I hope you are all having a good winter so far.
The Board just had a Tele- conference meeting this past week. We were planning to meet face to face, but the weather didn’t cooperate!
The wind, snow, and deep freeze temps kept us home. We plan to try again for a face to face
in March. One of the discussions at the meeting was to have the Region Reps and the
Member at Large do an article in the news letter on an alternating basis. I will begin the
year with the January newsletter. The Member at Larges’ main purpose is to be a consultant
and informant on medical issues, as well as a liaison with the Board of Nursing.
Lethia, our new Executive Director, has received a couple of questions regarding the
Nurse’s role in assisted living. I will attempt to answer these.
“The Scope and Standards of Assisted Living Nursing Practice” can be found on-line
at www.alnursing.org/alnursecert Scope and Standards*. This was written to describe the ethical
obligations and duties of the assisted living nurse, to guide the practice and conduct of the assisted
living nurse, and to articulate the assisted living nurse’s understanding of the profession’s commitment
to health care, nursing, and society. It is a comprehensive 13 page document. I will summarize the
responsibilities and principles listed:
Responsibilities of the RN, based on experience, knowledge and skills in care of the older adult,
include but are not limited to:
Assessment related to function and physical status of the resident on admission, in 30 days,
during acute changes in condition, and annually from the admission date. (The admission, 30 day,
and annual evaluation tool does not have to be done by a nurse, but the nurse should review these
and make an assessment of the person’s needs, do care planning, etc. in conjunction with this tool.)
Care planning: using information gathered during the assessment process, development of a
care plan, communication of the care to the resident, Proxy, and other relevant members of the health
care team; oversight of care implementation by assistive staff; recognition of deviation from plan.
Medication management: testing of individual residents to determine ability for self-administration of
medication, oversight of medication storage and administration.
Development and oversight of a health promotion and disease prevention program that includes
administration of immunizations as appropriate, development of protocols for infectious disease
management such as flu outbreaks, herpes zoster, C difficile, and tuberculosis, as relevant to the site.
Development and oversight of a philosophy of care that is focused on optimizing function of all residents
through physical activity and exercise activities.
Development and oversight of protocols for determining resident capacity, identification of a proxy, and
establishment of end of life care preferences.
Accountability for care practices (self and assistive staff) and that care will be provided with the best interest
of the resident in mind to assure the prevention of complications and the highest possible function and
quality of life of the individual.
Ongoing in-services for all staff as relevant to the needs of the residents and the community.
Principles of Assisted Living Nursing
Assisted living nursing practice requires a holistic approach in order to optimize and maintain if not
improve an older adult’s function, independence, engagement with the environment and with others,
maximize well-being and quality of life. The practice of nursing in assisted living is driven by the resident’s
preferences, supporting them in their choices. The nurse’s role incorporates a variety of activities such as
counseling, health educator, direct clinical care (e.g. wound management), medication management, and
helping older adults access the health care system.
*Refer to the article that I have referenced for specific examples and suggestions for developing and
implementing the above.
To be more specific for South Dakota, be familiar with the 44:70 regulations. Be sure your facility has
policies in place that coordinate with the 44’s and that these policies are being followed and updated, as
The DOH surveyors will want the following information regarding the resident care, when they do an
If you hold resident personal funds, they will need Surety Bond information
They will need to see your facility license and will want to know what optional services are listed.
Are you following the guidelines regarding the optional services?
(These guidelines are attached in this newsletter )
Make sure you are aware of what each optional service requires and that you are following
List of current residents and their admission dates
List of the discharged residents within the last 6 months and the reason for discharge
List of residents on therapeutic diets
Staff schedule and which staff administer medications and their title
Annual TB risk assessment and policy
Facility policy manual
You will also need to provide the following information:
Menus for the past 30 days, and the next three days
Menus-annual approval by dietitian
Extensions for therapeutic diets 3 nutritious meals daily with correct time frames
A diet manual
Qualified person in charge (Serv-safe)
Compliance with food code
SD Licensed dietitian who reviews the above (if you have the optional service of therapeutic diets)
Facility activity schedule
Information packet given to residents on admission (they will review a resident record and look to see
if all of the admission guidelines were followed, as well as on-going health maintenance)
All staff training conducted in the past 12 months (Were all the required subjects covered annually?)
Cognitive impairment orientation and annual training within 1 month of hire date if the facility is
approved to admit cognitively impaired residents
Training at orientation and annually on oxygen use if supplemental oxygen approval applies
They will also be adding the guidelines for the two new optional services (attached in this newsletter)
The new services are: Acceptance of Residents who require dining assistance and Acceptance of
residents who require total assistance with ADL’s or Two person assist.
You will need to provide personnel files for all facility staff. They will look for a Health evaluation at
the time of hire, TB testing, Assurance there are no convictions of abuse (background checks,
reference checks), job descriptions, and the age of the employee.
For all staff who hold a professional license, the surveyor will need to see copies of a current license.
For administrator, the surveyor will need to see evidence of qualifications.
For UAP’s administering medications the surveyor will need evidence of HS diploma/GED,
that they successfully passed the medication administration course, and the medication course instructor’s
current RN or RPh license. The board of Nursing approval of the course, and your medication control and
disposition policies and procedures.
Lethia also received a question regarding some guidelines for what constitutes “over level of care”.
44:70:01:05 addresses the following: An assisted living center may admit and retain any resident who is able to:
DOWNLAOD CURRENT 44'S HERE
Note: With the two new Optional services, several of these guidelines will change, however,
- Turn self in bed and raise from bed or chair independently or with assist of one staff;
- Transfer independently or with assist of one staff and do not require a mechanical life;
- Complete activities of daily living of mobility or ambulation, dressing, toileting, personal hygiene,
- and bathing, with assist of one staff but less than total assist;
- Feed self with set up, cueing, and supervision;
- Complete own ostomy or catheter care;
- Display normal expected behaviors for condition that do not place self or others at risk;
- Complete own injections if scheduled or required, or provided by nursing staff if assisted living staffing allows;
- Manage care for his or her own feeding tube, tracheotomy, or peritoneal dialysis;
- Remains free from the need for restraints, except for admission to a secured unit;
- Demonstrate no need for skilled services unless provided by contract with a Medicare certified home health agency or assisted living nursing staff for a limited time with a planned end date;
- Be free from communicable diseases that place other residents or staff at risk; and
- Maintain conditions that are stable and controlled that do not require frequent nursing care.
you will have to apply for these services (attached with this newsletter), be approved, and continue
to follow the guidelines of these options.
I hope this information has been helpful and truly apologize for it getting rather lengthy!
Have a wonderful 2015 and feel free to contact me with questions anytime,
Colette Broekemeier, RN ,
ALASD Member at Large
Autumn Winds Assisted Living
2905 Douglas Ave, Yankton, SD 57078
South Dakota Dept. of Health
NEW DEPT. OF HEALTH RULES
EFFECTIVE JANUARY 5TH, 2015
(9) A facility that admits or retains any resident who requires dining assistance shall develop a nutrition and hydration assistance program. Any staff member providing dining assistance shall be a certified nurse aide or shall have completed an approved nutrition and hydration dining assistance program. A nutrition and hydration assistance program curriculum shall be approved by the department. The curriculum shall include instruction from both a licensed speech-language pathologist and a registered dietician. The program shall consist of a minimum of 10 hours of training and clinical experience. Any dining assistant shall work under the supervision of a licensed nurse. A resident shall be assessed by nursing staff or registered nurse consultant before participating in a nutrition and hydration assistance program. Only those residents who have no complicated feeding problems may be allowed to participate. A resident that has difficulty swallowing, recurrent lung aspirations, or tube feeding may not participate. A dietician shall document any special nutritional needs and instructions on the resident’s care plan. If a facility has an approved nutrition and hydration assistance program, the facility shall have a licensed nurse to work the day shift at least 32 hours a week. A licensed nurse shall be on call at all times. The facility shall be approved for therapeutic diet. If a facility has an approved nutrition and hydration assistance program, the facility is exempt from the requirement of subsection 44:70:01:05(6)(d);
(10) A facility that admits or retains any resident who requires one or two staff for up to total assistance with completing activities of daily living (ADL) or assistance to turn or raise in bed and to transfer resident shall meet all the provisions of this subsection. Each direct care staff shall complete an approved certified nurse aide training program pursuant to chapter 44:04:18 or equivalent program approved by the department before assisting a resident. If a resident requires one or two staff for up to total assistance with completing ADLs listed in subsection 44:70:01:05(6)(c), or assistance to turn or raise in bed and to transfer the resident, the facility shall conduct and document a nursing assessment as to the resident’s need of total assistance. A facility shall complete and document an assessment on each new resident upon admission, upon a significant change in the resident’s condition, and at least semi-annually. If a resident requires one to two staff for up to total assistance with ADLs or assistance to turn or raise in bed and to be transferred, the facility shall have a licensed nurse to work the day shift at least 32 hours a week. A licensed nurse shall be on call at all times. The facility shall be approved for cognitive impairment and to administer medications. A facility licensed for this option is not eligible for a staffing exception as allowed under § 44:70:03:02.01. At least one certified nurse aide shall be on duty in each secure unit at any time a resident is present. If a mechanical lift is used, it shall be operated by at least two staff members. If a facility has been approved to provide a resident total assistance with ADLs or to turn or raise a resident in bed and to transfer a resident, the facility is exempt from the requirements of subsections 44:70:01:05(6)(a), (b), and (c). A facility that intends to offer services identified in subdivisions (2) to (8 10), inclusive, of this section shall comply with the additional requirements and request and receive approval printed on a new license from the department, prior to providing the additional services.
Download forms here for the new options:
PRACTITIONER REVIEW FORM
REQUEST FOR NEW OR RENWAL OF OPTIONAL SEVICES