THE FOLLOWING LEGAL STUDY ARTICLE POSTING IS INTENDED TO SUPPORT AWARENESS AND UNDERSTANDING. IT IS ONLY A PRELIMINARY LEVEL LEGAL STUDY ARTICLE AND IT IS NOT LEGAL ADVICE. IF THE READER SEEKS LEGAL ADVICE CONCERNING HIS OR HER PARTICULAR SITUATION, HE OR SHE SHOULD SEEK OUT AN ATTORNEY IN A LAWYER CLIENT RELATIONSHIP.
A. Pennsylvania State Regulated Domiciliary Care Home Providers Are Not 24/7 Awake and Present Direct Care Provider Settings , As A Domiciliary Level Provider Or Staff Setting Is Only A 24/7 Present and Available Provider Or Staff Setting.
Domiciliary Care Home Providers Are Designed To Be Safe, Supportive, Homelike Setting Providers. In Addition To Room, Board And Non-Emergency Medical Transportation Services, They Help Their Clients in Developing or Maintaining Self-Help Skills, Personal Hygiene Skills and Other Skills Relating To Activities of Daily Living. If Necessary, They Can Assist a Client With The Administration of Medication Prescribed For Self Administration.
See 6 Pa. Code § 21.71
A domiciliary care home provider shall operate in accordance with applicable provisions of this chapter to assure a safe, supportive, homelike setting for clients.
See 6 Pa. Code § 21.74
A provider is responsible for furnishing to a client or, if appropriate, paying for the full cost of, the following basic items:
(1) Adequate housing …. (2) Basic utilities, ….(3) Laundry service for bed linens, towels and personal clothing. A provider shall allow access to laundry equipment ….. (4) Three nutritious meals per day,…. (6) Basic furnishings …. (7) Transportation to enable a client to receive necessary, nonemergency medical services.
See 6 Pa. Code § 21.76
(a) The provider shall help the client in developing or maintaining self-help skills, personal hygiene skills and other skills relating to activities of daily living…..
(b) If necessary, the provider shall assist with the administration of medication prescribed for self-administration, ….
See 6 Pa. Code § 21.73
(a)_At least one provider or staff person shall be present and available on the premises when one or more clients are present in the home.
(b) The AAA may waive the requirements in subsection (a), if the clients are independently mobile and the provider or staff absences would be of limited duration and not during hours when the clients are sleeping….
B . Pennsylvania Personal Care Homes are 24/7 Awake and Present Direct Care Staff Settings. At Least One Direct Care Staff Person Must Be Present and Awake in the Personal Care Home At Any Time A Resident With Mobility Needs Is Present In the Personal Care Home.
Personal Care Homes Are Designed to Provide Safe, Humane, Comfortable and Supportive Residential Settings For Adults Who Do Not Require The Services In Or Of a Licensed Long-Term Care Facility, But Who Do Require Assistance Or Supervision with Activities of Daily Living, Instrumental Activities Of Daily Living, or Both.
See 55 Pa. Code § 2600.1 (b)
In Pennsylvania, personal care homes are designed to provide safe, humane, comfortable and supportive residential settings for adults who do not require the services in or of a licensed long-term care facility, but who do require assistance or supervision with activities of daily living, instrumental activities of daily living, or both.
See 55 Pa. Code § 2600.58
(a) If a home serves 16 or more residents, all direct care staff persons on duty in the home shall be awake at all times one or more residents are present in the home.
(b) If a home serves one or more but less than 16 residents with mobility needs, at least one direct care staff person shall be awake at all times residents are present in the home.
See 55 Pa. Code § 2600.4
A direct care staff person is a staff person who directly assists residents with activities of daily living, and instrumental activities of daily living and provides services or is otherwise responsible for the health, safety and well-being of the residents.
See 55 Pa. Code § 2600.4
The term “activities of daily living” ( ADL) includes eating, drinking, ambulating, transferring in and out of a bed or chair, toileting, bladder and bowel management, personal hygiene, securing health care, managing health care, self-administering medication and proper turning and positioning in a bed or chair.
The term “instrumental activities of daily living ” (IADL) includes the following terms when done on behalf of a resident : (i) Doing laundry. (ii) Shopping. (iii) Securing and using transportation. (iv) Managing finances. (v) Using a telephone. (vi) Making and keeping appointments. (vii) Caring for personal possessions. (viii) Writing correspondence. (ix) Engaging in social and leisure activities. (x) Using a prosthetic device. (xi) Obtaining and keeping clean, seasonal clothing.
C. Pennsylvania Assisted Living Residences Must, At A Minimum, Among Other Core Service Requirements, Provide 24 /7 Supervision, Monitoring And Emergency Response, Along With Basic Cognitive Support Services Such As Intermittent Cueing, Redirecting, Environmental Cues, Measures to Address Wandering, Dementia-Specific Activity Programming And Specialized Communication Techniques.
See 55 Pa. Code § 2800. 220 (c) (1)
An Assisted Living Residence shall, at a minimum, provide the following…core service :
(1) (i) 24-hour supervision, monitoring and emergency response.
(vii) Basic cognitive support services …… ( These services include the following : Intermittent cueing, Redirecting, Environmental cues, Measures to address wandering, Dementia-specific activity programming, Specialized communication techniques…..)
D. Unlike A Hospital Or Skilled Nursing Facility , A “Nursing Facility” Is An Intermediate Care Level Institution That Is Primarily Engaged In Providing Intermediate Level Nursing And Related Health And Medical Services That Are Available To Residents On A Continuous 24-Hour Basis In Accordance With Resident Care Plans That Are Ordered By, and Provided Under The Direction Of A Physician.
A ” Nursing Facility ” Is Designed To Provide Services Available On A Continuous 24-Hour Basis To A Person Who Does Not Require The Degree of Care and Treatment Provided In A Hospital or Skilled Nursing Facility, But Who Does Require Nursing And Related Health and Medical Services In The Context Of A Planned Program of Health Care and Management.
See 42 U.S.C. 1396r (a) (1)(C)
(a) ….the term “nursing facility “ . means an institution (or a distinct part of an institution) which—
(1) is primarily engaged in providing to residents –
(C) on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases;
See 42 CFR § 483.35
(a) Sufficient staff.
(1) The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans:
(i) Except when waived …, licensed nurses; and
(ii) Other nursing personnel, including but not limited to nurse aides.
(b) Registered nurse.
(1) Except when waived …., the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week.
See 55 Pa Code § 1181.2
Intermediate care—A level of care provided by a facility that is licensed by the Department of Health to provide intermediate care. Intermediate care shall be ordered by, and provided under the direction of a physician. It is available on a continuous 24-hour basis to a person who does not require the degree of care and treatment provided in a hospital or skilled nursing facility. Because of a mental or physical disability, the person does, however, require nursing and related health and medical services in the context of a planned program of health care and management. The term does not include intermediate care for the mentally retarded.
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