Assisted Living in Oregon

Agency: Department of Human Services, Seniors and People with Disabilities
Phone: (503) 945-5832
Website: www.oregon.gov/DHS/spwpd/index.shtml

Assisted Living means a building, complex, or distinct part thereof consisting of fully self-contained, individual living units where six or more seniors and adult persons with disabilities may reside in homelike surroundings. The facility offers and coordinates a range of supportive services available on a 24-hour basis to meet the activities of daily living (ADL), health, and social needs of the residents as in the rules. A program approach is used to promote resident self-direction and participation in decisions that emphasize choice, dignity, privacy, individuality, and independence. Residential Care Facility means a building, complex, or distinct part thereof consisting of shared or individual living units in a homelike surrounding where six or more seniors and adult persons with disabilities may reside. The facility offers and coordinates a range of supportive services available on a 24-hour basis to meet the ADL, health, and social needs of the residents as described in the rules. A program approach is used to promote resident self-direction and participation in decisions

Facility Scope of Care:
Facilities may care for individuals with all levels of care needs.

Move-In/Move-Out Requirements:
Residents may be asked to move out in certain situations. Thirtyday notification must be provided in most situations but there is a provision for less than 30-day notification when there are urgent medical and psychiatric needs. The following are specific reasons that a facility could request that a resident seek other living arrangements: (1) The resident's needs exceed the level of ADL services the facility provides as specified in the facility's disclosure information; (2) The resident engages in behavior or actions that repeatedly and substantially interferes with the rights, health, or safety of residents or others; (3) The resident has a medical or nursing condition that is complex, unstable, or unpredictable and exceeds the level of health services the facility provides as specified in the facility's disclosure information; (4) The facility is unable to accomplish resident evacuation in accordance with OAR 411-054-0090 (Fire and Life Safety); (5) The resident exhibits behavior that poses a danger to self or others; (6) The resident engages in illegal drug use or commits a criminal act that causes potential harm to the resident or others; or (7) There is non-payment of charges

Resident Assessment:
A standardized assessment form is used by state caseworkers to determine Medicaid eligibility and service level payment. Providers are not required to use a Department designated form but must address a common set of evaluation elements including specified resident routines and preferences; physical health status; mental health issues; cognition; communication and sensory abilities; ADLs; independent ADLs; pain; skin condition; nutrition habits, fluid preferences, and weight if indicated; treatments including type, frequency and level of assistance needed; indicators of nursing needs, including potential for delegated nursing tasks; and a review of risk indicators.

Medication Management:
Medication may be administered by specially trained, unlicensed personnel over the age of 18. In addition, Oregon applies nurse delegation rules to these regulations. All medications administered by the facility to a resident must be reviewed every 90 days by a registered pharmacist or registered nurse and recommendations must be documented and followed up on.

Physical Plant Requirements:
Assisted Living: Newly constructed private resident units must be a minimum of 220 square feet (not including the bathroom) and must include a kitchen and fully accessible bathroom. Preexisting facilities being remodeled must be a minimum of 160 square feet (not including the bathroom). Other extensive physical plant requirements apply. Residential Care Facilities: Resident units may be limited to a bedroom only, with bathroom facilities centrally located off common corridors. In bedroom units, the door must open to an indoor, temperature-controlled common area or common corridor and residents must not enter a room through another resident's bedroom. Resident units must include a minimum of 80 square feet per resident exclusive of closets, vestibules, and bathroom facilities and allow for a minimum of three feet between beds.

Residents Allowed Per Room:
In Assisted Living Facilities, resident units may only be shared by couples or individuals who choose to live together. In Residential Care Facilities, each resident unit may house no more than two residents.

Life Safety:
All buildings must have an automatic sprinkler system, smoke detectors, and an automatic and manual fire alarm system. Facilities must have a written emergency procedure and disaster plan for meeting all emergencies and disasters that must be approved by the state fire marshal. A minimum of one unannounced fire drill must be conducted and recorded every other month. Each month that a fire drill is conducted, the time (day, evening, and night shifts) and location of the drill must vary. Fire and life safety instruction to staff must be provided on alternate months

Alzheimer's Unit Requirements:
In 2010, Oregon developed new rules for the endorsement of Memory Care Communities, formerly known as Alzheimer's Care Units. To achieve endorsement, a community must meet underlying licensing requirements for Assisted Living and Residential Care as well as the endorsement rules. Endorsement rules focus on person-centered care, consumer protection, and staff training specific to caring for people with dementia, and include enhanced physical plant and environmental requirements. A Memory Care Community is defined as a special care unit in a designated separate area for individuals with Alzheimer's disease or other dementia that is locked, segregated, or secured to prevent or limit access by a resident outside the designated or separated area. Applicants for endorsement must demonstrate their capacity to operate a Memory Care Community, taking into account their history of compliance and experience in operating any care facility. Applicants without sufficient experience must employ a consultant or management company for at least the first six months of operation. Communities that are not endorsed may not advertise or imply that they have an endorsement. In addition to the residency agreement, an endorsed community must provide a Memory Care Community Uniform Disclosure Statement to residents or their representatives prior to move-in. Staffing levels must comply with licensing rules and be sufficient to meet the scheduled and unscheduled needs of residents. Staffing levels during nighttime hours shall be based on sleep patterns and needs of residents. Required policies and procedures include philosophy of how memory care services are provided and promotion of person-directed care, evaluation of behavioral symptoms and design for supports for an intervention plan, resident assessment for the use and effects of medications including psychotropic medications, wandering and egress prevention, and description of family support programs. Minimum services are specified including an individualized nutritional plan, an activity plan, evaluation of behavioral symptoms that negatively impact the resident or others in community, support to family and other significant relationships, and access to outdoor space and walkways. The physical design should maximize functional abilities, accommodate behavior related to dementia, promote safety, encourage dignity, and encourage independence. Specific elements for new construction or remodels include: SR-2 occupancy classification; lighting requirements that meet the ANSI/IESNA RP-28-07; and a secure outdoor recreation area.

Staff Training for Alzheimer's Care:
All Memory Care Community staff must be trained in required topics addressing the needs of people with dementia prior to providing care and services to residents and within 30 days of hire. They also must receive four hours of dementia-specific inservice training annually (in addition to licensing requirements of 12 hours of annual training). For an administrator of a Memory Care Community, 10 of the 20 hours of required annual continuing education must be related to the care of individuals with dementia.

Staffing Requirements:
The facility must have qualified staff sufficient in number to meet the 24-hour scheduled and unscheduled needs of each resident. Caregivers provide services for resident that include assistance with ADLs, medication administration, residentfocused activities, supervision, and support. Based on resident acuity and facility structural design, there must be adequate caregivers present at all times to meet the fire safety evacuation standards as required by the fire authority or DHS. The licensee is responsible for assuring that staffing is increased to compensate for the evaluated care and service needs of residents at move-in and for the changing physical and mental needs of the residents. A minimum of two caregivers must be scheduled and available at all times whenever a resident requires the assistance of two caregivers for scheduled and unscheduled needs. In facilities where residents are housed in two or more detached buildings, or if a building has distinct and segregated areas, a designated caregiver must be awake and available in each building and each segregated area at all times. Facilities must have a written, defined system to determine appropriate numbers of caregivers and general staffing based on resident acuity and service needs. Such systems may be either manual or electronic. Guidelines for systems must also consider physical elements of a building, use of technology, if applicable, and staff experience. Facilities must be able to demonstrate how their staffing system works. Staff under 18 years of age may not assist with medication administration or delegated nursing tasks and must be supervised when providing bathing, toileting, or transferring services.

Staff Education Training:
Prior to beginning their job responsibilities all employees must complete an orientation that includes: residents' rights and the values of community-based care; abuse and reporting requirements; standard precautions for infection control; and fire safety and emergency procedures. If staff members' duties include preparing food, they must have a food handler's certificate. All staff must receive a written description of their job responsibilities. The facility must have a training program that has a method to determine performance capability through a demonstration and evaluation process. The facility is responsible to assure that caregivers have demonstrated satisfactory performance in any duty they are assigned. Knowledge and performance must be demonstrated in all areas within the first 30 days of hire, including, but not limited to: -- The role of service plans in providing individualized resident care; -- Providing assistance with ADLs; -- Changes associated with normal aging; -- Identification of changes in the resident's physical, emotional, and mental functioning, and documentation and reporting on the resident's changes of condition; -- Conditions that require assessment, treatment, observation, and reporting; -- Understanding resident actions and behavior as a form of communication; -- Understanding and providing support for a person with dementia or related condition; and -- General food safety, serving, and sanitation. If the caregiver's duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments), must document that they have observed and evaluated the individual's ability to perform safe medication and treatment administration unsupervised. Prior to providing personal care services for a resident, caregivers must receive an orientation to the resident, including the resident's service plan. Staff members must be directly supervised by a qualified person until they have successfully demonstrated satisfactory performance in any task assigned and the provision of individualized resident services, as applicable. Staff must be trained in the use of the abdominal thrust and first aid. CPR training is recommended, but not required.

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers services to nursing home level residents in Assisted Living and Residential Care Facilities. It is a tiered system of reimbursement based on the services provided.