Assisted Living in Nebraska

Agency: Office of Long Term Care Facilities, Licensure Unit, Division of Public Health, Nebraska Department of Health and Human Services
Phone: (402) 471-2133
Website: www.hhs.state.ne.us/reg/regindex.htm

Assisted-Living Facilities provide shelter, food, and care for remuneration for a period of more than 24 consecutive hours to four or more persons who require or request such services due to age, illness, or physical disability.

Facility Scope of Care:
The facility may provide: (1) Activities of daily living (ADLs) (i.e., transfer, ambulation, exercise, toileting, eating, self-administration of medication, and similar activities); (2) Health maintenance activities (i.e., non-complex nursing interventions that can safely be performed according to exact directions, that do not require alteration of the standard procedure, and for which the results and resident responses are predictable); (3) Personal care (i.e., bathing, hair care, nail care, shaving, dressing, oral care, and similar activities); (4) Transportation; (5) Laundry; (6) Housekeeping; (7) Financial assistance/management; (8) Behavioral management; (9) Case management; (10) Shopping; (11) Beauty/barber services; and (12) Spiritual services.

Move-In/Move-Out Requirements:
Residents requiring complex nursing interventions or whose conditions are not stable or predictable will not be admitted, readmitted, or retained by the facility unless the resident has sufficient mental ability to understand the situation; assumes responsibility for arranging for care from a third party; or has care needs that do not compromise the facility operations, or create a danger to others in the facility. The facility is required to provide a 30-day advance written notice except in situations where the transfer or discharge is necessary to protect the health and safety of the resident, other residents, or staff.

Resident Assessment:
There is no required resident assessment form. However, the Assisted-Living Facility must evaluate each resident and must have a written service agreement negotiated with the resident and authorized representative, if applicable, to determine the services to be provided to meet the needs identified in the evaluation. The agreement must contain the services to be provided by the facility and other sources; how often, when, and by whom the services are provided; rights and responsibilities of the facility and of the resident; cost of services and terms of payment; and terms and conditions of continued residency. The resident service agreement must be reviewed and updated as the resident's needs change.

Medication Management:
When a facility is responsible for the administration or provision of medications, it must be accomplished by the following methods: 1) self-administration of medications by the resident, with or without supervision, when assessment determines the resident is capable of doing so; 2) by licensed health care professionals for whom medication administration is included in the scope of practice and in accordance with prevailing professional standards; or 3) by persons other than a licensed health care professional if the medication aides who provide medications are trained, have demonstrated minimum competency standards, and are appropriately directed and monitored. As of January 1, 2005, every person seeking admission to an Assisted-Living Facility must, upon admission and annually thereafter, provide the facility with a list of drugs, devices, biologicals, and supplements being taken or used by the person, including dosage, instructions for use, and reported use. The Assisted-Living Facility must provide for a registered nurse (RN) to review medication administration policies and procedures and document that review at least annually. An RN also is required to provide or oversee the training of medication aides

Physical Plant Requirements:
Assisted-Living Facilities must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The physical plant standards include support services, care and treatment areas, construction standards, and building systems. In existing facilities, private resident units must be a minimum of 80 square feet and double-occupancy units must provide a minimum of 60 square feet per resident. In new facilities, private resident units must be a minimum of 100 square feet and double-occupancy units must be a minimum of 160 square feet.

Residents Allowed Per Room:
An Assisted-Living Facility must provide resident bedrooms that allow for sleeping, afford privacy, provide access to furniture and belongings, and accommodate the care and treatment provided to the resident. With few exceptions, resident bedrooms must be a single room located within an apartment, dwelling, or dormitorylike structure. In existing facilities, a maximum of four residents is allowed per resident unit. In new facilities, a maximum of two residents is allowed per resident unit.

Life Safety:
All facilities must comply with applicable Nebraska state fire codes and standards to provide a safe environment. Life safety codes for Assisted-Living Facilities are based on National Fire Protection Association standards. Facilities are classified as either Residential Board and Care Occupancy or Limited Care Facility (Health Care Occupancy). Based on the evacuation capability of the residents, the Nebraska State Fire Marshal inspects and determines applicable requirements for fire drills, fire alarm systems, fire sprinkler systems, etc.

Alzheimer's Unit Requirements:
Facilities serving special populations (i.e., persons with Alzheimer's Disease, dementia, or related disorders) must provide care and services in accordance with the resident service agreement and the stated mission and philosophy of the facility; inform the resident or legal representative in writing of the facility's criteria for admission, discharge, transfer, resident conduct, and responsibilities; maintain a sufficient number of direct care staff with the required training and skills necessary to meet the resident's requirements; and provide a physical environment that conforms to and accommodates the special needs.

Staff Training for Alzheimer's Care:
The administrator and direct care staff must be trained in the facility or unit's philosophy and approaches to providing care and supervision for persons with Alzheimer's disease; the Alzheimer's disease process; and the skills necessary to care for and intervene and direct residents who are unable to perform ADLs, personal care, or health maintenance, and who may exemplify behavior problems or wandering tendencies.

Staffing Requirements:
The facility must have an administrator who is responsible for the overall operation of the facility. The administrator is responsible for overall planning, organizing, and directing the day-to-day operation of the facility. The administrator must report all matters related to the maintenance, operation, and management of the facility and be directly responsible to the licensee of the facility. The administrator is responsible for maintaining staff with appropriate training and skills and sufficient in number to meet resident needs as defined in the resident service agreements. The facility must provide for a RN to review medication administration policies and procedures and to provide or oversee training of medication aides at the facility.

Staff Education Training:
Direct-care staff must complete an initial orientation and ongoing training. An RN must provide or oversee specific areas of medication aide training.

Medicaid Policy and Reimbursements:
State supplemental payments may be available for Assisted-Living Facilities for persons eligible for assistance to the aged, blind, and disabled/Medicaid program. Additional services and/or payment may be available for persons who quality for Medicaid and who meet the criteria under the state's aged and disabled home and community-based waiver.