The purpose and effect of the proposed rule amendments are as follows: to include an additional requirement for determining admission procedures and continued residency, with corresponding changes to the assessment form; to include the requirement ...

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-14.0061: Admission and Appropriateness of Placement
PURPOSE AND EFFECT: The purpose and effect of the proposed rule amendments are as follows: to include an additional requirement for determining admission procedures and continued residency, with corresponding changes to the assessment form; to include the requirement that residents must be made aware of the location of documents in order to make complaints; to amend the “Advance Directives” subsection to remove the term “advance directives” and replace with “Do Not Resuscitate Orders”; to add the word “licensed” before the references to “nurse” and “health care provider” in subsection (1); and to replace the word “physician” with “licensed health care provider” in subsection (7).
SUBJECT AREA TO BE ADDRESSED: An additional requirement for determining admission procedures and continued residency, with corresponding changes to the assessment form; the requirement that residents must be made aware of the location of documents in order to make complaints; and to amend the “Advance Directives” subsection to remove the term “advance directives” and replace with “Do Not Resuscitate Orders.”
SPECIFIC AUTHORITY: 429.73 FS.
LAW IMPLEMENTED: 429.65, 429.73, 429.85 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: May 19, 2010, 10:00 a.m. – 11:00 a.m. EST
PLACE: Department of Elder Affairs, Conference Room 225F, 4040 Esplanade Way, Tallahassee, Florida 32399-7000
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; telephone number: [phone]; Email address: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; telephone number: [phone]; Email address: [e-mail]
If not requested in writing by May 14, 2010, a rule development workshop will not be conducted. AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities and Adult Family-Care Homes, May 2010, is located on the department website at the following address: http://elderaffairs.state.fl.us/english/rulemaking.php, under the heading “Adult Family-Care Homes, Rule Chapter 58A-14, F.A.C.”

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

58A-14.0061 Admission Criteria and Procedures, and Appropriateness of Placement, and Continued Residency Requirements.

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

(a) through (b) No change.

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

(d) through (h) No change.

(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 58A-14.007, F.A.C.

(j) through (l) No change.

(2) HEALTH ASSESSMENT. Prior to admission to an AFCH, the individual must be examined by a health care provider using AHCA Form 3110-1023 (AFCH-1110) 01/08, Resident Health Assessment for Adult Family-Care Homes (AFCH), January 2008, which is incorporated by reference, and available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308. The form may also be obtained from the agency’s Web site at http://ahca.myflorida.com/MCHQ/Long_Term_Care/Assisted_living/afc/Res_Health_Assmnt.pdf.

(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 1823, Resident Health Assessment for Assisted Living Facilities and Adult Family-Care Homes, which is incorporated by reference in Rule 58A-5.0181, F.A.C. It is available by writing to the Agency for Health Care Administration, Long-Term Care Bureau, 2727 Mahan Drive, Mail Stop 30, Tallahassee, FL 32308-5403 or calling [phone]. It also may be obtained from the Agency’s website at the address specified in Rule 58A-5.0181, F.A.C. The form must be completed as follows:

1. A licensed health care provider must complete Sections 1, Health Assessment, and 2., Self-Care and General Oversight Assessment.

a. 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.

b. The AFCH provider, or designee, may obtain the omitted information either verbally or in writing from the licensed health care provider.

c. Omitted information received verbally must be documented in the resident’s record, including the name of the licensed health care provider, the name of the AFCH provider, or designee, recording the information and the date the information was provided.

2. The AFCH provider, or designee, must complete Section 3, Services Offered or Arranged by the Facility, except for residents receiving Medicaid assistive care services or Medicaid Waiver Services.

(b) Every three years thereafter, or after a significant change, as defined in subsection (4) of Rule 58A-14.007, F.A.C., 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. The form must be completed as required in that paragraph. After the effective date of this rule, providers shall have up to 12 months to comply with this requirement.

(3) HOUSE RULES AND COMPLAINT PROCEDURES. Prior to, or at the time of admission a copy of the AFCH house rules, the Resident’s Bill of Rights established under Section 429.85, F.S., the name, address, and telephone number of the district long-term care ombudsman council and the Florida Abuse Hotline, and the procedure for making complaints to the ombudsman council and the abuse registry must be provided to the resident or the resident’s representative.

(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 58A-14.004, F.A.C., and the procedure for making complaints to these entities.

(b) Additionally, the provider, or designee, must make the resident, or representative, aware of the location of the documents posted pursuant to subsection (6) of Rule 58A-14.004, F.A.C.

(4) DO NOT RESUSCITATE ORDERS ADVANCE DIRECTIVES:

(a) Each adult family-care home (AFCH) must have written policies and procedures, which delineate the AFCH’S position with respect to the state law and rules relative to do not resuscitate orders (DNROs) advance directives. The policies shall not condition treatment or admission upon whether or not the individual has executed or waived an DNRO advance directive. In the event of conflict between the AFCH’s policies and procedures and the resident’s advance directive, provision should be made in accordance with Chapter 765, F.S.

(b) The AFCH’s policy must shall include:

1. No change.

2. At the time of admission, providing each resident, or the resident’s representative, with written information concerning the AFCH’s policies regarding DNROs resuscitation and advance directives, including information concerning DH Form 1896, Florida Do Not Resuscitate Order Form, incorporated by reference in Rule 64E-2.031, F.A.C.

3. At the time of admission, providing each resident, or the resident’s representative, with written information concerning the AFCH’s policies respecting advance directives.

3.4. The requirement that documentation of whether or not the resident has executed an DNRO advance directive must be contained in the resident’s record. If an DNRO advanced directive 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 advanced directive for a resident, the AFCH must document in the resident’s record that it has requested a copy.

4.5. 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 an DNRO advance directive, pursuant to Section 765.110, F.S.

(c) Pursuant to Section 429.73, F.S., an AFCH may honor a properly executed DNRO as follows:

1. In the event a resident experiences cardiopulmonary arrest, the AFCH provider, or designee, who is trained in cardiopulmonary resuscitation (CPR), may withhold cardiopulmonary resuscitation.

2.1. In the event a resident experiences of cardiopulmonary arrest distress, and the condition set forth in subparagraph (c)1. of this subsection does not apply, the AFCH provider, or designee, shall immediately contact “911.” Cardiopulmonary resuscitation may be withheld or withdrawn from a resident by an individual pursuant to Section 401.45, F.S.

2. Cardiopulmonary resuscitation may be withheld or withdrawn from a resident only if a valid DNRO is present and the withholding or withdrawing of cardiopulmonary resuscitation is executed 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 agency, 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 Familiesy 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 section, and covered by a residency agreement under Rule 58A-14.0062, 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 that:

1. through 3. No change.

(b) through (c) No change.

(7) DISCHARGE.

(a) No change.

(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 physician;

2. through 3. No change.

Rulemaking Specific 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,________.