Assisted Living in Rhode Island

Agency: Department of Health Facilities, Regulation Division
Phone: (401) 222-2566
Website: www.HEALTH.ri.gov

Assisted living residence means a publicly or privately operated residence that provides directly or indirectly by means of contracts or arrangements, personal assistance to meet the resident's changing needs and preferences, lodging, and meals to two or more adults who are unrelated to the licensee or administrator, excluding, however, any privately operated establishment or facility licensed pursuant to Chapter 23-17 of the General Laws of Rhode Island, as amended, and those facilities licensed by or under the jurisdiction of the Department of Mental Health, Retardation and Hospitals, the Department of Children, Youth and Families or any other state agency. Assisted living residences include sheltered care homes, board and care residences, or any other entity by any other name providing the above services that meet the definition of assisted living residences. Every residence is licensed with a fire code classification and a medication classification (see Medication Management). Some residences may also have a dementia classification. Fire Code Classifications Level F1 licensure is for a residence that has residents who are not capable of self preservation and these residences must comply with a more stringent life safety code. Level F2 licensure is for residences that will have residents who are capable of self preservation. Dementia Classification Dementia care licensure is required when one or more resident's dementia symptoms impact their ability to function as demonstrated by any of the following: (1) Safety concerns due to elopement risk or other behaviors; (2) Inappropriate social behaviors that adversely impact the rights of others; (3) Inability to self preserve due to dementia; or (4) A physician's recommendation that the resident needs dementia support consistent with this level. Additionally, if a residence advertises or represents special dementia services or if the residence segregates residents with dementia, this licensure is required.

Facility Scope of Care:
Facilities may provide assistance with activities of daily living; arrange for support services; and monitor residents' recreational, social, and personal activities. Residents requiring any more than temporary nursing services must move to a nursing facility. A resident may receive skilled nursing care or therapy from a licensed health care provider for a condition that results from a temporary illness or injury for up to 45 days subject to an extension of additional days as approved by the Department, or if the resident is under the care of a licensed hospice agency, provided the assisted living residence assumes responsibility for ensuring that such care is received.

Move-In/Move-Out Requirements:
Residences are licensed based on the level of service they provide and only residents meeting the classification criteria specified in the license may move in. Admission and residency are limited to persons possessing the physical mobility and judgmental ability to take appropriate action in emergency situations, except in special dementia care units. The residence can require that a resident move out only for certain reasons and with 30 days advance written notice of termination of residency agreement with a statement containing the reason, the effective date of termination, the resident's right to an appeal under state law, and the name/address of the state ombudsperson's office. In cases of a life-threatening emergency or non-payment of fees and costs, the 30-day notice is not required. If termination due to non-payment of fees and costs is anticipated, the residence must make a good faith effort to counsel the resident of this expectation. Reasons for requiring that a resident move out are: (1) If a resident does not meet the requirements for residency criteria stated in the residency agreement or requirements of state or local laws or regulations. The residence must make a good faith effort to counsel the resident if the resident shows indications of no longer meeting residence criteria. (2) If a resident is a danger to self or the welfare of others, and the residence has made reasonable accommodation without success to address resident behavior in ways that would make termination of residency agreement or change unnecessary. These attempts must be documented in the resident's records.

Resident Assessment:
Prior to a resident moving into a residence, the administrator must have a comprehensive assessment of the resident's health, physical, social, functional, activity, and cognitive needs and preferences conducted and signed by a registered nurse. The assessment must be on a form designed or approved by the Department of Health. The form designed by the department is available as Appendix 'C' to the regulations or online at http://www.health.ri.gov.

Medication Management:
Facilities are further classified by the degree to which they manage medications. Medication Classifications Level M1 is for a residence that has one or more residents who require central storage and/or administration of medications. In Level M1 facilities, licensed staff or registered medication aides are permitted to administer medications and monitor health indicators. Level M2 is for residences that have residents who require assistance with self-administration of medications (this term is defined in the regulations).

Physical Plant Requirements:
Private resident units must be a minimum of 100 square feet in area and eight feet wide; semi-private resident units must be a minimum of 160 square feet in area and 10 feet wide.

Residents Allowed Per Room:
A maximum of two residents is allowed per resident unit.

Life Safety:
Facilities must have sprinklers and smoke detectors. Residential board and care facilities must have carbon monoxide detectors, which must be either hardwired or wireless and be installed in accordance with National Fire Protection Association 720.

Alzheimer's Unit Requirements:
A residence that offers or provides services to residents with Alzheimer's disease or other dementia, by means of an Alzheimer Dementia Special Care Unit/Program, must disclose the type of services provided in addition to those services required by the state. A standard disclosure form created by the licensing agency must be completed and submitted to the licensing agency for review to verify the accuracy of the information reported on it. The form must also be provided to any individual seeking to move in to the residence. The information disclosed must explain the additional care that is provided through: (1) The residence's philosophy; (2) Pre-occupancy, occupancy, and termination of residence; (3) Assessment, service planning, and implementation; (4) Staffing patterns and staff training; (5) Physical environment; (6) Resident activities; (7) Family role in care; and (8) Program costs.

Staff Training for Alzheimer's Care:
In addition to training required for staff in all assisted living residences, staff in a residence licensed for dementia care level must receive at least 12 hours of orientation and training on (1) understanding various dementias; (2) communicating effectively with dementia residents; and (3) managing behaviors, within 30 days of hire and prior to beginning work alone in the assisted living residence.

Staffing Requirements:
Each residence must have an administrator who is certified by the Department of Health. All residences must provide staffing that is sufficient to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being of the residents, according to the appropriate level of licensing. At least one staff person who has completed employee training must be on the premises at all times. In addition, each residence must have responsible adults who are employees or who have a contractual relationship with the residence to provide the services required who is at least 18 years of age and: (1) Awake and on the premises at all times; (2) Designated in charge of the operation of the residence; and (3) Physically and mentally capable of communication with emergency personnel. All staff having contact with residents must have a criminal records check.

Staff Education Training:
All new employees must receive at least two hours of orientation and training in the areas listed below within 30 days of hire and prior to beginning work alone, in addition to any training that may be required for a specific job classification at the residences. Training areas include: (1) Fire and emergency procedures; (2) Recognition and reporting of abuse, neglect, and mistreatment; (3) Assisted living philosophy (goals/values: dignity, independence, autonomy, choice); (4) Resident's rights; and (5) Confidentiality. New employees who will have regular contact with residents and provide residents with personal care must receive at least 10 hours of orientation and training in the areas listed below within 30 days of hire and prior to beginning work alone in the assisted living residence, in addition to the areas identified above. Training areas include: (1) Basic sanitation and infection control (i.e., universal precautions); (2) Food service; (3) Medical emergency procedures; (4) Basic knowledge of aging-related behaviors; (5) Personal assistance;(6) Assistance with medications; (7) Safety of residents; (8) Record keeping; (9) Service plans; (10) Reporting; and (11) Where appropriate, basic knowledge of cultural differences. Employees must have on-going in-service training as appropriate for their job classifications and that includes the topics identified above.

Medicaid Policy and Reimbursements:
Two Medicaid home and community-based waivers cover services in assisted living, one for assisted living residents relocating from nursing homes and the other for the elderly and adults with physical disabilities.