Assisted Living in Arkansas

Agency: Department of Human Services, Office of Long Term Car
Phone: (501) 682-8468
Website: www.state.ar.us/dhs/aging/assistedliving.html, www.medicaid.state.ar.us/InternetSolution/General/units/oltc/index.aspx

An assisted living facility is a building or part of a building that undertakes, through its ownership or management, responsibility to provide assisted living services for a period exceeding 24 hours to more than three adult residents of the facility. Assisted living services may be provided either directly or through contractual arrangement. An assisted living facility provides, at a minimum, services to assist residents in performing all activities of daily living (ADLs) on a 24-hour basis

Facility Scope of Care:
The facility may supervise and assist with ADLs. Level I facilities provide 24-hour staff supervision by awake staff; assistance in obtaining emergency care 24 hours a day; assistance with social, recreational, and other activities; assistance with transportation; linen service; three meals a day; and medication assistance. Level II facilities offer services that directly help a resident with certain routines and ADLs and assistance with medication only to the extent permitted by the state's Nurse Practice Act. The assessment for residents with health needs must be completed by a registered nurse (RN).

Move-In/Move-Out Requirements:
The facility must not admit or retain residents whose needs are greater than the facility is licensed to provide. Level I facilities may not provide services to residents who: (1) Need 24-hour nursing services except as certified by a licensed home health agency for a period of 60 days with one 30-day extension; (2) Are bedridden; (3) Have transfer assistance needs that the facility cannot meet with current staffing; or (4) Present a danger to self or others or engage in criminal activities. Level II facilities may not provide services to residents who: (1) Need 24-hour nursing services; (2) Are bedridden; (3) Have a temporary (no more than 14 consecutive days) or terminal condition unless a physician or advanced practice nurse certifies the resident's needs may be safely met by a service agreement developed by the attending physician or advanced practice nurse and the resident; (4) Have transfer assistance needs that the facility cannot meet with current staffing; or (5) Present a danger to self or others or engage in criminal activities

Resident Assessment:
Each resident must have an initial evaluation completed by the assisted living residence. There is no required standard form

Medication Management:
Level I facility staff must provide assistance to enable residents to self-administer medications. In Level II facilities licensed nursing personnel may administer medication.

Physical Plant Requirements:
All living units in assisted living facilities must be independent apartments, including a kitchen that is a visually and functionally distinct area within the apartment or unit. Each apartment or unit of new construction shall have a minimum of 150 square feet per person or 230 square feet for two persons. A Level II facility must maintain physically distinct parts or wings to house individuals who receive, or are medically eligible for, a nursing home level of care separate and apart from those individuals who do not receive, or are not medically eligible for, the nursing home level of care.

Residents Allowed Per Room:
An apartment or unit must be single occupancy except in situations where residents are husband and wife or are two consenting adults who have requested and agreed in writing to share an apartment or unit. An apartment or unit may be occupied by no more than two persons.

Life Safety:
Each Assisted Living Facility built after these regulations became effective (April 2001 by Act 1230) must meet the requirements adopted by local municipalities based on National Fire Protection Association (NFPA) 101, Life Safety Code, 1985,or the 2000 edition of the International Building Code (IBC), and must be in compliance with the Americans with Disabilities Act. If the municipality in which the facility is located has not adopted requirements based on the above standards, or the Office of Long Term Care determines that the regulations adopted by the local municipality are not adequate to protect residents, the facility must meet the provisions of the 2000 Edition of the IBC, including the NFPA requirements referenced by the IBC. As such, all Assisted Living Facilities must be sprinklered

Alzheimer's Unit Requirements:
Level I and II facilities may have an Alzheimer's special care unit. There are additional requirements in the areas of assessments, individual support plans for the residents, physical design, egress control, staffing, staff training, and therapeutic activities.

Staff Training for Alzheimer's Care:
All staff must be trained within five months of hiring, with no less than eight hours of training per month during those five months. The following subjects must be covered in the training: facility policies; etiology, philosophy and treatment of dementia; stages of Alzheimer's disease; behavior management; use of physical restraints, wandering, and egress control; medication management; communication skills; prevention of staff burnout; activity programming; ADLs; individual-centered care; assessments; and creation of individual support plans. At least two hours of ongoing in-service training is required every quarter

Staffing Requirements:
A full-time administrator (40 hours per week) must be designated by each assisted living facility. A second administrator must be employed either part-time or full-time depending on the number of beds in the facility. Level I facilities must have sufficient staff to meet the needs of residents and must meet the staffing ratios specified in regulation. The ratios are based on number of residents and are designated for "day," "evening," and "night." Level II facilities must employ or contract with at least one RN, licensed practical nurses, certified nursing assistants (CNAs), and personal care aides. The RN does not need to be physically present but must be available to the facility by phone or pager. The facility must have a minimum of one staff person per 15 residents from 7 a.m. to 8 p.m. and one staff person per 25 residents from 8 p.m. to 7 a.m. There must be at least one CNA on the premises per shift.

Staff Education Training:
All staff, including contracted personnel who provide services to residents (excluding licensed home health agency staff), must receive orientation and training on the following topics: (1) Within seven calendar days of hire: building safety and emergency measures; appropriate response to emergencies; abuse, neglect, and financial exploitation and reporting requirements; incident reporting; sanitation and food safety; resident health and related problems; general overview of the job's specific requirements; philosophy and principles of independent living in an assisted living residence; and Residents' Bill of Rights; (2) Within 30 calendar days of hire: medication assistance or monitoring; communicable diseases; and dementia and cognitive impairment; and (3) Within 180 calendar days of hire: communication skills; review of the aging process, and disability sensitivity training.

Medicaid Policy and Reimbursements:
A Medicaid state plan service reimburses for personal care services. A Level II facility may provide care and services to individuals who are medically eligible for nursing home level-of-care and receive services through the Medicaid 1915(c) home and community-based services waiver.