Relates to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living.
TITLE OF BILL: An act to amend the public health law, in relation to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living
PURPOSE OR GENERAL IDEA OF BILL: To require that a registered nurse be on staff five days a week to assure adequate assessment and monitoring of resident care in certain adult care facilities.
SUMMARY OF SPECIFIC PROVISIONS: Amends Public Health Law section 4655 to require that adult care facilities pursuing new or renewing enhanced assisted living certificates include a registered nurse (RN) on staff a minimum of one shift per day, five days a week.
Facilities with resident populations that do not require full time oversight by the RN may employ the individual for administrative or other purposes, as well.
Determination of a resident's need for 24 hour skilled nursing care must be made by both the resident's physician and the facility's RN.
Existing facilities are given an additional 18 months to comply with the RN staffing requirement.
JUSTIFICATION: "Enhanced assisted living residences" (EALR) and "special needs assisted living residences" (SNALR) are categories of assisted living residences that are authorized to house residents who need a higher level of care, such as those who are chronically chairfast and unable to transfer, or suffering from significant dementia.
These individuals are inherently more fragile and more likely to be or become unstable and need full-time assistance than the general population of assisted living residents. Although under current regulatory requirements registered nurses are available on call, there is no system in place for residents to receive ongoing, in-person, professional monitoring or assessment. This type of ongoing evaluation is essential to helping residents age in place safely. This requirement had been adopted by DOH, but a court decision held that it required statutory authority, which this bill would provide.
The bill would update the requirements for obtaining or renewing certification as an EALR or SNALR to include having a full-time registered nurse on-site at the facility, employed primarily to coordinate and monitor resident care. To minimize the burden on smaller facilities, with the department's permission, the staff registered nurse may also be employed in an administrative or other capacity.
PRIOR LEGISLATIVE HISTORY: 2011-2012: S.6274 - Died in Committee
FISCAL IMPLICATIONS: None to the state.
EFFECTIVE DATE: Ninety days after becoming law.
STATE OF NEW YORK ________________________________________________________________________ 1417 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________Introduced by Sens. MONTGOMERY, KRUEGER, PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Aging AN ACT to amend the public health law, in relation to requiring a regis- tered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 4655 of the public health law, as added by chapter 2 of the laws of 2004, is amended to read as follows: S 4655. Certification procedures and requirements. 1. Notwithstanding any other provision of law, an assisted living operator may apply to the department to obtain an enhanced assisted living certificate pursuant to this section. (a) Such application shall be on a form approved by the department. (b) An assisted living operator may apply for such a certificate for the entire facility or any number of beds at the facility. (c) To obtain an enhanced assisted living certificate, the applicant must submit a plan to the department setting forth how the additional needs of residents will be safely and appropriately met at such resi- dence. Such plan shall include, but need not be limited to, a written description of services, staffing levels, staff education and training, work experience, and any environmental modifications that have been made or will be made to protect the health, safety and welfare of such persons in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY WILL MEET THE REGISTERED NURSE STAFFING REQUIREMENT. (d) In addition to any other requirements of assisted living, an oper- ator of enhanced assisted living may hire care staff directly pursuant to standards developed by the department or contract with a home careEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01611-01-3 S. 1417 2
services agency which has been approved to operate pursuant to article thirty-six of this chapter. (e) No assisted living residence shall be certified as enhanced assisted living unless and until the applicant obtains the written approval of the department. (F) (I) TO OBTAIN OR RENEW AN ENHANCED ASSISTED LIVING CERTIFICATE, THE APPLICANT SHALL BE REQUIRED TO HAVE A STAFF MEMBER ONSITE TO ASSESS AND MONITOR THE CONDITION OF RESIDENTS. AT A MINIMUM, THIS INDIVIDUAL SHALL BE A REGISTERED NURSE. (II) THE REGISTERED NURSE SHALL BE AT THE FACILITY A MINIMUM OF ONE SHIFT PER DAY, FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES OF THE REGIS- TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI- DENT ASSESSMENT AND MONITORING, AND ENSURING THAT ALL RESIDENTS ARE RECEIVING APPROPRIATE CARE. (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE MONITORING OR OVERSIGHT SERVICES OF A REGISTERED NURSE ON A FULL TIME BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER CAPACITY, AS APPROPRIATE FOR THE FACILITY. FACILITIES CHOOSING THIS OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT AND MONITORING. (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLIANCE WITH THIS PARAGRAPH NO LATER THAN EIGHTEEN MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW. 2. No resident shall be permitted to continue to age in place under the terms of an enhanced assisted living certificate unless the opera- tor, the resident's physician, THE FACILITY'S STAFF REGISTERED NURSE, and, if applicable, the resident's licensed or certified home care agen- cy, agree that the additional needs of the resident can be safely and appropriately met at the residence. A resident eligible for enhanced assisted living or his or her representative shall submit to the resi- dence a written report from a physician, which report shall state that: (a) the physician has physically examined the resident within the last month; and (b) the resident is not in need of twenty-four hour skilled nursing care or medical care which would require placement in a hospital or residential health care facility. 3. The residence must notify a resident that, while the residence will make reasonable efforts to facilitate the resident's ability to age in place pursuant to an individualized service plan, there may be a point reached where the needs of the resident cannot be safely or appropriate- ly met at the residence, requiring the transfer of the resident to a more appropriate facility in accordance with the provisions of this article. 4. If a resident reaches the point where he or she is in need of twen- ty-four hour skilled nursing care or medical care required to be provided by facilities licensed pursuant to article twenty-eight of this chapter or article nineteen, thirty-one or thirty-two of the mental hygiene law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE FACILITY'S STAFF RESIDENT NURSE, then the resident must be discharged from the residence and the operator shall initiate proceedings for the termi- nation of the residency agreement of such resident in accordance with the provisions of section four hundred sixty-one-h of the social services law. Provided, however, a resident may remain at the residence if each of the following conditions are met:S. 1417 3
(a) a resident in need of twenty-four hour skilled nursing care or medical care hires appropriate nursing, medical or hospice staff to care for his or her increased needs; (b) the resident's physician
[and], home care services agency [both]AND THE FACILITY'S STAFF REGISTERED NURSE ALL determine and document that, with the provision of such additional nursing, medical or hospice care, the resident can be safely cared for in the residence, and would not require placement in a hospital, nursing home or other facility licensed under article twenty-eight of this chapter or article nineteen, thirty-one or thirty-two of the mental hygiene law; (c) the operator agrees to retain the resident and to coordinate the care provided by the operator and the additional nursing, medical or hospice staff; and (d) the resident is otherwise eligible to reside at the residence. 5. In addition to the requirements otherwise required for licensure as assisted living, any residence that advertises or markets itself as serving individuals with special needs, including, but not limited to, individuals with dementia or cognitive impairments, must submit a special needs plan to the department setting forth how the special needs of such residents will be safely and appropriately met at such resi- dence. Such plan shall include, but need not be limited to, a written description of specialized services, staffing levels, staff education and training, work experience, professional affiliations or special characteristics relevant to serving persons with special needs, and any environmental modifications that have been made or will be made to protect the health, safety and welfare of such persons in the residence. In approving an application for special needs certification, the depart- ment shall develop standards to ensure adequate staffing and training in order to safely meet the needs of the resident. The standards shall be based upon recommendations of the task force established by section five of the chapter of the laws of two thousand four which added this section. IN ADDITION TO ANY OTHER STANDARDS WHICH THE DEPARTMENT MAY DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL BE SUBJECT TO THE SAME REGISTERED NURSE STAFFING REQUIREMENTS DETAILED IN PARAGRAPHS (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION. No resi- dence shall market [themselves]ITSELF as providing specialized services unless and until the department has approved such applicant for a special needs assisted living certificate. EXISTING SPECIAL NEEDS ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI- ANCE WITH THE NEW STAFFING REQUIREMENTS NO LATER THAN EIGHTEEN MONTHS AFTER THIS SENTENCE SHALL HAVE BECOME A LAW. 6. An enhanced assisted living certificate shall not be required of an adult care facility, or part thereof, which has obtained approval by the department to operate an assisted living program pursuant to section four hundred sixty-one-l of the social services law. Provided, however, such exemption shall only apply to those beds at the facility which are subject to the assisted living program. S 2. This act shall take effect on the ninetieth day after it shall have become a law; provided that any rules and regulations, and any other actions necessary to implement the provisions of this act on its effective date are authorized and directed to be completed on or before such date.