59A-37.004. Admission Criteria and Procedures, Appropriateness of Placement, and Continued Residency Requirements

(1) ADMISSION. In order to be admitted as a resident to an AFCH, an individual must:

(a) Be at least 18 years of age.

(b) Be free from apparent signs and symptoms of any communicable disease, including tuberculosis which is likely to be transmitted to others as documented in the Health Assessment Form described in subsection (2). A person who has HIV infection may be admitted provided the person would otherwise be eligible for admission according to this rule.

(c) Be capable of self-preservation in an emergency situation involving the immediate evacuation of the AFCH, with assistance with ambulation, if needed.

(d) Be able to perform, with supervision or assistance, activities of daily living.

(e) Not be a danger to self or others as determined by a health care provider or licensed mental health professional.

(f) Not require licensed professional mental health treatment on a 24-hour a day basis.

(g) Not have special dietary needs which cannot be met by the provider.

(h) Not be bedridden.

(i) Not have stage 3 or 4 pressure sores. An individual with a stage 2 pressure sore may be admitted only if the individual is under the care of a licensed nurse pursuant to a plan of care issued by a licensed health care provider. Such nursing service must be provided in accordance with Rule 59A-37.006, F.A.C.

(j) Not require the use of chemical or physical restraints.

(k) Not require 24-hour nursing supervision.

(l) Not have personal care and nursing needs which exceed the capability of the provider to meet or arrange for such needs. The provider is responsible for determining the appropriate placement of the individual in the AFCH.

(2) HEALTH ASSESSMENT.

(a) Prior to admission to an AFCH, an individual must have a face-to-face medical examination conducted by a licensed health care provider using AHCA Form 3110-1023, Resident Health Assessment for Adult Family-Care Homes (AFCH), January 2008, which is incorporated by reference. It is available by writing to the Agency for Health Care Administration, Assisted Living Unit, 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308-5403 or calling [phone]. It also may be obtained from the Agency’s website at http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Assisted_Living/docs/afch/AFCH_Res_Health_Assmnt.pdf.

1. Items on the form that may have been omitted by the licensed health care provider during the examination do not necessarily require an additional face-to-face examination for completion.

2. The AFCH provider, or relief person, may obtain the omitted information either verbally or in writing from the licensed health care provider.

3. Omitted information received verbally must be documented in the resident’s record, including the name of the licensed health care provider giving the information, the name of the AFCH provider or relief person recording the information, and the date the information was obtained.

(b) Every year thereafter, or after a significant change as defined in subsection (4) of Rule 59A-37.006, F.A.C., whichever comes first, the resident must have a face-to-face medical examination conducted by a licensed health care provider using the form referenced in paragraph (a) of this subsection. After the effective date of this rule, providers shall have up to 12 months to comply with this requirement for residents currently living in the AFCH.

(3) HOUSE RULES AND COMPLAINT PROCEDURES.

(a) Prior to, or at the time of admission, the AFCH must provide the resident, or representative, with the following:

1. A copy of the AFCH house rules,

2. The Resident’s Bill of Rights established under Section 429.85, F.S.,

3. Written information referenced in subsection (6) of Rule 59A-37.003, F.A.C., and the procedure for making complaints to these entities.

(b) Additionally, the provider, or relief person, must make the resident, or representative, aware of the location of the documents posted pursuant to subsection (6) of Rule 59A-37.003, F.A.C.

(4) DO NOT RESUSCITATE ORDERS:

(a) Each adult family-care home (AFCH) must have written policies and procedures, which delineate its position with respect to the state law and rules relative to do not resuscitate orders (DNROs). The policies shall not condition treatment or admission upon whether or not the individual has executed or waived a DNRO.

(b) The AFCH’s policy must include:

1. At the time of admission, providing each resident, or the resident’s representative, with a copy of Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” effective April 2006, or with a copy of some other substantially similar document which incorporates information regarding advance directives included in Chapter 765, F.S. Form SCHS-4-2006 is hereby incorporated by reference and is available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308, or the agency’s website at: http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/docs/adv_dir.pdf.

2. At the time of admission, providing each resident, or the resident’s representative, with written information concerning the AFCH’s policies regarding DNROs, including information concerning DH Form 1896, Florida Do Not Resuscitate Order Form, incorporated by reference in Rule 64J-2.018, F.A.C.

3. The requirement that documentation of whether or not the resident has executed a DNRO must be contained in the resident’s record. If a DNRO has been executed, a copy of that document must be made a part of the resident’s record. If the AFCH does not receive a copy of the DNRO for a resident, the AFCH must document in the resident’s record that it has requested a copy.

4. An AFCH shall be subject to revocation of its license pursuant to Section 408.815, F.S., if the AFCH, as a condition of treatment or admission, requires an individual to execute or waive a DNRO, pursuant to Section 765.110, F.S.

(c) Pursuant to Section 429.73, F.S., in the event a resident experiences cardiopulmonary arrest, an AFCH must honor a properly executed DNRO as follows:

1. The AFCH provider, or relief person, who is trained in cardiopulmonary resuscitation (CPR), may withhold cardiopulmonary resuscitation, or

2. The AFCH provider, or relief person, shall immediately contact “911.” Cardiopulmonary resuscitation may be withheld or withdrawn from a resident by an individual pursuant to Section 401.45, F.S.

3. Adult family-care home providers shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct for withholding or withdrawing cardiopulmonary resuscitation pursuant to such a Do Not Resuscitate Order and rules adopted by the department, pursuant to Section 429.73, F.S. Any AFCH provider, who, in good faith, obeys the directives of an existing DNRO, executed pursuant to Section 401.45, F.S., will not be subject to prosecution or civil liability for his or her performance regarding patient care.

(5) TEMPORARY EMERGENCY SERVICES. Residents placed on an emergency basis by the Department of Children and Family Services pursuant to Section 415.105 or 415.1051, F.S., must meet the admission requirements of this rule. However, only residents whose stay in the home exceeds 30 days must be examined by a licensed health care provider under subsection (2) of this rule, and covered by a residency agreement under Rule 59A-37.005, F.A.C. A temporary emergency placement may not be made if the placement causes the home to exceed licensed capacity.

(6) CONTINUED RESIDENCY.

(a) The criteria for continued residency shall be the same as the criteria for admission, including a face-to-face medical examination conducted by a licensed health care provider pursuant to subsection (2) of this rule, with the following exceptions:

1. A resident may be bedridden for up to 7 days for a temporary illness.

2. A resident with a stage 2 pressure sore must be discharged if the pressure sore has not healed within 30 days or has not been reduced to stage 1.

3. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the AFCH if:

a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice which coordinates the additional care that may be needed,

b. Continued residency is agreeable to the resident and the provider; and,

c. An interdisciplinary care plan is developed and implemented by the hospice in consultation with the provider.

(b) If the resident no longer qualifies for continued residency, the provider shall assist the resident to obtain another placement.

(c) The provider is responsible for monitoring the continued appropriateness of placement of a resident in the home.

(7) DISCHARGE.

(a) Except as provided in paragraph (b), a resident shall not be discharged without 30 days’ written notice stating reasons for the move or transfer. The notice shall be delivered to the resident or the resident’s representative.

(b) Residents shall only be moved or transferrred without the required 30 day notice for the following reasons:

1. The resident’s health requires an immediate relocation to a facility which provides a more skilled level of care as certified by a licensed health care provider,

2. The resident’s behavior poses an imminent danger to self or others, significantly interferes with the orderly operation of the home, or is continually offensive to other residents, or

3. The AFCH has had its license denied, revoked, or has voluntarily surrendered its license.

Rulemaking Authority 429.73 FS. Law Implemented 429.65, 429.73, 429.85 FS. History–New 2-2-95, Formerly 10A-14.0061, Amended 9-19-96, 6-6-99, 1-1-04, 4-29-08, 9-16-10, Formerly 58A-14.0061, 7-1-19.