While many have an understanding with the type of care received at a nursing home, there is much confusion about Georgia personal care homes. In fact, personal care homes provide assistance with daily living and some help with the administration of medications. Facilities cannot provide nursing or medical services, although residents may contract for that care.
Schenk: Hey out there. Welcome back to the podcast. My name is Rob. I’m going to be your host for this episode. We’re going to have a pretty quick, short and dirty episode about personal care homes in the state of Georgia.
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So today, I wanted to have a quick episode dedicated to talking about the role of personal care homes as it relates to care of Georgia residents. There is a misconception about what nursing homes do, what personal care homes do and what assisted living facilities do. They in fact all do different things. They are all regulated differently. There are different sets of guidelines and rules for each one of them. So in my experience, my clients who have been injured in personal care homes oftentimes did not know what services their loved one was truly getting in a personal care home. In their mind, they thought that they were getting the services that would be provided traditionally at a nursing home. In fact, as we’ll talk about, many of the services provided in nursing homes are illegal or inappropriate to be provided in a personal care home.
So let’s go to the Georgia rules and regulations for our understanding of what a personal care home is and how it fits in that hierarchy of care, of facility, of institutional care in the state of Georgia. If you’re outside of the state of Georgia, this might not apply to you. Every state is different, although nursing homes are federally regulated and pretty uniform across the country. Assisted living facilities and what we would call personal care homes are regulated on a state-by-state basis and your state might not even have a personal care home designation. It might not even have a facility that functions in the same way. So I would direct you guys who are outside of Georgia to your own particular state regulations.
So dealing with Georgia, what is a personal care home? A personal care home means any dwelling, whether operated for profit or not, which undertakes through its ownership and management to provide or arrange for the provision of housing, food service and one or more personal services for two or more adults who are not related to the owner or administrator by blood or marriage.
So a couple of key components to that definition – first, your own house, if your mother or grandmother lives there, doesn’t mean that you live in a personal care home. This regulation is attempting to make sure that we are not falling under the rubric of personal care home simply for the fact that we have our extended family living with us under one roof. In fact, the personal care home is a facility that houses people that are not related to one another and require a certain amount of services. So again, the services provided at a personal care home are personal services – housing, food service and one or more personal services are the services provided at a personal care home.
But what is a personal service? Again, we go to the regulations. Personal services include but are not limited to individual assistance with or supervision of self-administered medication, assistance with ambulation with transfer and essential activities of daily living such as bathing, grooming, dressing and toileting.
So two key components of that, of the personal services. The first is the personal services would include what we would typically refer to as assistance with activities of daily living – getting up and getting dressed, walking around, moving around, ambulating, personal hygiene, doing your laundry, cooking your food and eating. Personal care homes are allowed to employ persons that will assist the residents in those activities of daily living, helping Grandmother get into a wheelchair, helping Mother stand up, providing hygiene care, helping them onto the toilet or off the toilet, helping them with these personal essential activities of daily living.
The other component of personal services, of personal care services for which the personal care home is allowed to provide is assistance and supervision of self-administered medication. So what does that mean? Self-administered medications mean those prescription or over the counter drugs that the resident personally chooses to ingest or apply where the resident has been assessed and determined to have the cognitive skills necessary to articulate the needs for the medications and generally knows the times the medications are to be taken and physical characteristics of medications to be taken.
So self-administered medications does not include IV medications. It does not include medications that are required to be injected with a syringe. It simply means that someone is allowed at that personal care home to help that resident with their prescription medications that can be taken orally or topically with limited assistance.
The resident, according to this regulation, needs to be able to articulate what the medicine is for or that in general they need the medication. So essentially, if there’s such mental incapacity that the resident cannot take a pill and put it into their own mouth, then theoretically, they are not – this is not self-administered medication and that’s not a service that a personal care home should provide. So that is the first, in my opinion, critical difference between a personal care home or assisted living facility and a nursing home. The staff are only supposed to provide limited assistance with the administration of medications. In other words, “Here you go, Ms. Johnson. Here is your pill,” as opposed to, “I’m going to put this pill in the individual’s mouth because they don’t know what’s going on and they physically can’t do it themselves.” That would be contrary to the regulations for personal care homes.
Now just because you can’t physically do it doesn’t mean it’s not self-administered. If you have the wherewithal to say, “That’s my medication but my arm doesn’t work. Just put it in my mouth,” that’s okay. That’s limited assistance. But not having the wherewithal to identify the medication and not being able to physically do it, then you’re running afoul of these regulations.
So personal services are the self-administration of medications as well as assistance with activities of daily living. Those are the only services that are allowed to be provided at a personal care home. There cannot be nursing services, so if you need intravenous drips, if you need wound care, if you need a medical diagnosis of any sort, that cannot be done by the personal care home itself. The resident would have to hire that individual as they need. A staff member, even if it’s a nurse working at that personal care home, cannot provide, under the law, theoretically, nursing services to any resident.
So that is a major misconception that most people have about personal care homes. Personal care home essentially is employing people only to help with activities of daily living, not any type of higher learned individuals with nursing or medical backgrounds. In fact, a personal care home is under the law allowed to have no one with a medical background working there. You do not need to have any medical background to work there. Now there are qualifications and there are trainings that are required, but in terms of training and experience in nursing care, not required. Not required.
So who is qualified to be admitted to a personal care home? A personal care home is only allowed to admit and retain ambulatory residents who are capable of self-preservation with minimal assistance, i.e. staff may assist the resident from transferring from a sitting or reclining position and provide verbal directions to residents who are able to self-propel to the nearest exit. In other words, the personal care home can only admit persons who can make it out on their own or with limited assistance in an emergency situation, an individual who can walk and can be told where the exit is, an individual who is in a wheelchair and can wheel themselves out if you just tell them where the exit is. If the individual does not have the wherewithal to find an exit or to understand that there is an emergency or needs to be wheeled out on their own, then those potentially run afoul of this regulation and should not be in that personal care home.
The personal care home should almost function as your own house. The people in your house should be able to get out of that house if it’s on fire. Or if they can’t, only minimal directional assistance should be provided to that resident. And again, we often see personal care homes cited for this where they’re allowing residents with such severe dementia that they are confined to a wheelchair and are unable to wheel themselves out of the facility. And I think that our community in Georgia needs to educated on this because unfortunately it will take a catastrophic tragedy for these laws to change, I think, unless we educate ourselves about what personal care homes should do and how they are admitting these persons in that shouldn’t be in there.
A personal care home must not admit or retain persons who require the use of physical or chemical restraints, isolation or confinement for behavioral control. So they cannot admit people who are a danger to others or who need sedatives or that need to be isolated in order to not hurt somebody. The personal care home is not that kind of a place. Those individuals may or may not need to go to a nursing home. Personal care home cannot have somebody that needs to be sedated or needs to be isolated because of behavioral issues.
And then no personal care home is permitted to admit residents who either require continuous medical services or continuous nursing care and treatment. So even though a resident is allowed to have medical providers come into the facility to provide nursing or medical services, if that resident needs around the clock medical services, even if they hire that out, they’re not allowed in the personal care home. The personal care home is on the lowest end of the spectrum in terms of nursing services and medical services. It really is not a place – it’s not a hospital, it’s not designed to be a nursing home. So if you need continuous nursing care, even if you’re willing to hire it yourself, cannot be admitted to a personal care home.
Finally no personal care home is permitted to admit or retain a resident who needs care beyond which the home is permitted to provide. So if a resident otherwise qualifies to be in that personal care home but needs so much assistance with daily, with activities of daily. The personal care home doesn’t have enough staff to help. They cannot admit that resident. The personal care home cannot use as an excuse, “Well we don’t have enough personnel to keep your loved one safe with personal services.” That is not an excuse. If they do not have enough personnel to keep your loved one safe, they should not have admitted your loved one in the first place. This regulation makes it such that they cannot use that as an excuse.
So what are the differences, the real hardcore differences between an assisted living facility and a personal care home? The primary, in my opinion, the primary difference in the assisted living facility and the personal care home is the administration of medications. So the assisted living facility is allowed to have a slightly more cognitively impaired resident who needs more help with medications, and the amount of medications and the level of medications that can be provided by the staff is higher in an assisted living facility.
There are some other differences between assisted living facilities and personal care homes, but I consider that one of the primary differences. So in terms of the hierarchy of services provided, the skilled nursing facility or the nursing home is the highest followed then by the assisted living facility and then the personal care home. So assisted living facilities are a little higher step up from a personal care home, so much so in fact that regulations say that personal care homes are not allowed to market themselves as providing assisted living facility services or assisted living service. That is a term of art that represents that there is a service difference between assisted living facilities and personal care homes. Personal care homes that hold themselves out to provide assisted living services are in violation of the law because the public should understand that those are different brands and they should know they’re going to get different services in personal care homes versus assisted living facilities.
So those are some key components to personal care homes, and maybe in another episode we’ll get to the level of training that the staff in a personal care home should go to versus an assisted living facility and what you can expect in terms of ongoing training and experience required to run a personal care home. But I think that this is the basics that you should know about personal care homes in Georgia.
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