Assisted Living in Indiana

Agency: Indiana State Department of Health, Division of Long Term Care (ISDH) Indiana Division of Aging (DA)
Phone: (317) 233-7442
Website: www.in.gov/isdh/20227.htm www.in.gov/fssa/elderly/aging/index.html

Residential Care Facility means a health care facility that provides residential nursing care. Residential nursing care may include, but is not limited to, the following: (1) Identifying human responses to actual or potential health conditions; (2) Deriving a nursing diagnosis; (3) Executing a minor regimen based on a nursing diagnosis or executing minor regimens as prescribed by a physician, physician assistant, chiropractor, dentist, optometrist, podiatrist, or nurse practitioner; (4) Administering, supervising, delegating, and evaluating nursing activities

Facility Scope of Care:
A health facility that provides residential nursing care or administers medications prescribed by a physician must be licensed as a Residential Care Facility. A facility that provides services such as room, meals, laundry, activities, housekeeping, and limited assistance with activities of daily living (ADLs) without providing administration of medication or residential nursing care is not required to be licensed. A Residential Care Facility that retains appropriate professional staff may provide comprehensive nursing care to residents needing care for a selflimiting condition, notwithstanding the items listed under MoveIn/Move-Out Requirements.

Move-In/Move-Out Requirements:
The resident must be discharged if the resident: (1) is a danger to self or others; (2) requires 24-hour, comprehensive nursing care or comprehensive nursing oversight; (3) requires less than 24-hour comprehensive nursing care, comprehensive nursing oversight or rehabilitative therapies and has not entered into a contract with an appropriately licensed provider of the resident's choice to provide those services; (4) is not medically stable; or (5) meets any two of the following three criteria: (a) Requires total assistance with eating; (b) Requires total assistance with toileting; (c) Requires total assistance with transferring

Resident Assessment:
While there is no required form, an evaluation of the individual needs of each resident must be initiated prior to admission and must be updated at least semi-annually and when there is a substantial change in the resident's condition. The minimum scope and content of the resident evaluation must include, but is not limited to, (1) the resident's physical, cognitive, and mental status; (2) the resident's independence in ADLs; (3) the resident's weight taken on admission and semi-annually thereafter; and (4) if applicable, the resident's ability to self-administer medications. Following the evaluation, the Residential Care Facility must identify and document the services to be provided and specify the scope, frequency, need, and preference of the resident for such services

Medication Management:
Each facility shall choose whether it administers medication and/or provides residential nursing care. These policies shall be outlined in the facility policy manual and clearly stated in the admission agreement. The administration of medications and the provision of residential nursing care shall be as ordered by the resident's physician and shall be supervised by a licensed nurse on the premises or on call. Medication shall be administered by licensed nursing personnel or qualified medication aides. Administration of medications means preparation and/or distribution of prescribed medications. Administration does not include reminders, cues, and/or opening of medication containers or assistance with eye drops, such as steadying the resident's hand, when requested by a resident.

Physical Plant Requirements:
Private resident units must be a minimum of 100 square feet and multiple-occupancy resident units must provide a minimum of 80 square feet per resident. The facility shall have living areas with sufficient space to accommodate the dining, activity, and lounge needs of the residents and to prevent the interference of one function with another.

Residents Allowed Per Room:
For facilities and additions to facilities for which construction plans are submitted for approval after July 1, 1984, resident rooms shall not contain more than four residents' beds.

Life Safety:
No life safety code surveys are required for Residential Care Facilities. The state fire marshal's office surveys these facilities for fire safety precautions. Sanitation and safety standards must be in accordance with ISDH Residential Care Facility rules.

Alzheimer's Unit Requirements:
If a facility locks, secures, segregates, or provides a special program or special unit for residents with Alzheimer's disease, related disorders, or dementia, and advertises to the public that it is offering a special care unit, it must prepare a written disclosure statement on a required form that includes information on the following: (1) The mission or philosophy concerning the needs of residents with dementia; (2) The criteria used to determine that a resident may move into a special care unit; (3) The process for the assessment, establishment, and implementation of a plan for special care; (4) Information about staff including number of staff available and training provided; (5) The frequency and types of activities for residents with dementia; (6) Guidelines for using physical and chemical restraints; (7) An itemization of the health facility's charges and fees for special care; and (8) Any other features, services, or characteristics that distinguish the care provided in special care. This form must be filed with the FSSA Division of Aging annually and made available to anyone seeking information on services for individuals with dementia. Facilities required to submit an Alzheimer's and dementia special care unit disclosure form must designate a qualified director for the special care unit.

Staff Training for Alzheimer's Care:
Staff who have contact with residents in dementia units must have (additionally) a minimum of six hours of dementia-specific training within six months and three hours annually thereafter to meet the needs of cognitively impaired residents.

Staffing Requirements:
Staff shall be sufficient in number, qualifications, and training in accordance with applicable state laws and rules to meet the 24- hour scheduled and unscheduled needs of the residents and services provided. The number, qualifications, and training of staff shall depend on skills required to provide for the specific needs of the residents. A minimum of one awake staff person, with current CPR and first aid certificates, shall be on site at all times. If 50 or more residents of the facility regularly receive residential nursing services and/or administration of medication, at least one nursing staff person shall be on site at all times. Residential facilities with more than 100 residents regularly receiving residential nursing services and/or administration of medication shall have at least one additional nursing staff person awake and on duty at all times for every 50 residents. Any unlicensed employee providing more than limited assistance with ADLs must either be a certified nurse aide or a home health aide

Staff Education Training:
Prior to working independently, each employee must be given an orientation that must include specific information. There must be an organized in-service education and training program planned in advance for all personnel in all departments at least annually. For nursing personnel, this shall include at least eight hours per calendar year; for non-nursing personnel, it shall include at least four hours per calendar year. The facility must maintain complete records of all trainings.

Medicaid Policy and Reimbursements:
Assisted living services (levels 1-3) are available under the aged and disabled waiver. All providers for this service must have a Residential Care Facility license from ISDH.