Personal care homes are a type of Georgia licensed facility that provides “personal services” and related care to residents. Personal care homes providing or marketing care to those with cognitive impairments, or maintaining “memory care units,” must meet heighted safety requirements. Learn more about memory care units in Georgia personal care homes in this episode.
Schenk: Hey out there. Welcome back to the show. My name is Rob. I’m going to be your host for this episode. We’re going to be talking about memory care units, units that provide personal services to individuals that have cognitive impairments, dementia, Alzheimer’s, in personal care homes within the state of Georgia.
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So last week – not last week, last episode I should say, we talked all about personal care homes in the state of Georgia. We discussed what makes a facility a personal care home versus an assisted living facility versus a nursing home because there are significant differences between the services that are provided in a personal care home versus those that are provided in a nursing home or assisted living facility. Now if you’re interested in a more in-depth discussion on that, I encourage you to check out that episode.
In this episode, I want to unpack the definitions, the regulations, the requirements for personal care homes that purport to provide specialized care to those individuals that have Alzheimer’s, dementia or cognitive kind of impairments. Again, personal care homes, I should say, are governed, are overseen in the state of Georgia by the Department of Community Health, the rules and regulations as promulgated, as they say, by the Department of Community Health. And that’s where I’m going to be going today to get the information I’m providing to you. These are the things that are required by any personal care home serving those types of individuals.
Now we say it is a memory care unit, so in the regulations, essentially a memory care unit is going to be the specialized location within the personal care home that serves persons with probable diagnosis of Alzheimer’s disease or other dementia and either provides specialized care in locked units or holding itself out to providing specialized care to those residents.
Now what are those additional requirements? In other words, if there is no memory care unit, you just fall under the regulations of personal care homes. If you’re a personal care home that has a memory care unit, what can you expect from those regulations if you have a loved one in a memory care unit. What can you expect that personal care home to do for your loved one?
The first thing is this – that the personal care home, if there is a memory care unit, must develop, train and enforce policies and procedures for staff to deal with residents who may elope, meaning wander away from the facility, including what actions are to be taken if that does in fact happen. So obviously if you’re dealing with persons with Alzheimer’s or dementia, if they’re mobile, there is a potential for elopement. There is a potential for wandering. And so personal care homes must have a policy and procedure in place to deal with that potential likelihood.
The second requirement for memory care units in a personal care home is that there is adequate safety devices in place that actually do not impede on the free movement of those residents. So for example, locking exit doors, providing passcodes for entrance and exiting of the facility, alarms that will alert the staff that someone has eloped. So there needs to be some type of system on the exit doors or at least the doors that lead outside that would alert the staff that someone has eloped. Those would be required in some form. They’re required for memory care units.
Another requirement, and this is actually something that I encourage individuals that are thinking about placing a loved one into a personal care home, this is a requirement that the personal care home develop and provide upon request a written description of the memory care unit. So the regulation requires that the home, the personal care home must develop an accurate, written description of the special care unit that includes the following – a statement of philosophy admission, how the services of the special memory care unit are different from the services provided in the rest of the personal care home, staffing, including job titles of staff who work in the unit, staff training and continuing education requirements, admission procedures including screening criteria, assessment and service planning protocol including criteria to be used that would trigger a reassessment of the resident status before the customary quarterly review, staffing patterns maintained within the unit, including the ratio of direct care staff to resident for a 24-hour cycle, a description of the physical environment including safety and security features, a description of activities including frequency and type, how the activities meet the needs of residents with dementia, the program’s fee or fee structure for all services provided by the unit or home, discharge criteria and procedures, the procedures that will be utilized handling emergency situations and the involvement of the unit with families and family support programs.
All that should be included in the written description that is available upon the request of anyone who asks for it. And the reason why that is important for you, if you are determining whether or not you want to put your loved one in that personal care home is because you get to see what they’re about. You get to see what their philosophy is. You get to see their staff-to-resident ratios. These things are important when you’re evaluating the care that your loved one is going to receive. It’s important to see how they approach this written description. Do they even have one? If they don’t have one, that could be a possible red flag for you because it’s actually required by the regulations, so if they don’t have one, what other regulations are they not adhering to?
So ask for that written description. Even if your loved one is already in a personal care home, in a memory care unit in a personal care home, ask for that written description. Ask to see it. Then review it and see if they are actually delivering the care that they are promising to in that written description. So it’s an important requirement and I think that everybody should know about it that has a loved one in a personal care home.
So the next requirement I want to talk about is that there are certain design features that should be included in a memory care unit, again required by the state regulations. A personal care home with a memory unit must have secured outdoor spaces and walkways which are wheelchair accessible and allow residents to ambulate safely but prevent undetected egress, which means undetected leaving the facility’s grounds, high visual contrast between floors and walls and doorways and walls in resident use areas except for fire exits, doors and exit ways that may be designed to minimize contrasts in facility areas where the residents should not enter. In other words, there needs to be a way visually to make the floors and walls recognizable to people with vision issues.
Individually identify entrances to residents’ rooms to assist residents and readily identifying their own personal spaces. So in other words, in order to prevent residents with cognitive impairments and Alzheimer’s and dementia from going into the wrong rooms, the facility must make the entrance to their rooms recognizable. So a lot of times, you’ll see people’s pictures, like it’s not just Unit or Room 172, it’ll be a picture of the resident and maybe some things that are personal to the resident like maybe a picture of a baseball glove, something like that that is visually recognizable to the resident.
A communication system which permits the staff in the unit to communicate with one another along with staff outside the unit and with emergency services personnel as needed. So there needs to be some type of walkie-talkie system, call system, some type of device that the staff can have on their person as they walk the grounds and can communicate with one another if something happens. That’s again – this is from the regulations. If you’re visiting your loved one and you don’t see them, the staff, able to communicate with one another at a moment’s notice other than just yelling down the hallway, then that can be a potential problem because again, the memory care unit has a heightened duty above and beyond the rest of the personal care home. The memory care unit needs to be able to act on a moment’s notice if there’s an emergency because the residents may or may not be able to react in the same way to that emergency as other residents of the personal care home. So being able for the staff to communicate with one another quickly, it’s imperative in memory care unit.
Another requirement that is different from a regular personal care home is that there are additional staffing and orientation requirements for the staff. The first one is the administration of medication. So medications for residents living in the memory care unit must be provided to the residents by either or both of the following – a licensed registered nurse or a licensed practical nurse who is working under the supervision of a licensed physician or registered nurse or a proxy caregiver employed by the home in compliance with the regulations.
So you’ve got two categories – one, nurse or LPN who is under the supervision of a physician or nurse, or proxy caregiver. So it’s important that you understand that there may not be any nurses at that personal care home, memory care unit or not. And if there is not, it’s important that you understand whether or not the proxy caregiver, that’s what they call that, if the proxy caregiver has received the appropriate training for dealing with individuals with cognitive impairments. So it’s really important. Medications can only be handed out at a memory care unit by a nurse, LPN or an adequately trained proxy caregiver.
Also with regard to staff training, staff who prior to caring for residents independently have successfully completed an orientation program that includes at least the following components – one, the home’s philosophy related to the care of residents with dementia. The home’s policies and procedures relating to the care and the staff’s particular responsibilities including wandering and egress control and an introduction to common behavior problems characteristic of residents residing in units and appropriate behavioral management techniques. In other words, the staff at a memory care unit has heightened requirements that are directly related to providing personal services to those with Alzheimer’s and dementia and also education on the symptoms and signs of dementia, being able to understand how to interact with somebody who has these cognitive issues.
Also there is a heightened duty with regard to assessment protocols in a memory care unit. As we talked about many times on this podcast, nursing homes are required to do a comprehensive assessment on every resident. That is the – it’s not the exact, but it’s the same concept, general concept in a personal care home. In a personal care home in a memory care unit, there must be an assessment which leads to an individualized service plan. So a post admission assessment must be used to develop a resident’s individual service plan within 14 days of admission. The service plan must develop, be developed by a team with at least one member of the direct care staff participating and input from each shift of direct care staff that provides care to the resident. All team members participating must sign the service plan, and the service plan must be shared with the direct care staff providing care to the resident and serve as a guide for delivering services to the resident.
Again, there is an assessment and we’ll talk about what goes into the assessment here in a second, but the assessment needs the service plan, and that service plan must be developed by at least one member of the direct care staff per shift. And the reason why that’s the case is because you want to be able to understand the resident’s behavior throughout the entire day. For example, the first shift staff that works during the day might not see any behavioral issues. However, the second shift staff might notice that the individual suffers from sun-downers or their behavior becomes more aggressive as the lights go out. So that’s just one example why it’s important why you have members of each shift take part in the service and development of this service plan because again, the individual behavior and medication needs and personal service needs may change depending on what shift we’re in.
Then the service plan itself has certain requirements as well, and the service plan is the document the staff are going to look at to understand what medications are needed, what services are needed and the level of assistance that the resident needs for those services.
Now the service plan is required to include a description of the resident’s care and social needs and the services to be provided, including frequency to address care and social needs, resident’s expressed preferences regarding care activities and interests, specific behaviors to be addressed with interventions to be used, names of staff primarily responsible for implementing the service plan, evidence of family involvement in the development of the plan when appropriate and evidence of the service plan being updated at least quarterly or more frequently if the needs of the resident changes substantially.
So those are all the requirements of the service plan, and as I mentioned, those are important because no two people are the same and no two residents should be treated the same because they all have different levels of need, levels of treatment that are required, behavioral issues, they’re all different. So having a service plan that addresses those is crucial.
And so finally I want to talk about the assessment itself. The assessment in a memory care unit is going to be done hopefully, again, by a team. And the assessment will look at what are the needs of that particular resident as it relates to personal services, activities of daily living. So what is the level of self-care for the particular activities of daily living? In other words, how much can the resident do on their own?
Then the assessment will look at how much help does the resident need for a particular activity of daily living? So is the individual in need of one person to provide support, one person to provide a lot of help, two people to provide help? Does the individual need a lift to get out of bed? These types of things. So how much self-care is needed and how much help, if there is help that is required? Those are critical to the assessment. Assessing behavioral issues, assessing the risk of fall, assessing the risk of elopement, these are all things that should be taken into account and I think even higher level of assessment in memory care units.
So I hope this has been a little bit informative about the differences between regular personal care homes and then personal care homes that have memory care units because, again, they are different. The level of care in each are different because the needs of the resident are theoretically different.
So if you did find this episode informative, let us know. Please like and subscribe wherever you get your podcasts from. If you are so inclined, please check us out on YouTube, Nursing Home Abuse Podcast on YouTube. Leave a comment there, hit the notification bell. New episodes come out every other week, that is twice a month on Mondays. And with that, folks, we’ll see you next time.