins Intrductin One f the functins f the NARA Adult Care Plicy Cmmittee is t make recmmendatins regarding minimum standards fr adult care licensing. T help infrm the Cmmittee, an analysis and cmparisn f state regulatins is a prerequisite step. Histrically, NARA has cnducted state licensing cmparisn using the NARA Licensing Categries as a baseline. The Cmmittee enhanced the categries t incrprate mre current regulatry areas generally cnsidered in regulatins fr adult care: General Prvisins Physical Site Fire Safety and Emergency Preparedness Resident Rights Staffing Care and Services Resident Health Medicatin Nutritin Transprtatin Recrds At the NARA Seminar in September 2013, members f the Cmmittee made a presentatin n the Cmmittee s prject wrk plan and cllected input t priritize which licensing categries were imprtant fr NARA t establish mdel benchmarks fr assisted living. Based n the results f a participant questinnaire, the tp three were: Staffing (includes: rati, number, qualificatins, training) General prvisin (includes: definitin f assisted living, scpe f services permitted) Resident Rights (includes: respect, privacy, autnmy, prtectin frm abuse) T avid and minimize any ptential misinterpretatin when reviewing each state s assisted living regulatins using a standardized evaluatin tl based n the enhanced NARA Licensing categries, the Cmmittee decided t cnduct a survey with a fcus n staffing and staff qualificatins t be sent t the directrs f each state s licensing agency. Methdlgy Based n the enhancements made t the NARA Licensing categries which align better with current regulatry areas generally cnsidered in regulatins fr adult care, and taking int cnsideratin pririties expressed by a small fcus grup at the 2013 NARA Seminar with respect t the Cmmittee s future prject wrk t establish a mdel benchmark fr adult care regulatins, a survey instrument was develped with a fcus n staffing and staff qualificatins. Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 3 f 10

4 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins The NARA Licensing Categries enhanced fr adult care regulatins indicates that the categry f Staffing culd include requirements fr: - Ratis, number f staff, qualificatins - Staff health examinatins - Staff supervisin - Staff training and develpment - Prhibited actins twards residents - Use f restrictive prcedures - Perfrmance review / staff satisfactin Between June and July 2014, specific questins were established t understand the presence and variatin in state regulatins regarding staffing and staff qualificatins. Cntacts fr each state were btained frm the Natinal Center fr Assisted Living (NCAL) Assisted Living Regulatry Review Surveys were sent by t state cntacts n July 31, Alternative state cntacts were sught if s were undeliverable. Reminders were sent t thse wh prmised t respnd t the survey. Respnses received between August 2014 and February 3, 2015 was summarized int tables fr analysis. Survey Findings A. States Respnding t Survey 1 The NARA survey questinnaire was sent t state licensing cntacts in 51 States n July 31, As f February 3, 2015: 29 respnses (56.9%) received 26 frm state cntacts (Alaska, Delaware, District f Clumbia, Gergia, Idah, Illinis, Iwa, Kansas, Luisiana, Maryland, Michigan, Mntana, Nebraska, New Hampshire, New Jersey, New Mexic, New Yrk, Oregn, Pennsylvania, Rhde Island, Suth Carlina, Tennessee, Texas, Utah, Virginia, West Virginia) and 3 cmpleted by a member f the Cmmittee (Califrnia, Hawaii, Washingtn) 6 prmised t send a survey respnse; r request was frwarded t anther persn 16 n respnses (due t either undeliverable, ut f ffice, r n respnse) B. Assisted Living & Licensing Althugh the fcus f the survey is n staffing and staff qualificatins, it is imprtant t cllect infrmatin as t hw states define assisted living and the scpe f services that may r may nt be prvided t prvide cntext when interpreting survey results. Of the 29 States included in this survey: - Definitins vary amng states but a cmmn theme is prviding supprt services t assist with activities f daily living. - With respect t reference being made t prvisin f nursing r health related services: 15 States (52%) include in their definitin reference t prvisin f health-related services and/r medicatin administratin (Delaware, District f Clumbia, Gergia, Illinis, Iwa, 1 Fr ease f reprting the District f Clumbia is included in the use f the term state. Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 4 f 10

5 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins Luisiana, Maryland, Mntana, New Hampshire, Oregn, Pennsylvania, Rhde Island, Texas, Utah, Virginia) 6 States (21%) include in their definitins that sme level f nursing may be prvided but place limitatins such as: being intermittent, nt 24-hur nursing, nt skilled nursing (Delaware, Kansas, Luisiana, New Hampshire, New Jersey, West Virginia). 10 States (34%) made n reference t health related services, medicatin administratin r nursing services (Alaska, Califrnia, Hawaii, Idah, Nebraska, New Mexic, New Yrk, Suth Carlina, Tennessee, Washingtn) - 28 States (96%) indicated that licensing is required t perate r prvide Assisted Living. When asked what triggers when a license is required, respnses varied with respect t type f services/care prvided, number f residents, ther, r a cmbinatin f these. The States f Califrnia and Hawaii appear t have criteria ther than the type f services/care prvided and/r the number f residents, which trigger when a license is required. C. Staffing Requirements The NARA Licensing Categries enhanced fr adult care regulatins (Appendix 1) indicates that the categry f Staffing culd include requirements fr: - Ratis, number f staff, qualificatins - Staff health examinatins - Staff supervisin - Staff training and develpment - Prhibited actins twards residents - Use f restrictive prcedures - Perfrmance review / staff satisfactin T understand the presence and variatin in state regulatins regarding staffing and staff qualificatins, specific questins were develped fr the survey. Of the 29 States included in this survey: - 22 States (76%) have regulatins that d nt specify a minimum staff-t-resident rati. Unslicited cmments frm 8 respndents typically refer t prviding adequately trained staff in sufficient numbers t meet the needs f the residents and/r assure resident health and safety (Alaska, Califrnia, Delaware, Idah, Oregn, Rhde Island, Texas, Washingtn). - 7 States (24%) have regulatins that specify the minimum staff-t-resident rati (Califrnia, Gergia, Michigan, New Mexic, New Yrk, Suth Carlina, West Virginia). - 6 States (21%) have regulatins that specify the minimum number f direct care staff hurs per resident per day (Illinis, Michigan, New Mexic, Pennsylvania, Suth Carlina, West Virginia) States (62%) have regulatins that specify having a licensed nurse available (r n-call) at all times (Alaska, Califrnia, Hawaii, Idah, Iwa, Kansas, Luisiana, Maryland, Mntana, New Hampshire, New Jersey, Oregn, Pennsylvania, Rhde Island, Tennessee, Utah, Washingtn, West Virginia). Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 5 f 10

6 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins - 19 States (65%) have regulatins that specify having t prvide additinal staff necessary t meet the needs f residents (e.g. fr transprtatin, laundry, fd service, husekeeping, facility maintenance) (Alaska, Califrnia, Gergia, Idah, Iwa, Luisiana, Michigan, Mntana, New Jersey, New Mexic, New Yrk, Oregn, Pennsylvania, Rhde Island, Tennessee, Utah, Virginia, Washingtn, West Virginia). - With respect t an Administratr f an Assisted Living facility: 22 States (76%) have regulatins specifying the persn s minimum age 23 States (79%) have regulatins specifying the persn s minimum level f educatin 27 States (93%) have regulatins specifying the persn s minimum level training and/r certificatin - 8 States (27%) require a Supervisr r Manager f Care staff (Delaware, Idah, Illinis, Iwa, Maryland, Michigan, New Jersey, Rhde Island). Of these 8 States: 4 have a regulatin specifying the persn s minimum age; 6 have regulatins specifying their minimum level f educatin; and 8 have regulatins specifying minimum level f training and/r certificatin. - With respect t an Direct Care staff : 18 States (62%) have regulatins specifying the persn s minimum age 4 States (14%) have regulatins specifying the persn s minimum level f educatin 12 States (41%) have regulatins specifying the persn s minimum level training and/r certificatin - With respect t an Direct Care staff, as a cnditin f emplyment in an Assisted Living facility: 15 States (52%) have regulatins requiring a valid/current First Aid training certificate 9 States (31%) have regulatins requiring a valid/current CPR training certificate 12 States (41%) have regulatins requiring a medical evaluatin prir t emplyment 5 States (17%) have regulatins requiring an immunizatin histry frm their health care prvider 19 States (65%) have regulatins requiring a Tb status frm their health care prvider 24 States (83%) have regulatins requiring a criminal histry backgrund check prir t emplyment 7 States (24%) have regulatins requiring a criminal recrd checks t be redne at specific intervals - With respect t an staff cnduct at an Assisted Living facility: 28 States (96%) have regulatins prhibiting staff frm neglecting residents 26 States (90%) have regulatins prhibiting staff frm abusing residents Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 6 f 10

7 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins 20 States (69%) have regulatins prhibiting staff frm applying restraints n residents. Of the 9 States that dn t have regulatins prhibiting staff frm applying restraints, 2 States indicates that certain types f restraints are allwed under specific circumstances and/r staff must be trained. - With respect t regulatry requirements fr staff training and develpment: 24 States (83%) require facilities t have an annual training plan fr staff 26 States (90%) require facilities t prvide dementia-specific training fr staff 7 States (24%) require facilities t cnducting regular reviews f staff perfrmance 2 States (7%) require facilities t regularly measure r survey staff satisfactin Cnclusins It is anticipated that NARA may be able t describe state trends and patterns in regulatry requirements. Using the enhanced NARA Licensing Categry fr General Prvisins and Staffing in adult care settings and what thse categries include as a baseline, we can cnclude frm the survey sample that: A. General Prvisins - Definitin (e.g. fr assisted living ) Hw assisted living is defined in regulatins vary amng States. Nevertheless, licensing is required t perate and the trigger tends t be dependent n the type f services prvided and the number f persns in care. - Definitin f the scpe f services that may r may nt be prvided The scpe f services amng State regulatins appears t have the cmmn theme f prviding supprt services t assist with activities f daily living. Variatin amng States exist as t whether health-related services, medicatin administratin r skilled nursing is included r excluded frm the scpe f services permitted in an assisted living setting. - Type f events that must be reprted t Licensing This infrmatin was nt cllected in this survey. B. Staffing - Ratis, number f staff, qualificatins Based n the survey sample, State assisted living regulatins d nt typically have specific staff-tresident ratis. On the cntrary, regulatins fr assisted living typically refer t prviding adequately trained staff in sufficient numbers t meet the needs f the residents and/r assure resident health and safety. Regulatry requirements fr Administratrs appear t emphasize minimum level training and/r certificatin. Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 7 f 10

8 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins Regulatry requirements fr Direct Care staff appear t emphasize meeting a minimum age and having a satisfactry criminal recrd backgrund check. - Staff health examinatins Obtaining an emplyee s Tb status frm their health care prvider appears t be a requirement in just ver half f the States sampled in this survey. In cntrast, btaining immunizatin histry fr vaccine preventable cmmunicable diseases is generally nt reflected in assisted living regulatins. Such requirements may be cntained in ther public health regulatins fr the State. - Staff supervisin Less than ne quarter f the States sampled have a requirement fr a Supervisr r Manager f Care staff. Hwever, just ver half f the States sampled have a requirement fr a licensed nurse t be available (r n-call) at all times. - Staff training and develpment Mst f the States sampled have requirements that assisted living settings must (i) have an annual training plan fr staff and (ii) prvide dementia-specific training fr staff. - Prhibited actins twards residents Mst f the States sampled have requirements prhibiting staff frm neglecting r abusing residents. - Use f restrictive prcedures Apprximately tw-thirds f States sampled prhibit the use f restraints. In States where restraints are nt prhibited, there are regulatry requirements specifying that nly certain types f restraints are allwed under specific circumstances and/r staff must be trained. - Perfrmance review / staff satisfactin Only abut ne-quarter f States sampled require assisted living settings t cnduct regular reviews f staff perfrmance. Tw States in the sample have regulatry requirements whereby assisted living settings must regularly measure r survey staff satisfactin. A full cpy f the NARA Survey f State Assisted Living Regulatins: assisted living & licensing; staffing and staff qualificatins which includes the survey questinnaire develped and summary tables f survey respnses is available in the NARA Member s Area f the NARA website. Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 8 f 10

9 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins Appendix 1: NARA Licensing Categries Chapter 2: Frmulatin f Rules in the NARA Licensing Curriculum (2000) includes a sectin n Subject Areas fr Licensing Rules. This set f subject areas is ften referred t as the NARA Licensing Categries which shuld be incrprated int any set f human care licensing. Thse categries were used as a starting pint and enhanced by the NARA Adult Care Plicy Cmmittee t incrprate mre current regulatry areas generally cnsidered in regulatins fr adult care. Licensing Categries fr adult care 1. General Prvisins - Definitin (e.g. fr assisted living ) - Definitin f the scpe f services that may r may nt be prvided. - Type f events that must be reprted t Licensing. 2. Physical Site - Accessibility, windws, lighting, rm temperature, water temp. - Telephne and cmmunicatins. - Furnishings, maintenance. - Bedrm flr area & ccupancy. - Bathrms and bathing. - Kitchen and dining area. - Living rm and lunge areas. - Recreatinal areas indr and utdr. - Laundry area fr resident use. 3. Fire Safety and Emergency Preparedness - Smke detectrs, sprinkler system, emergency lights, emergency plan. 4. Resident Rights - Respect, privacy, autnmy, prtectin frm abuse 5. Staffing - Ratis, number f staff, qualificatins. - Staff health examinatins. - Staff supervisin. - Staff training and develpment. - Prhibited actins twards residents. - Use f restrictive prcedures. - Perfrmance review / staff satisfactin. 6. Care and Services - Orientatin package fr new residents. - Admissin / discharge criteria. - Residency agreement. - Individual services / treatment plans. - Develpmental and recreatinal activities. - Equipment fr prgrams. - Infectin cntrl Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 9 f 10

10 Executive Summary: NARA Survey f State Assisted Living Regulatin: assisted living & licensing; staffing and staff qualificatins 7. Resident Health - Medical evaluatin prir t admissin. - Immunizatin histry and Tb status. 8. Medicatin - Strage, training, administratin. 9. Nutritin - Strage, preparatin and serving. - Quality and quantity f fd served. - Resident participatin in meal planning and preparatin. 10. Transprtatin - Scpe f transprtatin services prvided. 11. Recrds - Cnfidentiality, cntent, retentin. Nvember 13, 2015 Natinal Assciatin fr Regulatry Administratin Page 10 f 10