Assisted Living in South Dakota

Agency: Department of Health, Office of Health Care Facilities Licensure and Certification
Phone: (605) 773-3356
Website: www.state.sd.us/doh/Facility/levels.htm

Assisted living centers are defined as any institution, rest home, boarding home, place, building, or agency that is maintained and operated to provide personal care and services that meet some need beyond basic provision of food, shelter, and laundry to five or more persons in a free-standing, physically separated facility.

Facility Scope of Care:
Facilities must provide supportive services, activities, and services to meet the spiritual needs of residents. Facilities must also provide for the availability of physician services. Nothing in regulation limits or expands the rights of any healthcare worker to provide services within the scope of the professional's license, certification, or registration, as provided by South Dakota law. If the facility admits and retains residents on therapeutic diets, it must have a registered dietician consultant.

Move-In/Move-Out Requirements:
Before admission, a physician must determine that residents are in reasonably good health and free from communicable disease, chronic illness, or disability that would require any services beyond supervision, cueing, or limited hands-on physical assistance to carry out normal activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Facilities may not admit or retain residents who require more than intermittent nursing care or rehabilitation services. If individuals live in the center who are not capable of self-preservation, the center must comply with the Life Safety Code pertaining to individuals who do not have this capability. Residents covered by Medicaid cannot be involuntarily transferred or discharged unless their needs and welfare cannot be met by the facility.

Resident Assessment:
Nursing assessments are not required. An assisted living center must ensure an evaluation of each resident's care needs is documented at the time of admission, 30 days after admission, and annually thereafter to determine if the facility can meet the needs for each resident. The resident evaluation instrument must be approved by the department and must address at least the following: (1) Nursing care needs; (2) Medication administration needs; (3) Cognitive status, including IADLs; (4) Mental health status; (5) Physical abilities including ADLs, ambulation, and the need for assistive devices; and (6) Dietary needs.

Medication Management:
Facilities that admit or retain residents who require administration of medications must employ or contract with a licensed nurse to review and document resident care and condition at least weekly. Unlicensed staff must be at least 18 years of age, pass an approved medication course, and receive annual training for medication administration.

Physical Plant Requirements:
Private resident units must be a minimum of 120 square feet and shared resident units must provide a minimum of 100 square feet per resident. If a facility admits and retains cognitively impaired residents, exit alarms must be installed. Call systems must be installed in facilities for physically impaired residents.

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

Life Safety:
The 2000 edition of the Life Safety Code (LSC) has been adopted under South Dakota administrative rules for medical facilities. All newly constructed assisted living centers must be equipped with an automatic sprinkler system, fire alarm systems, and smoke detection systems based on their occupancy classification. These systems must be installed in accordance with National Fire Protection Association (NFPA) codes (NFPA-13 & NFPA 72). All existing assisted living centers are inspected for compliance using the appropriate occupancy classification of the LSC and NFPA codes and standards

Alzheimer's Unit Requirements:
Each facility with secured units must comply with the following: (1) Physician's order for confinement of the resident that includes medical symptoms that warrant seclusion that must be reviewed periodically; (2) Therapeutic programming must be provided and documented in the resident's plan of care; (3) Confinement may not be used as a punishment or for the convenience of staff; (4) Confinement and its necessity must be based on comprehensive assessment of a resident's physical, cognitive, and psychosocial needs, and risks and benefits of confinement must be communicated to the resident's family; (5) Comply with Life Safety Code regarding locked doors; and (6) Staff working in secured unit must have specific training regarding the needs of residents in the unit and at least one caregiver must be on the secured unit at all times. Any new secured unit must be located at grade level and have direct access to an outside area. Every new secured unit must have an outdoor area that is accessible to the residents and enclosed by a fence.

Staff Training for Alzheimer's Care:
Staff working in secured units must have specific training regarding the needs of residents in the unit and at least one caregiver must be on the secured unit at all times.

Staffing Requirements:
An administrator must be responsible for the daily overall management of the facility. There must be a sufficient number of qualified, awake personnel to provide effective care (at least 0.8 hours per resident per day). At least one staff person must be on duty at all times.

Staff Education Training:
The facility must have a formal orientation program and ongoing education for all staff. Ongoing education programs must cover the following subjects annually: (1) Fire prevention and response (the facility must conduct fire drills quarterly for each shift); (2) Emergency procedures and preparedness; (3) Infection control and prevention; (4) Accident prevention and safety procedures; (5) Proper use of restraints; (6) Patient and resident rights; (7) Confidentiality of resident information; (8) Incidents and diseases subject to mandatory reporting and facility's reporting mechanism; (9) Care of residents with unique needs; (10) Dining assistance, nutritional risks, and hydration needs of residents; (11) Working with cognitively impaired residents (if approved for admitting/retaining cognitively impaired residents); and (12) Oxygen handling and administration (if approved to provide supplemental oxygen)

Medicaid Policy and Reimbursements:
A broad Medicaid home and community-based services waiver coupled with state funds covers services in assisted living.