When is an individual no longer eligible to continue as a resident in an assisted living facility? There is a regulatory answer for this question. Continued residency should be determined by the owner or administrator of a facility, as he or she is responsible for determining the appropriateness of an individual’s admission, as well as the continued appropriateness of residence. A determination shall be based upon the strengths, needs, and preferences of the resident; the care and services offered or arranged for by the facility in accordance with facility policy; and any limitations in law or rule related to admission criteria or continued residency for the type of license held by the facility.
Recently there have been several situations that have caused this issue to be discussed. One such situation is when a resident has been admitted to hospice care due to a terminal diagnosis and no longer meets continued residency criteria, and later, is discharged from hospice services. There are times when this resident might stabilize, would no longer meet the criteria for hospice services and then officially discharged from hospice care. Does this mean the resident can continue in the ALF? In some cases, the answer is “no.” There are times when a resident has declined to the point of no longer meeting resident criteria but has plateaued; thus he or she cannot receive the needed support from hospice to continue in the ALF.
The regulation states in 58A-5.0181 (4) (c) that 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:
- 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;
- Both the resident, or the resident’s legal representative if applicable, and the facility agree to continued residency;
- A licensed hospice, in consultation with the facility, develops and implements a interdisciplinary care plan that specifies the services being provided by hospice and those being provided by the facility; and,
- Documentation of the requirements of this paragraph is maintained in the resident’s file.
Two of the items that need to be considered are transfers and whether the resident is bedridden or not.
“Assistance with Transfer” means providing verbal and physical cuing or physical assistance, or both, while the resident moves between the bed and a standing position or between the bed and a chair or wheelchair. The term does not include total physical assistance with transfer provided by staff to residents.
A resident must be able to transfer without a mechanical lift, and this needs to be considered a safe transfer. The part that may require a resident to move to a higher level of care would be if the resident needed total physical assistance with transfers. If hospice is not involved in coordinating a resident needing this level of care, then the resident would need to be discharged.
Another thing that needs consideration is if the resident is considered bedridden. “Bedridden” means confined to bed because of inability to ambulate or transfer to a wheelchair even with assistance, or to sit safely in a chair or wheelchair without personal assistance or physical restraint.
Sometimes the positioning of a resident in a wheelchair is not safe without the hospice specific equipment.
These items are not the only things to be considered for continued residency in an assisted living, but they are two items that would need to be reviewed by the owner or administrator if a resident is discharged from hospice services. This is not the typical scenario, but it happens.
As the administrator of the facility, if a resident is discharged from hospice services, you should make a thorough review of the needs of the resident. If the needs can continue to be met without the added services that hospice was providing, then it is possible to have the resident continue in your facility. However, if they cannot be met, the only appropriate action is to initiate a 45-day notice of discharge.