BILL REQ. #:  S-4904.1 

READ FIRST TIME 02/01/06.   

     AN ACT Relating to the provision of services for nonresident individuals residing in long-term care settings; amending RCW 18.20.020; adding a new section to chapter 18.20 RCW; and adding a new section to chapter 74.39 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.20.020 and 2004 c 142 s 1 are each amended to read as follows:
     As used in this chapter:
     (1) "Boarding home" means any home or other institution, however named, which is advertised, announced, or maintained for the express or implied purpose of providing housing, basic services, and assuming general responsibility for the safety and well-being of the residents, and may also provide domiciliary care, consistent with chapter 142, Laws of 2004, to seven or more residents after July 1, 2000. However, a boarding home that is licensed for three to six residents prior to or on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. "Boarding home" shall not include facilities certified as group training homes pursuant to RCW 71A.22.040, nor any home, institution or section thereof which is otherwise licensed and regulated under the provisions of state law providing specifically for the licensing and regulation of such home, institution or section thereof. Nor shall it include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the department of housing and urban development.
     (2) "Basic services" means housekeeping services, meals, nutritious snacks, laundry, and activities.
     (3) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
     (4) "Secretary" means the secretary of social and health services.
     (5) "Department" means the state department of social and health services.
     (6) "Resident's representative" means a person designated voluntarily by a competent resident, in writing, to act in the resident's behalf concerning the care and services provided by the boarding home and to receive information from the boarding home, if there is no legal representative. The resident's competence shall be determined using the criteria in RCW 11.88.010(1)(e). The resident's representative may not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident. The resident's representative shall not have authority to act on behalf of the resident once the resident is no longer competent.
     (7) "Domiciliary care" means: Assistance with activities of daily living provided by the boarding home either directly or indirectly; or health support services, if provided directly or indirectly by the boarding home; or intermittent nursing services, if provided directly or indirectly by the boarding home.
     (8) "General responsibility for the safety and well-being of the resident" means the provision of the following: Prescribed general low sodium diets; prescribed general diabetic diets; prescribed mechanical soft foods; emergency assistance; monitoring of the resident; arranging health care appointments with outside health care providers and reminding residents of such appointments as necessary; coordinating health care services with outside health care providers consistent with RCW 18.20.380; assisting the resident to obtain and maintain glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices; observation of the resident for changes in overall functioning; blood pressure checks as scheduled; responding appropriately when there are observable or reported changes in the resident's physical, mental, or emotional functioning; or medication assistance as permitted under RCW 69.41.085 and as defined in RCW 69.41.010.
     (9) "Legal representative" means a person or persons identified in RCW 7.70.065 who may act on behalf of the resident pursuant to the scope of their legal authority. The legal representative shall not be affiliated with the licensee, boarding home, or management company, unless the affiliated person is a family member of the resident.
     (10) "Nonresident individual" means a person who resides in independent senior housing, independent living units in continuing care retirement communities, or in other similar living environments or in a boarding home and may receive one or more of the services listed in RCW 18.20.030(5)((, but)). A nonresident individual may not receive domiciliary care, as defined in this chapter, directly or indirectly by the ((facility)) boarding home and may not receive the items and services listed in subsection (8) of this section, except during the time the person is receiving adult day services as defined in this section. A nonresident individual residing in independent senior housing that is part of a continuing care retirement community may, in addition to the services listed in RCW 18.20.030(5), receive the services listed in section 3 of this act.
     (11) "Resident" means an individual who is not related by blood or marriage to the operator of the boarding home, and by reason of age or disability, chooses to reside in the boarding home and receives basic services and one or more of the services listed under general responsibility for the safety and well-being of the resident and may receive domiciliary care or respite care provided directly or indirectly by the boarding home and shall be permitted to receive hospice care through an outside service provider when arranged by the resident or the resident's legal representative under RCW 18.20.380.
     (12) "Resident applicant" means an individual who is seeking admission to a licensed boarding home and who has completed and signed an application for admission, or such application for admission has been completed and signed in their behalf by their legal representative if any, and if not, then the designated representative if any.
     (13) "Adult day services" means care and services provided to a nonresident individual by the boarding home on the boarding home premises, for a period of less than twenty-four continuous hours, and does not involve an overnight stay.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.20 RCW to read as follows:
     Nothing in this chapter shall be interpreted as limiting the right of any resident or nonresident as defined in RCW 18.20.020 from receiving services that are provided under Title XVIII of the federal social security act.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.39 RCW to read as follows:
     (1) A continuing care retirement community may provide certain supportive services and health care services to nonresidents who reside in the independent senior housing setting to promote independence, personal hygiene, and safety in his or her own apartment.
     (2) The supportive services or health care services that may be provided are services that a person without a functional limitation would customarily and personally perform without assistance or are services that are provided as a convenience to the nonresident. Home health agencies and hospice agencies are allowed to provide beneficiaries with these services to which they are otherwise entitled as a matter of federal law.
     (3) The individual who chooses to receive supportive services or health care services is responsible for initiating the scheduling of such services by informing the continuing care retirement community of those permitted services that the individual would need or prefer to have performed or provided.
     (4) The responsibility to initiate supportive services or health care tasks, to possess the necessary knowledge and training for those tasks, and to exercise judgment regarding the manner of their performance rests and remains with the person who has chosen to request that those tasks be provided or performed by the continuing care retirement community.
     (5) When a licensed health care provider orders or performs treatment involving a health care task to be performed under this section, the responsibility to ascertain that the patient understands the treatment and will be able to follow through on the care task is the same as it would be for a patient who performs the health care task for himself or herself, and the licensed health care provider incurs no additional liability when ordering or performing a health care task which is to be performed under this section.
     (6) Nurses, advanced registered nurse practitioners, or nurse practitioners, licensed under chapter 18.79 RCW, may perform the following supportive services or health care tasks to nonresidents who reside in the independent senior housing setting of a continuing care retirement community, or may delegate these tasks to registered or certified nursing assistants in accordance with RCW 18.79.260:
     (a) Ear irrigation;
     (b) Blood glucose monitoring;
     (c) Assistance with compression stockings;
     (d) Assistance with inserting hearing aids;
     (e) Nonresident specific blood pressure monitoring following a medication change;
     (f) Reminding the nonresident of a scheduled health care appointment;
     (g) Delivery of meals to nonresidents; and
     (h) First aid care.
     (7) Persons providing services under subsection (6) of this section shall document the supportive services or health care services given and the client's response to the services or care.
     (8) Licensed nurses, or registered or certified nursing assistants under chapter 18.88A RCW, when providing services under subsection (6) of this section, shall document the supportive services or health care services given and the client's response to the services or care.
     (9) Persons providing health care services or supportive services under this section shall not simultaneously be responsible for providing care and services in the licensed boarding home or nursing home of the continuing care retirement community.
     (10) For the purpose of this section, a continuing care retirement community has the same meaning defined in RCW 70.38.025.