It is easy to become confused about different types of long-term care facilities. In Georgia, a personal care home is not the same thing as an assisted living facility. An assisted living facility is a personal care home that serves over 25 people and is licensed to provided “assisted living care,” which includes assistance with daily living and administration of medications. On this week’s episode, nursing home abuse attorney Rob Schenk discusses five things to know about Georgia personal care homes.
Schenk: Hello and welcome back to the Nursing Home Abuse Podcast. My name is Rob Schenk and I will be your host for this episode, which we will be talking about Georgia personal care homes. Obviously, based on the title of the podcast, we focus a majority of our time on skilled nursing facilities known as nursing homes. We don’t often talk about facilities that have degrees of care that are lower than that, locations, facilities in which the level of care required by the residents is not as great. They can still require care but it’s not like the skilled nursing facilities that we call nursing homes. In fact, very rarely do we talk about that, but I know right off the top of my head, not because I’m looking down at this sheet of paper, that we dealt with assisted living facilities and personal care homes in Episode 22, where we talked about the various standards of care in those facilities, and then of course, we had the fabulous Eric Carlson on to talk about assisted living facilities on Episode 108 back in March of 2018.
But in Georgia, there are several different types of facilities. There are nursing homes, there are assisted living facilities and there are personal care homes. And personal care homes are not the same thing as a nursing home or an assisted living facility. There are differing degrees of requirements to be met.
So a personal care home, right off the bat before we go into the five things you should know about personal care homes in Georgia, right off the bat, a personal care home is not regulated on a federal level, and again, that was the topic of discussion on Episode 108. But personal care homes in Georgia, that is overseen basically by the Department of Community Health, the healthcare regulation division. They are the ones that promulgate the regulations that the personal care homes have to follow. So that can be interesting in the sense that we all often talk about the federal regulations, but we talk about assisted living facilities and we talk about personal care homes, we’re talking about state regulations promulgated by the Department of Community Health. So that is where I’m going to get the information that we are going to be talking about today in the five things to know about personal care homes.
The first thing that we should talk about is straight up the definitions of things. I kind of elaborated on that or I kind of hinted at that, but now we’ll elaborate a little bit further, but according to the Georgia regulations, a personal care home by definition means any dwelling, whether operated for profit or not, which undertakes through its ownership and management to provide and arrange for the provision of housing, food service and one or more personal services – I’m going to underline that so we can figure out what personal services – one or more personal services for two or more adults who are not related to the owner or the administrator by blood or marriage. So it’s a location operated for profit or not that undertakes to provide or arrange for the provision of housing, food service and personal services.
So what are personal services? Under the Georgia regulations, personal services include but are not limited to individual assistance with or supervision of self-administered – self-administered – medication, assistance with ambulation and transfer and essential activities of daily living, such as eating, bathing, grooming, dressing and toileting. That’s the personal services that a personal care home in Georgia will provide to a resident.
So this is kind of separate and apart from assisted living care, which assisted living care means under the regulations literally the specialized care and services provided by an assisted living community, which includes the provision of personal services, the administration of medications by a certified medication aide and the provision of assisted self-preservation.
And again, the definition of assisted living facility, just to be clear, is a personal care home that serves 25 or more persons and is licensed to provide assisted living care. And we just found that to be the difference being that assisted living care is not just personal services but also the administration of medications by a certified medication aide and the provision of assisted self-preservation. So it’s a little bit – assisted living care is a little more hands on than the care provided at a personal care home.
So that’s the difference in terms of a personal care home and an assisted living facility. They’re not the same thing. Assisted living facility has a little bit different requirements. So that’s number one, the definitions.
Number two of the five things to know about Georgia personal care homes is the admission criteria. So among others, the persons admitted to a personal care home must be at least 18 years old. The home is permitted to admit and retain only ambulatory residents who are capable of self-preservation with minimal assistance. In other words, staff may assist the resident in transferring from sitting or reclining position and provide verbal directions to residents who are able to self-propel to the nearest exit.
So what does ambulatory mean? The home is permitted to admit and retain only ambulatory residents. So what does that mean? Ambulatory, as per the regulations, means a resident who has the ability to move from one place to place – sorry, from place to place by walking unaided or aided by protheses, brace, cane, crutches, walker or handrail, or by propelling a wheelchair or scooter, who can respond to an emergency condition whether caused by fire or otherwise and can escape with minimal human assistance, such as guiding a resident to an exit.
In other words, an ambulatory resident means someone that can almost take care of themselves in terms of being able to respond to an emergency. It’s someone that if they’re in a wheelchair, they can move themselves. They don’t have to be pushed. If it’s someone that can walk, they have the wherewithal to be able to locate and go to an exit, maybe with some assistance in saying, “Hey, go this way,” but they can comprehend that and get out. That is an ambulatory resident and those are the only types of residents who are able to be admitted into a personal care home.
The home must not admit or retain persons who require the use of physical or chemical restraints, isolation or confinement due to behavioral control – in other words, the personal care home cannot contain anybody that is a risk of danger to the other residents, and that they can’t be somebody that requires medication to prevent them from hurting other people.
No home is permitted to admit residents who either require continuous medical services or continuous nursing home and treatment. And this is a big one where if an individual resident requires continuous skilled nursing care, then their only options are an assisted living facility or a nursing home.
Medical nursing health or therapeutic services required on a periodic basis or for short term illness must not be provided as services of the home, the personal care home. When such services are required, they must be purchased by the resident or the resident’s representative or the legal surrogate, if any, from appropriately licensed providers managed independently from the home. The home may assist in arrangement from such services but not provision of the services. So in other words, if in some point in time, the resident requires some type of maybe physical therapy or nursing assistance of some nature, the personal care home is not the one that’s going to take care of it. It’s the individual resident that has to take care to provide those services, to contract out those services.
No home is permitted to admit or retain a resident who needs care beyond what the home is permitted to provide. And so in other words, maybe sometimes you’ll hear of facilities taking on people that they’re unable to provide services for just to get that money. In this instance, they’re prohibited by law from doing that. If they don’t meet the threshold of a resident as put out by these regulations, then they can’t be admitted.
The administrator or the on-site manager of a home must conduct an interview with the applicant or the representative or legal surrogate, if any, of the applicant to ascertain whether the home can meet the applicant’s needs. The administrator or on-site manager must obtain a report of physical examination conducted by a licensed physician or a nurse practitioner or a physician’s assistant dated within 30 days prior to the day of admission using the specific report physical examination form made available by the department.
When a home admits a resident without the required physical examination pursuant to a specific request for an emergency placement made by a governmental agency or local law, the home must retain documentation of the need for emergency placement and obtain a copy of the physical examination within 14 days.
So in other words, you’ve got to do a head-to-toe assessment, because what the personal care home is saying is, “We’re not going to provide you with specialized nursing services. If you’re in here, you’re able to ambulate, to do your own thing with minimal assistance. That’s why you’re here. You’re not ready for a nursing home, assisted living facility situation.” So that’s why this assessment is so important because oftentimes, you’re above and beyond what the personal care home can provide, because the personal care home is only going to provide personal services. And again, those personal services are only individual assistance with supervision of self-administered – self-administered medications, assistance with ambulation and transfer and essential activities of daily living, such as eating, bathing, grooming, dressing and toileting, not medication, not nursing services. So that’s number two – the criteria to be admitted into a personal care home.
So number three is staffing. The personal care home must maintain a minimum on-site staff to resident ratio of one awake – and I can’t believe that’s in the regs, but on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours and one awake direct care staff person per 25 residents during non-waking hours where the residents have minimal care needs. So that’s – it’s 1:15 during waking hours and 1:25 during non-waking hours, so at night, obviously.
However, the home must staff above these minimum on-staff ratios to meet the specific residents’ ongoing health, safety care needs. Staff, such as cooks and maintenance staff who do not receive ongoing direct care training and whose job duties do not routinely involve the oversight or delivery of direct personal care to residents must not be counted towards the minimum staffing ratios. In other words, you can’t fudge the numbers by saying the cook is going to count towards the staff ratio for another entity, such as a private home provider.
Hospice or private sitters cannot be counted in the staff ratios for the home, so in other words, if a personal care home resident hires, contracts out hospice care, that doesn’t count to the staff ratio. The personal care home must still meet the minimum staffing ratio, 1:15 during waking hours and 1:25 during non-waking hours.
At least one administrator, on-site manager or responsible staff person must be on the premises 24 hours a day and available to respond to residents’ needs. Residents must be supervised consistent with their needs. All staff, including the administrator or on-site manage who offer direct care to the residents on behalf of the home must maintain an awareness of each resident’s normal appearance and must intervene as appropriate if a resident’s state of health appears to be in jeopardy. So in other words, if Mrs. Johnson has a limp and it’s not normal for her to have a limp, then they need to know that and be able to respond to the changing needs of the residents.
Sufficient staff time must be provided by the home such that each resident receives treatments, medications and diets prescribed, receives proper care to prevent pressure ulcers and contractures, is kept comfortable and clean, is treated with dignity kindness, consideration and respect, is protected from avoidable injury and infection, is given prompt, unhurried assistance if she or he requires help with eating, is given assistance if needed with daily hygiene, including baths, is given assistance when transferring if needed.
Again, the staff requirements and the staff ratio, again, only go towards the personal services provided by the personal care home, which is generally the assistance with daily living activities – eating, bathing, hygiene, that kind of thing. If your loved one requires more than that, a nurse to provide medicine, a nurse service for administration of different medical treatments, then they’re not a candidate for personal care homes. So even though the government of Georgia, the Department of Community Health has said, “These are the staff ratio minimums.” Be aware of that – that is what the staff is going to be doing.
Number four – assessment and care plan. So assessments and care plans must be carried out just like any nursing home, just like any assisted living facility. The personal care home must complete a resident’s needs assessment of the resident at the time of admission and update as changes occur addressing the resident’s care needs, taking into account the resident’s family supports, the resident’s functional capacity relative to the activities of daily living, physical care needs, medical information provided, cognitive behavioral impairments, if any, and personal preferences relative to care needs.
So that’s the assessment. It’s very similar to a nursing home assessment. You’re basically doing a head to toe observation of the individual getting an understanding of cognitive impairments, if any, and I would say in this instance, to make sure that they’re not a candidate for a nursing home rather than a personal care home. So in other words, is this level of care appropriate for this person?
Written care plan – so the personal care home, just like a nursing home, has to put in a plan based on that assessment. Utilizing the information acquired during the admission process and the move-in adjustment period, a personal care home, which provides caregivers and member care must develop the resident’s individual written care plan within 14 days of admission and requires staff to use the care plan as a guide for the delivery of care and services to the resident.
And similar to a nursing home, the care plan has got to have a few things, and that includes, one, a description of the resident’s care and social needs and the services that have been provided, including frequency to address care and social needs. Two, resident’s personal preferences regarding care, activities and interests, and this includes what TV they like to watch, maybe what religion they subscribe to, that kind of thing. Three, specific behaviors to be addressed with interventions to be used. Four, any physician’s order or order of a nurse practitioner or physician’s assistant working under protocol or job description. Five, staff primarily responsible for implementing the care plan. Six, evidence of resident and family involvement in the development of the plan when appropriate. And finally, evidence of the care plan being updated at least annually or more frequently. So that’s kind of the drafting of the care plan, the execution of the care plan, so you’ve got to have one at least once a year.
So that’s what I think is important is even though the level of services being provided to the personal care home resident is not as intensive as what you would get in a nursing home, you still at a minimum have to have an assessment and a care plan, if anything, to weed out the personal care home residents who need to go to the nursing home.
And number five with regards to the five things you should know about personal care homes in Georgia is the concept of changing conditions and transfer. So in case of an accident or sudden adverse change in the residents’ physical condition or emotional adjustment, the home must take the actions appropriate to the specific circumstances to address the needs of the resident, including notifying the representative or legal surrogate if any. The personal care home must maintain a record all such accidents or sudden adverse changes and the home’s response in the resident’s files. An immediate investigation of the circumstances associated with an accident or injury involving a resident must be initiated by the administrator or the on-site manager of the home. Additionally, a report of the occurrence of the accident or injury must be made to the representative of the legal surrogate, if any, with a copy of the notification report maintained in the resident’s file. The complete investigative review concerning the circumstances of the cause of the incident and opportunities to identify and improve care must be maintained in a central file for quality assurance or peer review.
The administrator or the on-site manager of the home must initiate immediate transfer if the resident develops a physical or mental condition requiring continuous medical care or nursing care if a resident’s continuing behavior or condition directly and substantially threatens the health, safety and welfare of the resident or any other residents. In the event such an immediate transfer is warranted, the administrator or the on-site manager of the home must advise both the resident and the resident’s legal representative.
And we actually touched upon or we will be touching upon that concept of when is a facility required to call you, all the times a facility is required to call you, in an upcoming episode of the Nursing Home Abuse Podcast. So stay tuned for that.
But those are five things to know about a personal care home. I think the main thing to understand is that have an understanding of whether or not your loved one is fit for personal care or fit for assisted living or a nursing home. That’s the most important thing. I think that people have expectations that their loved one is a superhero and can do everything themselves, and that might not necessarily be the case. And the best advocate for your loved one is always going to be you. I’m not saying that doctors or nursing home staff don’t look out for your people, but you’re going to be the number one advocate for your loved one, and you need to see whether or not they qualify for personal care home or they need to go to assisted living or a nursing home.
So if you have questions about personal care homes, how they’re different than assisted living facilities and how they’re different than nursing homes, I would highly recommend you go check out the Department of Community Health, their website. It lays the groundwork and the regulations out for you to read. A lot of this, it’s counterintuitive that it would be like this but it’s in plain language and it’s easy to understand, so go to the Georgia Department of Community Health’s website, click on the regulations of personal care homes. You can actually go in depth and read it. You can spend maybe an afternoon reading through the regulations and how it would affect you in everything from admissions to transfers to who qualifies to be in there, how it’s different from the other forms of care for our elder population. So I encourage you to check that out.
This would actually conclude this episode of the Nursing Home Abuse Podcast. New episodes every other week, two times a month on Monday mornings for you to check out. There are two ways you can consume every episode. The first way is to watch us online on our YouTube channel or on our website, which is NursingHomeAbusePodcast.com or – did I say the YouTube already? – yeah, the YouTube or the website, NursingHomeAbusePodcast.com – I’m losing it – or wherever you get your podcast from. I hope that you’ve found this episode informative even though I read pretty much the whole time, read regulations to you the whole time, but you know, I feel like I cherry picked the most important parts and I hope that you are better for it listening to it. I know I am. So with that, we will see you next time.