I have to admit that I have not looked over Arizona DHS Article 8 in a while. I mean, probably years. I took the Assisted Living Managers class last month and it was evident there were some significant changes in recent.
Since Arizona Department of Health Services isn’t the best about communicating changes, I thought I would do a comparison of these rules. The problem is the Article 8 is not archived online from what I can see and the only version I had archived was from 2014. Nevertheless, I thought it was a worthwhile exercise. These are the rules changes that I identified between my August 2014 archive and November 2019.
3. “Assisted living services” means supervisory care services, personal care services, directed care services, behavioral care, or ancillary services provided to a resident by or on behalf of an assisted living facility.
The term behavioral services has been removed and replaced with behavioral care. It appears that DHS is continuing to delineate between assisted living and behavioral facilities. You can see this again in the changes in resident acceptance rules down below.
j. Cover termination of residency, including:
i. Termination initiated by the manager of an assisted living facility, and
ii. Termination initiated by a resident or the resident’s representative;
Termination is now split into two types- initiated by resident or representative and initiated by manager. Update your documentation to reflect this.
m. Cover methods by which the assisted living facility is aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility is authorized to provide;
This is a policy and procedure requirement. You will need to create a policy and procedure that addresses this requirement and describes how your facility and staff monitors residents. I would suggest incorporating this in your care plan for your residents as well.
7. Documentation is maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each;
This is a requirement for the facility to maintain work schedule documents for caregivers and assistant caregivers. Archive these documents for one year.
3. As part of the policies and procedures required in R9-10-803(C)(1)(h), a plan is established, documented, and implemented to ensure that the manager or a caregiver is available as back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work is not available or not able to provide the required assisted living services; and
This is another policy and procedure requirement for facility personnel. You now need to have a plan to provide backup for absent employees. You need to identify and document PRN personnel both in policy and procedure and don’t forget to establish an employee file or files.
R9-10-807 Residency and Residency Agreements
C. A manager shall not accept or retain an individual if
1. The individual requires continuous: manager shall not accept or retain an individual if:
a. Medical services;
b. Nursing services, unless the assisted living facility complies with A.R.S. § 36- 401(C); or
c. Behavioral health services;
2. The primary condition for which the individual needs assisted living services is a behavioral health issue;
3.The services needed by the individual are not within the assisted living facility’s scope of services and a home health agency or hospice service agency is not involved in the care of the individual.
So evidently some assisted living homes have been taking residents which require behavioral services. And DHS doesn’t like it. This is now verboten. If this is the primary condition and the reason for services, they need to go to a facility licensed for behavioral services.
There is also accommodation to accept residents that may initially be outside your scope of service as long as the resident is on hospice or home health services. This will allow you to accept the resident and expand your scope of service while the resident receives services from hospice or home health.
R9-10-808 Service Plan
4. Multiple media sources, such as daily newspapers, current magazines, internet sources, and a variety of reading materials, are available and accessible to a resident to maintain the resident’s continued awareness of current news, social events, and other noteworthy information.
Well it looks like DHS is finally coming in to the 21st century and realizes newspapers are well on the way out. This rule has been amended to read “media sources”, with suggestions which include internet sources, etc. It’s no longer compulsory to maintain a newspaper subscription to remain compliant. Yay!
R9-10-819. Pest Control
2. A pest control program that complies with A.A.C. R3-8-201(C)(4) is implemented and documented;
The change here is the requirement to be compliant with A.A.C. R3-8-201(C)(4). This states
An individual may not provide pest management services at a school, child care facility, health care institution, or food-handling establishment unless the individual is a certified applicator in the certification category for which services are being provided.
The key element here is that assisted living home are considered health care institutions. This means you’ll need to have a licensed pest control service apply pesticide in accordance with your pest control plan.
There was also some minor changes to Article 8 in November of 2019 which reflected a change in which building codes are followed. You can read about this changes here.