The new Assisted Living Facility (ALF) rule took effect May 10, 2018. Several significant changes will impact ALF providers, including training and assistance with Self-Administration of Medications. These areas were highlighted by the Agency for Health Care Administration (AHCA) as main areas of change during the assisted living track at FHCA’s Annual Conference in July.
One of the first changes outlined that new employees who are not Core trained must receive a two-hour preservice orientation prior to interacting with residents. This training must cover resident rights, the facility’s license type and services offered by the facility. There must be a signed document stating this preservice orientation has been completed, and this statement must be maintained in the employee’s file.
Assistance with Self-Administration of Medication and Other Care Needs
Another significant change relates to Assistance with Self-Administration of Medication. AHCA reviewed these steps that providers must follow to assist a resident with medication:
- Bringing the medication in previously dispensed, properly labeled container to the resident
- In the presence of the resident, reading the label ALOUD
- Opening the container
- Removing the prescribed amount of medication
- Closing the container
- Placing oral dosage in the resident’s hand or another container
- Applying topical medication
- Returning medication container to proper storage/documenting on MOR
There are several new skills that can be taught to a resident assistant which will assist a resident with medications. A new duty requiring additional training is assisting a resident with an Insulin pen by dialing the prescribed amount to be injected and handing the pen to the resident for self-injection. This can only be done with an insulin syringe that is prefilled with the proper dosage by a pharmacist or the manufacturer. Staff may assist by using a glucometer to perform blood glucose testing as prescribed by the physician.
Staff can also assist a resident with a nebulizer, which is commonly used for medical reasons. Staff can also assist residents with oxygen nasal cannulas and continuous positive airway pressure (CPAP) devices. The only exclusion defined is titration of the oxygen levels.
Anti-embolic stockings and hosiery can now be applied and removed by staff. Proper cleaning of these items should be noted.
Trained staff may also assist with placement and removal of colostomy bags, excluding the removal of the flange or manipulation of the stoma site. Be aware there are many manufacturers of these items, and each residents’ products may need to be reviewed so staff are assisting properly.
Trained staff may measure vital signs to include blood pressure, heart rate, temperature and respiratory rate. There is nothing that defines specific equipment used, so it would be up to the facility to ensure staff are using quality equipment to facilitate vital signs. Regulations do not outline whether blood pressure is taken with a manual cuff or a digital cuff; however, it should be carefully noted that facility practices should be done with best practices in mind. The unlicensed, trained staff who take these vital signs still do not interpret the vital signs, as that is not part of their scope of practice. Put in practices which won’t cause this to be compromised.
The trained, unlicensed staff who currently have the four hours of required training must receive an additional two hours of training focused on the new skills prior to assisting with these duties. Any new staff trained will need the total of six hours of training from this point forward. As before, all staff who have been trained will require the two-hour updates annually.
Clarification for admission and continued residency were also mentioned. AHCA clarified that a resident who is in a Standard ALF, LNS or LMH license may not have tube feedings, management of post-surgical drainage tubes and wound vacuum devices. Treatment of surgical incisions or wounds is only allowable when the underlying condition has been stabilized and a plan of care has been developed. This plan must be maintained in the resident’s record. Details are outlined in the Chapter 58A-5 F.A.C.
With the expanded skills and requirements, there are opportunities and challenges. Moving from the assisted living facility they know as home into a more skilled setting could be as traumatic as the medical issues themselves. The services your ALF can now offer to your current and future residents can help better meet their needs. Making sure these skills are performed properly and training is complete will allow people to stay in their ALF home longer, possibly for life.