58A-5.0181. Admission Procedures, Appropriateness of Placement and Continued Residency Criteria  


Effective on Thursday, May 10, 2018
  • 1(1) ADMISSION CRITERIA.

    4(a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited nursing services, or limited mental health license:

    321. Be at least 18 years of age.

    402. Be free from signs and symptoms of any communicable disease that is likely to be transmitted to other residents or staff. An individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that the individual would otherwise be eligible for admission according to this rule.

    913. Be able to perform the activities of daily living, with supervision or assistance if necessary.

    1074. Be able to transfer, with assistance if necessary. The assistance of more than one person is permitted.

    1255. Be capable of taking medication, by either self-administration, assistance with self-administration, or administration of medication.

    141a. If the resident needs assistance with self-administration of medication, the facility must inform the resident of the professional qualifications of facility staff who will be providing this assistance. If unlicensed staff will be providing assistance with self-administration of medication, the facility must obtain written informed consent from the resident or the resident’s surrogate, guardian, or attorney-in-fact.

    198b. The facility may accept a resident who requires the administration of medication if the facility employs a nurse who will provide this service or the resident, or the resident’s legal representative, designee, surrogate, guardian, or attorney-in-fact, contracts with a third party licensed to provide this service to the resident.

    2486. Not have any special dietary needs that cannot be met by the facility.

    2627. Not be a danger to self or others as determined by a physician, or mental health practitioner licensed under chapter 490 or 491, F.S.

    2878. Not require 24-hour licensed professional mental health treatment.

    2969. Not be bedridden.

    30010. Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that:

    325a. The resident either:

    329(I) Resides in a standard or limited nursing services licensed facility and contracts directly with a licensed home health agency or a nurse to provide care; or

    356(II) Resides in a limited nursing services licensed facility and care is provided by the facility pursuant to a plan of care issued by a health care provider;

    384b. The condition is documented in the resident’s record and admission and discharge logs; and,

    399c. If the resident’s condition fails to improve within 30 days as documented by a health care provider, the resident must be discharged from the facility.

    42511. 426Residents admitted to standard, limited nursing services, or limited mental health licensed facilities may n441ot require any of the following nursing services:

    449a. 450Artificial airway management of any kind, except that of continuous positive airway pressure may be provided through the use of a CPAP or bipap machine;

    475b. Assistance with tube feeding,

    480c. Monitoring of blood gases,

    485d. 486Management of post-surgical drainage tubes and wound vacuum devices;

    495e. The administration of blood products in the facility; or

    505f. Treatment of surgical incisions or wounds, unless the surgical incision or wound and the 520underlying 521condition have been stabilized and a plan of care has been developed. 533The plan of care must be maintained in the resident’s record.

    54412. In addition to the nursing services listed above, residents admitted to facilities holding only standard and/or limited mental health licenses may not require any of the following nursing services:

    574a. Hemodialysis and peritoneal dialysis performed in the facility;

    583b. Intravenous therapy performed in the facility.

    59013. Not require 24-hour nursing supervision.

    59614. Not require skilled rehabilitative services as described in rule 60659G-4.290, 607F.A.C.

    60815. 609Be appropriate for admission to the facility as 617determined by the facility administrator. The administrator must base the determination on:

    629a. An assessment of the strengths, needs, and preferences of the individual;

    641b. The medical examination report required by section 649429.26, F.S., 651and subsection (2) of this rule, if available;

    659c. The facility’s admission policy and the services the facility is prepared to provide or arrange in order to meet resident needs. Such services may not exceed the scope of the facility’s license unless specified elsewhere in this rule; and,

    699d. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in rule chapter 69A-40, F.A.C.

    722(b) A resident who otherwise meets the admission criteria for residency in a standard licensed facility, but who requires assistance with the administration and regulation of portable oxygen or assistance with routine colostomy care 756of stoma site flange placement, 761may be admitted to a facility with a standard license as long as the facility has a nurse on staff or under contract to provide the assistance or to provide training to the resident on how to perform these functions themselves.

    802(c) Nursing staff may not provide training to unlicensed persons, 812as defined in section 816429.256(1)(b), F.S., 818to perform skilled nursing services, and may not delegate the nursing services described in this section to certified nursing assistants or unlicensed persons. This provision does not restrict a resident or a resident’s representative from contracting with a licensed third party to provide the assistance if the facility is agreeable to such an arrangement and the resident otherwise meets the criteria for admission and continued residency in a facility with a standard license.

    891(d) An individual enrolled in and receiving hospice services may be admitted to an assisted living facility as long as the individual otherwise meets resident admission criteria.

    918(e) Resident admission criteria for facilities holding an extended congregate care license are described in rule 93458A-5.030, 935F.A.C.

    936(2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face medical examination completed by a health care provider as specified in either paragraph (a) or (b) of this subsection.

    970(a) A medical examination completed within 60 calendar days before the individual’s admission to a facility pursuant to section 989429.26(4), F.S. 991The examination must address the following:

    9971. The physical and mental status of the resident, including the identification of any health-related problems and functional limitations,

    10162. An evaluation of whether the individual will require supervision or assistance with the activities of daily living,

    10343. Any nursing or therapy services required by the individual,

    10444. Any special diet required by the individual,

    10525. A list of current medications prescribed, and whether the individual will require any assistance with the administration of medication,

    10726. Whether the individual has 1077signs or symptoms of Tuberculosis, Methicillin Resistant Staphylococcus Aureus, Scabies or any other communicable disease, 1092which are likely to be transmitted to other residents or staff,

    11037. A statement on the day of the examination that, in the opinion of the examining health care provider, the individual’s needs can be met in an assisted living facility; and,

    11348. The date of the examination, and the name, signature, address, telephone number, and license number of the examining health care provider. The medical examination may be conducted by a health care provider licensed under chapter 458, 459 or 464, F.S.

    1175(b) A medical examination completed after the resident’s admission to the facility within 30 calendar days of the admission date. The examination must be recorded on AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, March 2017, which is incorporated by reference and available online at: 1222http://www.flrules.org/Gateway/reference.asp?No=Ref-091701224. Faxed or electronic copies of the completed form are acceptable. The form must be completed as instructed.

    12421. Items on the form that have been omitted by the health care provider during the examination may be obtained by the facility either orally or in writing from the health care provider.

    12752. Omitted information must be documented in the resident’s record. Information received orally must include the name of the health care provider, the name of the facility staff recording the information, and the date the information was provided.

    13133. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the elements described in this section of AHCA Form 1823.

    1357(c) Any information required by paragraph (a), that is not contained in the medical examination report conducted before the individual’s admission to the facility must be obtained by the administrator using AHCA Form 1823 within 30 days after admission.

    1396(d) Medical examinations of residents placed by the department, by the Department of Children and Families, or by an agency under contract with either department must be conducted within 30 days before placement in the facility and recorded on AHCA Form 1823 described in paragraph (b).

    1442(e) An assessment that has been conducted through the Comprehensive, Assessment, Review and Evaluation for Long-Term Care Services (CARES) program may be substituted for the medical examination requirements of section 1472429.26, F.S. 1474and this rule.

    1477(f) Any orders issued by the health care provider conducting the medical examination for medications, nursing, therapeutic diets, or other services to be provided or supervised by the facility may be attached to the health assessment. A health care provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, for residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory arrest.

    1548(g) A resident placed in a facility on a temporary emergency basis by the Department of Children and Families pursuant to section 1570415.105 1571or 1572415.1051, F.S., 1574is exempt from the examination requirements of this subsection for up to 30 days. However, a resident accepted for temporary emergency placement must be entered on the facility’s admission and discharge log and counted in the facility census. A facility may not exceed its licensed capacity in order to accept such a resident. A medical examination must be conducted on any temporary emergency placement resident accepted for regular admission.

    1643(3) ADMISSION PACKAGE.

    1646(a) The facility must make available to potential residents a written statement(s) that includes the following information listed below. Providing a copy of the facility resident contract or facility brochure containing all the required information meets this requirement.

    16841. The facility’s admission and continued residency criteria;

    16922. The daily, weekly or monthly charge to reside in the facility and the services, supplies, and accommodations provided by the facility for that rate;

    17173. Personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any;

    17384. Nursing services that the facility is prepared to provide to residents and additional costs to the resident, if any;

    17585. Food service and the ability of the facility to accommodate special diets;

    17716. The availability of transportation and additional costs to the resident, if any;

    17847. Any other special services that are provided by the facility and additional cost if any;

    18008. Social and leisure activities generally offered by the facility;

    18109. Any services that the facility does not provide but will arrange for the resident and additional cost, if any;

    183010. The facility rules and regulations that residents must follow as described in rule 184458A-5.0182, 1845F.A.C.;

    184611. The facility policy concerning Do Not Resuscitate Orders pursuant to section 1858429.255, F.S., 1860and rule 186258A-5.0186, 1863F.A.C., and Advance Directives pursuant to chapter 765, F.S.;

    187212. 1873If the facility is licensed to provide extended congregate care, t1884he facility’s residency criteria for residents receiving extended congregate care services. 1895The facility must also provide 1900a description of the additional personal, supportive, and nursing services provided by the facility including additional costs and any limitations on where extended congregate care residents may reside based on the policies and procedures described in rule 193758A-5.030, 1938F.A.C.;

    193913. If the facility advertises that it provides special care for individuals with Alzheimer’s disease and related disorders, a written description of those special services as required in section 1968429.177, F.S.; 1970and,

    197114. The facility’s resident elopement response policies and procedures.

    1980(b) Before or at the time of admission, the resident, or the resident’s responsible party, guardian, or attorney-in-fact, if applicable, must be provided with the following:

    20061. A copy of the resident’s contract that meets the requirements of rule 201958A-5.025, 2020F.A.C.,

    20212. A copy of the facility statement described in paragraph (a) of this subsection, if one has not already been provided,

    20423. A copy of the resident’s bill of rights as required by rule 205558A-5.0182, 2056F.A.C.; and,

    20584. A Long-Term Care Ombudsman Program brochure that includes the telephone number and address of the district office.

    2076(c) Documents required by this subsection must be in English. If the resident is not able to read, or does not understand English and translated documents are not available, the facility must explain its policies to a family member or friend of the resident or another individual who can communicate the information to the resident.

    2131(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (c) of this subsection, criteria for continued residency in any licensed facility must be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a health care provider at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in rule 220658A-5.0131, 2207F.A.C. 2208The results of the examination must be recorded on AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule and must be completed in accordance with that paragraph. Exceptions to the requirement to meet the criteria for continued residency are:

    2252(a) The resident may be bedridden for 2259no more than 22627 consecutive days.

    2265(b) A resident requiring care of a stage 2 pressure sore may be retained provided that:

    22811. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility has a limited nursing services license and services are provided pursuant to a plan of care issued by a health care provider,

    23232. The condition is documented in the resident’s record; and,

    23333. If the resident’s condition fails to improve within 30 days, as documented by a health care provider, the resident must be discharged from the facility.

    2359(c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met:

    23861. The resident qualifies for, is admitted to, and consents to receive services from a licensed hospice that coordinates and ensures the provision of any additional care and services that the resident may need;

    24202. 2421Both the resident, or the resident’s legal representative if applicable, and the facility agree to continued 2437residency;

    24383. 2439A licensed hospice, in consultation with the facility, develops and implements a 2451interdisciplinary care plan that specifies the services being provided by hospice and those being provided by the facility; and,

    24704. Documentation of the requirements of this paragraph is maintained in the resident’s file.

    2484(d) The facility administrator is responsible for monitoring the continued appropriateness of placement of a resident in the facility at all times.

    2506(e) A hospice resident that meets the qualifications of continued residency pursuant to this subsection may only receive services from the assisted living facility’s staff which are within the scope of the facility’s license.

    2540(f) Assisted living facility staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of their professional licensure or training.

    2582(g) Continued residency criteria for facilities holding an extended congregate care license are described in Rule 259858A-5.030, 2599F.A.C.

    2600(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident’s needs, as determined by the facility administrator or health care provider, the resident must be discharged in accordance with section 2642429.28, F.S.

    2644Rulemaking Authority 2646429.07, 2647429.41 FS. 2649Law Implemented 2651429.07, 2652429.26, 2653429.28, 2654429.41 FS. 2656History–New 9-17-84, Formerly 10A-5.181, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0181, Amended 1026692670302671267295, 6267426752-96, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 10-14-10, 4-17-14, 5-10-18.