BILL REQ. #: H-1582.2
State of Washington | 63rd Legislature | 2013 Regular Session |
READ FIRST TIME 02/22/13.
AN ACT Relating to raising licensure limits to allow assisted living facilities to serve a higher acuity resident population; amending RCW 18.20.330, 18.20.160, and 18.20.030; reenacting and amending RCW 18.20.020; and adding new sections to chapter 18.20 RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 18.20.330 and 2012 c 10 s 22 are each amended to read
as follows:
(1) Assisted living facilities are not required to provide
intermittent nursing services. The assisted living facility licensee
may choose to provide any of the following intermittent nursing
services through appropriately licensed and credentialed staff,
however, the facility may or may not need to provide additional
intermittent nursing services to comply with the reasonable
accommodation requirements in federal or state law:
(a) Medication administration;
(b) Administration of health care treatments;
(c) Diabetic management;
(d) Nonroutine ostomy care;
(e) Tube feeding; and
(f) Nurse delegation consistent with chapter 18.79 RCW.
(2) The licensee shall clarify on the disclosure form any
limitations, additional services, or conditions that may apply under
this section.
(3) In providing intermittent nursing services, the assisted living
facility shall observe the resident for changes in overall functioning
and respond appropriately when there are observable or reported changes
in the resident's physical, mental, or emotional functioning.
(4) The assisted living facility may provide intermittent nursing
services to ((the extent permitted by RCW 18.20.160)) residents who do
not require the frequent presence and supervision of a licensed
registered nurse.
NEW SECTION. Sec. 2 A new section is added to chapter 18.20 RCW
to read as follows:
(1) In addition to the intermittent nursing services that may be
provided under RCW 18.20.330, the licensee may, but is not required to,
provide continuing nursing services, as defined by the department in
rule, to meet the needs of more complex residents that can be served
under RCW 18.20.330, if the licensee has obtained a designation on its
license under section 4 of this act.
(2) The licensee shall clarify on the disclosure form any
limitations, additional services, or conditions that may apply under
this section.
(3) In providing continuing nursing services, the assisted living
facility shall observe the resident for changes in overall functioning
and respond appropriately when there are observable or reported changes
in the resident's physical, mental, or emotional functioning that
exceed the licensee's licensure limitations and any limitations
described in the disclosure form.
(4) The assisted living facility may provide continuing nursing
services to the extent permitted by RCW 18.20.160.
Sec. 3 RCW 18.20.160 and 2012 c 10 s 11 are each amended to read
as follows:
((No person operating an assisted living facility licensed under
this chapter shall admit to or retain in the assisted living facility
any aged person requiring nursing or medical care of a type provided by
institutions licensed under chapters 18.51, 70.41 or 71.12 RCW, except
that when registered nurses are available, and upon a doctor's order
that a supervised medication service is needed, it may be provided.
Supervised medication services, as defined by the department and
consistent with chapters 69.41 and 18.79 RCW, may include an approved
program of self-medication or self-directed medication. Such
medication service shall be provided only to residents who otherwise
meet all requirements for residency in an assisted living facility. No
assisted living facility shall admit or retain a person who requires
the frequent presence and frequent evaluation of a registered nurse,
excluding persons who are receiving hospice care or persons who have a
short-term illness that is expected to be resolved within fourteen
days.)) The assisted living facility licensed under this chapter must
assume general responsibility for each resident and must promote each
resident's health, safety, and well-being consistent with the resident
negotiated care plan. In addition, the assisted living facility may
provide assistance with activities of daily living, health support
services, intermittent nursing services, and continuing nursing
services, as may be further defined by the department in rule, and
consistent with the care and services included in the disclosure form
required under RCW 18.20.300. To provide continuing nursing services,
the licensee shall obtain from the department a designation on its
license under section 4 of this act. No assisted living facility may
admit or retain a person who requires the frequent presence and
frequent evaluation of a licensed registered nurse, excluding persons
who are receiving hospice care or persons who have a short-term illness
that is expected to be resolved within fourteen days, without first
obtaining a designation on its license under section 4 of this act.
The assisted living facility must assure that sufficient numbers and
appropriately qualified and trained staff are available to provide care
and services consistent with this chapter.
NEW SECTION. Sec. 4 A new section is added to chapter 18.20 RCW
to read as follows:
(1) An assisted living facility may provide continuing nursing
services if it secures a designation on its license from the
department.
(2) At least sixty days prior to the anticipated designation to
provide continuing nursing services, the applicant must submit to the
department a completed application on a form developed by the
department.
(3)(a) The applicant must, annually and at least thirty calendar
days prior to any changes to increase or decrease the scope of services
provided under this section, demonstrate to the satisfaction of the
department the ability to provide continuing nursing services to meet
the nursing-related needs of residents under this section and
consistent with the applicant's disclosure statement or as it may later
be revised.
(b) The department shall consider the following criteria when
granting a continuing nursing service designation under this section:
(i) The experience of the applicant for endorsement; and
(ii) The compliance history of the applicant in the operation of a
Washington state licensed nursing facility, adult family home, or
assisted living facility, as applicable.
(4) If an assisted living facility with a continuing nursing
services designation has reason to believe that a resident has medicare
part B coverage for the continuing nursing services, in whole or in
part, provided under this section, the assisted living facility shall
inform the resident of this possible benefit. If the resident opts to
use his or her medicare part B benefit, the resident may then contract
for nursing or rehabilitative services offered through an outside
health care provider under RCW 18.20.380.
(5) The department shall establish fees to be paid by assisted
living facilities prior to the issuance of an initial or renewal
designation under this section. The department shall establish the fee
at a level that defrays the cost of the administration of the
designation program.
(6) For the purposes of this section, "continuing nursing services"
means the resident has been assessed with a condition or diagnosis that
is expected to require the frequent presence and supervision of a
licensed registered nurse.
Sec. 5 RCW 18.20.030 and 2012 c 10 s 3 are each amended to read
as follows:
(1) After January 1, 1958, no person shall operate or maintain an
assisted living facility as defined in this chapter within this state
without a license under this chapter.
(2) An assisted living facility license is not required for the
housing, or services, that are customarily provided under landlord
tenant agreements governed by the residential landlord-tenant act,
chapter 59.18 RCW, or when housing nonresident individuals who chose to
participate in programs or services under subsection (5) of this
section, when offered by the assisted living facility licensee or the
licensee's contractor. This subsection does not prohibit the licensee
from furnishing written information concerning available community
resources to the nonresident individual or the individual's family
members or legal representatives. The licensee may not require the use
of any particular service provider.
(3) Residents receiving domiciliary care, directly or indirectly by
the assisted living facility, are not considered nonresident
individuals for the purposes of this section.
(4) An assisted living facility license is required when any person
other than an outside service provider, under RCW 18.20.380, or family
member:
(a) Assumes general responsibility for the safety and well-being of
a resident;
(b) Provides assistance with activities of daily living, either
directly or indirectly;
(c) Provides health support services, either directly or
indirectly; ((or))
(d) Provides intermittent nursing services, either directly or
indirectly; or
(e) Provides continuing nursing services, either directly or
indirectly.
(5) An assisted living facility license is not required for one or
more of the following services that may, upon the request of the
nonresident, be provided to a nonresident individual: (a) Emergency
assistance provided on an intermittent or nonroutine basis; (b)
systems, including technology-based monitoring devices, employed by
independent senior housing, or independent living units in continuing
care retirement communities, to respond to the potential need for
emergency services; (c) scheduled and nonscheduled blood pressure
checks; (d) nursing assessment services to determine whether referral
to an outside health care provider is recommended; (e) making and
reminding the nonresident of health care appointments; (f) preadmission
assessment for the purposes of transitioning to a licensed care
setting; (g) medication assistance which may include reminding or
coaching the nonresident, opening the nonresident's medication
container, using an enabler, and handing prefilled insulin syringes to
the nonresident; (h) falls risk assessment; (i) nutrition management
and education services; (j) dental services; (k) wellness programs; (l)
prefilling insulin syringes when performed by a nurse licensed under
chapter 18.79 RCW; or (m) services customarily provided under landlord
tenant agreements governed by the residential landlord-tenant act,
chapter 59.18 RCW.
Sec. 6 RCW 18.20.020 and 2012 c 10 s 2 are each reenacted and
amended to read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Adult day services" means care and services provided to a
nonresident individual by the assisted living facility on the assisted
living facility premises, for a period of time not to exceed ten
continuous hours, and does not involve an overnight stay.
(2) "Assisted living facility" 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, an assisted living facility that is licensed for three
to six residents prior to or on July 1, 2000, may maintain its assisted
living facility license as long as it is continually licensed as an
assisted living facility. "Assisted living facility" 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.
(3) "Basic services" means housekeeping services, meals, nutritious
snacks, laundry, and activities.
(4) "Department" means the state department of social and health
services.
(5) "Domiciliary care" means: Assistance with activities of daily
living provided by the assisted living facility either directly or
indirectly; or health support services, if provided directly or
indirectly by the assisted living facility; or intermittent nursing
services, if provided directly or indirectly by the assisted living
facility; or continuing nursing services, if provided directly or
indirectly by the assisted living facility.
(6) "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.
(7) "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, assisted living facility, or management
company, unless the affiliated person is a family member of the
resident.
(8) "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
an unlicensed room located within an assisted living facility. Nothing
in this chapter prohibits nonresidents from receiving one or more of
the services listed in RCW 18.20.030(5) or requires licensure as an
assisted living facility when one or more of the services listed in RCW
18.20.030(5) are provided to nonresidents. A nonresident individual
may not receive domiciliary care, as defined in this chapter, directly
or indirectly by the assisted living facility and may not receive the
items and services listed in subsection (6) of this section, except
during the time the person is receiving adult day services as defined
in this section.
(9) "Person" means any individual, firm, partnership, corporation,
company, association, or joint stock association, and the legal
successor thereof.
(10) "Resident" means an individual who is not related by blood or
marriage to the operator of the assisted living facility, and by reason
of age or disability, chooses to reside in the assisted living facility
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 assisted living facility 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.
(11) "Resident applicant" means an individual who is seeking
admission to a licensed assisted living facility 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.
(12) "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
assisted living facility and to receive information from the assisted
living facility, 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, assisted living facility, 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.
(13) "Secretary" means the secretary of social and health services.