HB 92 - Adult residential homes; change personal care home references
Georgia House of Representatives - 1995/1996 Sessions
HB 92 - Adult residential homes; change personal care home references
1. Childers 13th
House Comm: HumR / Senate Comm: /
House Vote: Yeas Nays Senate Vote: Yeas Nays
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House Action Senate
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1/9/95 Read 1st Time
1/10/95 Read 2nd Time
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Rules Suspended to Introduce
Code Sections amended: 10-1-393, 25-2-13, 37-4-21, 38-4-2, 48-13-9, 10-1-393,
25-2-13, 31-6-2, 31-7-1, 31-7-12, 31-7-12.1, 31-7-12.2, 31-7-256, 31-7-257,
31-7-259, 31-8-51, 31-8-81, 37-4-21, 38-4-2, 48-13-9,49-6-60, 49-6-63
HB 92 LC 11 8473
A BILL TO BE ENTITLED
AN ACT
1- 1 To amend Title 31 of the Official Code of Georgia Annotated,
1- 2 relating to health, so as to delete certain references and
1- 3 provisions relating to personal care homes and provide
1- 4 instead for the regulation of adult residential homes and
1- 5 assisted living facilities and services rendered therein; to
1- 6 provide for definitions; to establish admission and
1- 7 retention criteria for such homes and facilities and for the
1- 8 provision of services thereby; to provide for licensing,
1- 9 registration, inspections, and reviews of those homes and
1-10 facilities; to provide for investigations of complaints
1-11 regarding those homes and facilities; to provide for rules
1-12 and regulations; to reclassify certain institutions; to
1-13 provide for staffing requirements and agreements; to provide
1-14 for assessments and determinations of appropriateness of
1-15 admissions to and retention in such homes and facilities; to
1-16 change definitions relating to state health planning and the
1-17 regulation of hospitals and related institutions; to change
1-18 references and provisions relating to personal care homes so
1-19 that those references and provisions apply to adult
1-20 residential homes, assisted living facilities, or both; to
1-21 delete certain provisions regarding temporary licenses for
1-22 personal care homes pending satisfactory criminal records
1-23 checks for personnel thereof; to amend Code Section 10-1-393
1-24 of the Official Code of Georgia Annotated, relating to
1-25 unfair or deceptive practices in consumer transactions, Code
1-26 Section 25-2-13 of the Official Code of Georgia Annotated,
1-27 relating to buildings presenting certain hazards, Code
1-28 Section 37-4-21 of the Official Code of Georgia Annotated,
1-29 relating to admission of mentally retarded persons for
1-30 respite care, Code Section 38-4-2 of the Official Code of
1-31 Georgia Annotated, relating to powers of the Department of
1-32 Veterans Service Board, Code Section 48-13-9 of the Official
1-33 Code of Georgia Annotated, as enacted by an Act approved
1-34 April 15, 1993 (Ga. L. 1993, p. 1292), relating to local
1-35 government regulatory fees, and Article 5 of Chapter 6 of
1-36 Title 49 of the Official Code of Georgia Annotated, relating
1-37 to community care and services for the elderly, so as to
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LC 11 8473
2- 1 change references and provisions relating to personal care
2- 2 homes so that those references and provisions apply to adult
2- 3 residential homes and assisted living facilities and
2- 4 services; to provide for all related matters; to provide for
2- 5 an effective date; to repeal conflicting laws; and for other
2- 6 purposes.
2- 7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
2- 8 Code Section 10-1-393 of the Official Code of Georgia
2- 9 Annotated, relating to unfair or deceptive practices in
2-10 consumer transactions, is amended by striking paragraph (26)
2-11 of subsection (b) thereof and inserting in its place the
2-12 following:
2-13 "(26) With respect to any individual or facility
2-14 providing personal care services in an adult residential
2-15 home, as defined in subsection (a) of Code Section
2-16 31-7-12, or in an assisted living facility, as defined
2-17 in subsection (a) of Code Section 31-7-12.1:
2-18 (A) Any person or entity not duly licensed or
2-19 registered as a personal care an adult residential
2-20 home or assisted living facility formally or
2-21 informally offering, advertising to, or soliciting the
2-22 public for residents or referrals; or
2-23 (B) Any personal care adult residential home, as
2-24 defined in subsection (a) of Code Section 31-7-12, or
2-25 assisted living facility offering, advertising, or
2-26 soliciting the public to provide services:
2-27 (i) Which are outside the scope of personal care
2-28 services specifically permitted by Code Section
2-29 31-7-12 for adult residential homes and Code Section
2-30 31-7-12.1 for assisted living facilities; and
2-31 (ii) For which it has not been specifically
2-32 authorized.
2-33 Nothing in this subparagraph prohibits advertising by
2-34 a personal care an adult residential home or assisted
2-35 living facility for services authorized by the
2-36 Department of Human Resources under a waiver or
2-37 variance pursuant to subsection (b) of Code Section
2-38 31-2-4;. (C) For purposes of this paragraph, 'personal care'
3- 2 means protective care and watchful oversight of a
3- 3 resident who needs a watchful environment but who does
3- 4 not have an illness, injury, or disability which
3- 5 requires chronic or convalescent care including medical
3- 6 and nursing services.
3- 7 The provisions of this paragraph shall be enforced
3- 8 following consultation with the Department of Human
3- 9 Resources which shall retain primary responsibility for
3-10 issues relating to licensure of any individual or facility
3-11 providing personal care services adult residential home or
3-12 assisted living facility;".
SECTION 2.
3-13 Code Section 25-2-13 of the Official Code of Georgia
3-14 Annotated, relating to buildings presenting certain hazards,
3-15 is amended by striking subparagraph (b)(1)(J) thereof and
3-16 inserting in its place the following:
3-17 "(J) Personal care Adult residential homes required to
3-18 be licensed as such by the Department of Human
3-19 Resources and having at least seven beds for nonfamily
3-20 adults and assisted living facilities, and the
3-21 Commissioner shall, pursuant to Code Section 25-2-4,
3-22 by rule adopt state minimum fire safety standards for
3-23 those homes and facilities, and any structure that was
3-24 constructed as or converted to a personal care home on
3-25 or after April 15, 1986 an adult residential home or
3-26 assisted living facility on or after the date this
3-27 subparagraph becomes effective, shall be deemed to be
3-28 a proposed building pursuant to subsection (d) of Code
3-29 Section 25-2-14 and that structure may be required to
3-30 be furnished with a sprinkler system meeting the
3-31 standards established by the Commissioner if he the
3-32 Commissioner deems this necessary for proper fire
3-33 safety."
SECTION 3.
3-34 Title 31 of the Official Code of Georgia Annotated, relating
3-35 to health, is amended by adding after paragraph (2) of Code
3-36 Section 31-6-2, relating to definitions regarding state
3-37 health planning, a new paragraph (2.1) to read as follows:
3-38 "(2.1) 'Assisted living facility' means any dwelling,
3-39 whether operated for profit or not, which undertakes
3-40 through its ownership or management to provide or
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LC 11 8473
4- 1 arrange for the provision, in a homelike,
4- 2 noninstitutional setting on a 24 hour per day basis, of
4- 3 housing, food service, protection, oversight, and
4- 4 assisted living services, as defined in Code Section
4- 5 31-7-12.1, for two or more adults who are not related to
4- 6 the owner or administrator of the facility by blood or
4- 7 marriage. Assisted living facilities shall be limited
4- 8 to 25 beds. Preference shall be given in awarding
4- 9 certificates of need to assisted living facilities to
4-10 those applicants attached to or located on the same
4-11 campus with a skilled nursing facility, provided that
4-12 the applicant demonstrates that such collocation will
4-13 result in economies of scale through the use of shared
4-14 services."
SECTION 4.
4-15 Said title is further amended by striking paragraph (5) of
4-16 that Code Section 31-6-2, relating to definitions regarding
4-17 state health planning, and inserting in its place a new
4-18 paragraph (5) to read as follows:
4-19 "(5) 'Clinical health services' means diagnostic,
4-20 treatment, or rehabilitative services provided in a
4-21 health care facility, or parts of the physical plant
4-22 where such services are located in a health care
4-23 facility, and includes, but is not limited to, the
4-24 following: radiology and diagnostic imaging, such as
4-25 magnetic resonance imaging and positron emission
4-26 tomography; radiation therapy; biliary lithotripsy;
4-27 surgery; intensive care; coronary care; pediatrics;
4-28 gynecology; obstetrics; general medical care;
4-29 medical/surgical care; inpatient nursing care, whether
4-30 intermediate, skilled, or extended care; cardiac
4-31 catheterization; open-heart surgery; inpatient
4-32 rehabilitation; and alcohol, drug abuse, and mental
4-33 health services; and assisted living services, as
4-34 defined in Code Section 31-7-12.1."
SECTION 5.
4-35 Said title is further amended by striking paragraph (8) of
4-36 that Code Section 31-6-2, relating to definitions regarding
4-37 state health planning, and inserting in its place a new
4-38 paragraph (8) to read as follows:
4-39 "(8) 'Health care facility' means hospitals; other
4-40 special care units, including but not limited to
4-41 podiatric facilities; skilled nursing facilities;
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LC 11 8473
5- 1 intermediate care facilities; personal care homes;
5- 2 assisted living facilities; ambulatory surgical or
5- 3 obstetrical facilities; health maintenance
5- 4 organizations; home health agencies; diagnostic,
5- 5 treatment, or rehabilitation centers, but only to the
5- 6 extent that subparagraph (G) or (H), or both
5- 7 subparagraphs (G) and (H), of paragraph (14) of this
5- 8 Code section are applicable thereto; and facilities
5- 9 which are devoted to the provision of treatment and
5-10 rehabilitative care for periods continuing for 24 hours
5-11 or longer for persons who have traumatic brain injury,
5-12 as defined in Code Section 37-3-1."
SECTION 6.
5-13 Said title is further amended by striking paragraph (18) of
5-14 that Code Section 31-6-2, which reads as follows:
5-15 "(18) 'Personal care home' means a residential facility
5-16 having at least 25 beds and providing, for compensation,
5-17 protective care and oversight of ambulatory, nonrelated
5-18 persons who need a monitored environment but who do not
5-19 have injuries or disabilities which require chronic or
5-20 convalescent care, including medical, nursing, or
5-21 intermediate care. Personal care homes include those
5-22 facilities which monitor daily residents' functioning
5-23 and location, have the capability for crisis
5-24 intervention, and provide supervision in areas of
5-25 nutrition, medication, and provision of transient
5-26 medical care. Such term does not include:
5-27 (A) Old age residences which are devoted to
5-28 independent living units with kitchen facilities in
5-29 which residents have the option of preparing and
5-30 serving some or all of their own meals; or
5-31 (B) Boarding facilities which do not provide personal
5-32 care.",
5-33 and inserting in its place the following:
5-34 "(18) Reserved."
SECTION 7.
5-35 Said title is further amended by striking subparagraph (B)
5-36 of paragraph (1) of Code Section 31-7-1, relating to
5-37 definitions regarding the regulation of hospitals and
5-38 related institutions, and inserting in its place a new
5-39 subparagraph (B) to read as follows:
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LC 11 8473
6- 1 "(B) Any building, facility, or place in which are
6- 2 provided two or more beds and other facilities and
6- 3 services that are used for persons received for
6- 4 examination, diagnosis, treatment, surgery, maternity
6- 5 care, nursing care, or personal care for periods
6- 6 continuing for 24 hours or longer and which is
6- 7 classified by the department, as provided for in this
6- 8 chapter, as either a hospital, nursing home, or
6- 9 personal care home adult residential home or assisted
6-10 living facility, as defined in this article;".
SECTION 8.
6-11 Said title is further amended by striking Code Section
6-12 31-7-12, which reads as follows:
6-13 "31-7-12. (Index)
6-14 (a) As used in this Code section, the term:
6-15 (1) 'Personal care home' means any dwelling, whether
6-16 operated for profit or not, which undertakes through its
6-17 ownership or management to provide or arrange for the
6-18 provision of housing, food service, and one or more
6-19 personal services for two or more adults who are not
6-20 related to the owner or administrator by blood or
6-21 marriage.
6-22 (2) 'Personal services' includes, but is not limited to,
6-23 individual assistance with or supervision of
6-24 self-administered medication and essential activities of
6-25 daily living such as eating, bathing, grooming,
6-26 dressing, and toileting.
6-27 (b) All personal care homes shall be licensed as provided
6-28 for in Code Section 31-7-3, except that, in lieu of
6-29 licensure, the department may require persons who operate
6-30 personal care homes with two or three beds for nonfamily
6-31 adults to comply with registration requirements delineated
6-32 by the department. Such registration requirements within
6-33 this category shall authorize the department to promulgate
6-34 pursuant to Chapter 13 of Title 50, the 'Georgia
6-35 Administrative Procedure Act,' reasonable standards to
6-36 protect the health, safety, and welfare of the occupants
6-37 of such personal care homes.
6-38 (c) Upon the designation by the department and with the
6-39 consent of county boards of health, such boards may act as
6-40 agents to the department in performing inspections and
6-41 other authorized functions regarding personal care homes
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LC 11 8473
7- 1 licensed under this chapter. With approval of the
7- 2 department, county boards of health may establish
7- 3 inspection fees to defray part of the costs of inspections
7- 4 performed for the department.
7- 5 (d) The state ombudsman or community ombudsman, on that
7- 6 ombudsman's initiative or in response to complaints made
7- 7 by or on behalf of residents of a registered or licensed
7- 8 personal care home, may conduct investigations in matters
7- 9 within the ombudsman's powers and duties.
7-10 (e) The department shall promulgate procedures to govern
7-11 the waiver, variance, and exemption process related to
7-12 personal care homes pursuant to Chapter 2 of this title.
7-13 Such procedures shall include published, measurable
7-14 criteria for the decision process, shall take into account
7-15 the need for protection of public and individual health,
7-16 care, and safety, and shall afford an opportunity for
7-17 public input into the process."
7-18 and inserting in its place a new Code Section 31-7-12 to
7-19 read as follows:
7-20 "31-7-12. (Index)
7-21 (a) As used in this Code section, the term:
7-22 (1) 'Activities of daily living' means bathing, shaving,
7-23 brushing teeth, combing hair, dressing, eating,
7-24 laundering, cleaning room, managing money, writing
7-25 letters, shopping, using public transportation, making
7-26 telephone calls, grooming, obtaining appointments,
7-27 engaging in leisure and recreational activities, or
7-28 other similar activities.
7-29 (2) 'Adult residential home' means any dwelling, whether
7-30 operated for profit or not, which undertakes through its
7-31 ownership or management to provide or arrange for the
7-32 provision, in a homelike, noninstitutional setting on a
7-33 24 hour per day basis, of housing, food service,
7-34 protection, oversight, minimal assistance with
7-35 activities of daily living, and supervision of the
7-36 self-administration of medications for two or more
7-37 adults who are not related to the owner or administrator
7-38 of the home by blood or marriage. Adult residential
7-39 homes that were not licensed by or registered with the
7-40 department as personal care homes immediately prior to
7-41 the date this Code section becomes effective in 1994
7-42 shall be limited to no more than 25 beds.
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8- 1 (3) 'Ambulatory resident' means a resident who has the
8- 2 ability to move from place to place by walking, either
8- 3 unaided or aided by prosthesis, brace, cane, crutches,
8- 4 walker, or hand rails or by propelling a wheelchair; who
8- 5 can respond to an emergency condition, whether caused by
8- 6 fire or otherwise, and escape with minimal human
8- 7 assistance such as guidance to an exit, using the normal
8- 8 means of egress.
8- 9 (4) 'Chemical restraint' means a psychopharmacologic
8-10 drug that is used for discipline or convenience and is
8-11 not required to treat medical symptoms.
8-12 (5) 'Physical restraint' means any manual or physical
8-13 device, material, or equipment attached or adjacent to
8-14 the resident's body that the individual cannot remove
8-15 easily which restricts freedom or normal access to one's
8-16 body. Physical restraints include, but are not limited
8-17 to, leg restraints, arm restraints, hand mitts, soft
8-18 ties or vests, and wheelchair safety bars. Also
8-19 included as restraints are facility practices which
8-20 function as a restraint, such as tucking in a sheet so
8-21 tightly that a resident in bed cannot move, bedrails, or
8-22 chairs that prevent rising or placing a wheelchair-bound
8-23 resident so close to a wall that the wall prevents the
8-24 resident from rising.
8-25 (6) 'Resident' means a person who resides in an adult
8-26 residential home.
8-27 (b) No adult residential home shall admit or retain a
8-28 resident who needs care beyond which the facility is
8-29 permitted to provide. Criteria for admission to an adult
8-30 residential home are as follows:
8-31 (1) Persons admitted to an adult residential home must
8-32 be at least 18 years of age;
8-33 (2) The adult residential home shall admit or retain
8-34 only ambulatory residents and residents capable of
8-35 self-administration of medications;
8-36 (3) The adult residential home shall not admit or retain
8-37 persons who require the use of physical or chemical
8-38 restraints, isolation, or confinement for behavioral
8-39 control;
8-40 (4) Persons admitted to an adult residential home may
8-41 not be confined to bed;
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9- 1 (5) Persons admitted to an adult residential home must
9- 2 be able to participate in social activities;
9- 3 (6) Applicants requiring daily medical or nursing
9- 4 services shall not be admitted or retained at the
9- 5 facility;
9- 6 (7) Medical, nursing, or health services required for
9- 7 short-term illness shall not be provided as services of
9- 8 the adult residential home. When such services are
9- 9 required, they shall be purchased by the resident or the
9-10 resident's representative or legal surrogate, if any,
9-11 from appropriately licensed home health agencies or
9-12 nursing homes. The adult residential home may assist in
9-13 arrangement for such services but not in the provision
9-14 of those services. The adult residential home shall not
9-15 solicit or receive any remuneration from providers in
9-16 return for the referral of its residents to such
9-17 providers.
9-18 (c) All services provided to residents of adult
9-19 residential homes must be:
9-20 (1) Provided in accordance with a written plan of care
9-21 that describes the needs of the residents and how such
9-22 needs will be met; and
9-23 (2) Based on the same uniform minimum data set used to
9-24 assess nursing home residents.
9-25 (d) All adult residential homes shall be licensed by the
9-26 department as provided for in Code Section 31-7-3, except
9-27 that, in lieu of licensure, the department may require
9-28 persons who operate adult residential homes with two or
9-29 three beds for nonfamily adults to comply with
9-30 registration requirements delineated by the department.
9-31 Such registration requirements within this category shall
9-32 authorize the department to promulgate pursuant to Chapter
9-33 13 of Title 50, the 'Georgia Administrative Procedure
9-34 Act,' reasonable standards to protect the health, safety,
9-35 and welfare of the occupants of such adult residential
9-36 homes.
9-37 (e) Upon the designation by the department and with the
9-38 consent of county boards of health, such boards may act as
9-39 agents to the department in performing inspections and
9-40 other authorized functions regarding adult residential
9-41 homes licensed under this chapter. With approval of the
9-42 department, county boards of health may establish
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10- 1 inspection fees to defray part of the costs of inspection
10- 2 performed for the department.
10- 3 (f) The department's Office of Regulatory Services,
10- 4 Long-term Care Section, or its successor, shall
10- 5 investigate complaints made by or on behalf of residents
10- 6 of adult residential homes to ensure that each adult
10- 7 residential home satisfies all applicable statutes, rules,
10- 8 and regulations and shall each year perform on-site
10- 9 inspections of 5 percent of all licensed adult residential
10-10 homes within two months of the inspections performed by
10-11 the county boards of health in accordance with subsection
10-12 (e) of this Code section, such homes being randomly chosen
10-13 by the department for inspection. In conducting such
10-14 surveys, the department's Office of Regulatory Services
10-15 shall use the same survey protocols that the county boards
10-16 of health use in performing inspections in accordance with
10-17 subsection (e) of this Code section. If the county board
10-18 of health has determined that the adult residential home
10-19 is in compliance with all applicable statutes, rules, and
10-20 regulations, but the department's Office of Regulatory
10-21 Services determines that the adult residential home is not
10-22 in compliance, the determination of the department's
10-23 Office of Regulatory Services shall be binding and
10-24 supersede that of the county board of health.
10-25 (g) The department's Office of Aging Section, or its
10-26 successor, in conjunction with the community care unit
10-27 established pursuant to Chapter 6 of Title 49, shall
10-28 perform on-site reviews of all adult residential homes at
10-29 least annually to determine if residents are appropriately
10-30 placed in the adult residential homes. The department
10-31 shall utilize the procedure set out in Code Section
10-32 31-7-12.2 in determining if placement is appropriate.
10-33 (h) The state ombudsman or community ombudsman, on that
10-34 ombudsman's initiative or in response to complaints made
10-35 by or on behalf of residents of a registered or licensed
10-36 adult residential home, may conduct investigations in
10-37 matters within the ombudsman's powers and duties.
10-38 (i) The department shall promulgate rules and regulations
10-39 to govern adult residential homes pursuant to Chapter 2 of
10-40 this title. Pending the promulgation of such rules and
10-41 regulations, adult residential homes shall be subject to
10-42 the department's rules and regulations governing personal
10-43 care homes, except insofar as those rules and regulations
10-44 conflict with the provisions of this Code section.
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11- 1 (j) All institutions licensed by or registered with the
11- 2 department as 'personal care homes' as of the date
11- 3 immediately preceding the date this Code section becomes
11- 4 effective shall be reclassified and be deemed to be
11- 5 licensed or registered as adult residential homes and,
11- 6 after that date, shall be subject to all statutes, rules,
11- 7 and regulations governing adult residential homes."
SECTION 9.
11- 8 Said title is further amended by adding after Code Section
11- 9 31-7-12 new Code Sections 31-7-12.1 and 31-7-12.2 to read as
11-10 follows:
11-11 "31-7-12.1. (Index)
11-12 (a) As used in this Code section, the term:
11-13 (1) 'Activities of daily living' means bathing, shaving,
11-14 brushing teeth, combing hair, dressing, eating,
11-15 laundering, cleaning room, managing money, writing
11-16 letters, shopping, using public transportation, making
11-17 telephone calls, grooming, obtaining appointments,
11-18 engaging in leisure and recreational activities, or
11-19 other similar activities.
11-20 (2) 'Assisted living facility' means any dwelling,
11-21 whether operated for profit or not, which undertakes
11-22 through its ownership or management to provide or
11-23 arrange for the provision, in a homelike,
11-24 noninstitutional setting on a 24 hour per day basis, of
11-25 housing, food service, protection, oversight, and
11-26 assisted living services for two or more adults who are
11-27 not related to the owner or administrator of the
11-28 facility by blood or marriage. Assisted living
11-29 facilities shall be limited to 25 beds.
11-30 (3) 'Assisted living services' includes, but is not
11-31 limited to, limited nursing services, assistance with
11-32 activities of daily living, and specialized services for
11-33 persons diagnosed as having advanced Alzheimer's disease
11-34 or dementia.
11-35 (4) 'Chemical restraint' means a psychopharmacologic
11-36 drug that is used for discipline or convenience and is
11-37 not required to treat medical symptoms.
11-38 (5) 'Limited nursing services' means acts that may be
11-39 performed by licensed practical nurses under Article 2
11-40 of Chapter 26 of Title 43, relating to practical nurses,
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12- 1 in accordance with physicians' orders but is limited to
12- 2 nursing assessments; assessment of the physical and
12- 3 mental status of residents; assistance with
12- 4 self-administered medications; the administering of
12- 5 insulin, influenza shots, nonlegend medications,
12- 6 vitamins, eye, ear, and nose drops, B-12 injections,
12- 7 epinephrine, topical ointments, and tuberculosis Mantoux
12- 8 tests; and applying heat such as dry heat, hot water
12- 9 bottle, heating pad, aquathermia, moist heat, hot
12-10 compress, sitz bath, and hot soaks. Also included as
12-11 permitted acts are routine change of colostomy bag,
12-12 passive range of motion exercises, ice caps, urine tests
12-13 such as clean catch, sterile specimen, clinitest,
12-14 glucometer, and routine dressings that do not require
12-15 packing or irrigation but are for abrasions, skin tears,
12-16 and closed surgical wounds. Ear irrigation, eye
12-17 irrigation, replacement of an established
12-18 self-maintained indwelling urinary catheter or
12-19 intermittent urinary catheterizations, enemas and
12-20 digital stool removal therapies, and care of casts,
12-21 braces, and splints such as leg or hand braces are
12-22 permitted acts. Notwithstanding the foregoing, care for
12-23 head braces such as a halo, care of physical or chemical
12-24 restraints, and care of Stage 2, 3, and 4 pressure
12-25 ulcers are not permitted acts.
12-26 (6) 'Physical restraint' means any manual or physical
12-27 device, material, or equipment attached or adjacent to
12-28 the resident's body that the individual cannot remove
12-29 easily which restricts freedom or normal access to one's
12-30 body. Physical restraints include, but are not limited
12-31 to, leg restraints, arm restraints, hand mitts, soft
12-32 ties or vests, and wheelchair safety bars. Also
12-33 included as restraints are facility practices which
12-34 function as a restraint, such as tucking in a sheet so
12-35 tightly that a resident in bed cannot move, bedrails, or
12-36 chairs that prevent rising or placing a wheelchair-bound
12-37 resident so close to a wall that the wall prevents the
12-38 resident from rising.
12-39 (7) 'Resident' means a person who resides in an assisted
12-40 living facility.
12-41 (b) No assisted living facility shall admit or retain a
12-42 resident who needs care beyond which the facility is
12-43 permitted to provide. Criteria for admission to an
12-44 assisted living facility are as follows:
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13- 1 (1) Persons admitted to an assisted living facility must
13- 2 be at least 18 years of age;
13- 3 (2) The assisted living facility shall not admit or
13- 4 retain persons who require the use of physical or
13- 5 chemical restraints, isolation, or confinement for
13- 6 behavioral control, except in temporary emergency
13- 7 situations or until the resident can be transferred to
13- 8 another facility;
13- 9 (3) Applicants requiring continuous medical or nursing
13-10 services shall not be admitted or retained at the
13-11 facility;
13-12 (4) Only limited nursing services shall be provided by
13-13 the assisted living facility. Additional medical,
13-14 nursing, or health services required for short-term
13-15 illness shall not be provided by employees or
13-16 contractors of the assisted living facility as services
13-17 of the assisted living facility. When such services are
13-18 required, they shall be purchased by the resident or the
13-19 resident's representative or legal surrogate, if any,
13-20 from licensed home health providers or nursing
13-21 facilities. The assisted living facility may assist in
13-22 the arrangement for such services but not in the
13-23 provision of those services. The assisted living
13-24 facility shall not solicit or receive any remuneration
13-25 from providers in return for the referral of its
13-26 residents to such providers.
13-27 (c) All assisted living services must be:
13-28 (1) Provided in accordance with a written plan of care
13-29 that describes the needs of the residents and how such
13-30 needs will be met; and
13-31 (2) Based on the same uniform minimum data set used to
13-32 assess nursing home residents.
13-33 (d) All assisted living facilities shall be licensed by
13-34 the department as provided for in Code Section 31-7-3
13-35 after the facility has received a certificate of need from
13-36 the State Health Planning Agency. The department's Office
13-37 of Regulatory Services, Long-term Care Section, or its
13-38 successor, shall perform on-site inspections of all
13-39 assisted living facilities at least annually and shall
13-40 investigate complaints made by or on behalf of residents
13-41 of assisted living facilities to ensure that such
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14- 1 facilities satisfy all applicable, statutes, rules, and
14- 2 regulations.
14- 3 (e) The state ombudsman or community ombudsman, on that
14- 4 ombudsman's initiative or in response to complaints made
14- 5 by or on behalf of residents of an assisted living
14- 6 facility, may conduct investigations within the
14- 7 ombudsman's powers and duties.
14- 8 (f) The department's Office of Aging Section, or its
14- 9 successor, in conjunction with the community care unit
14-10 established pursuant to Chapter 6 of Title 49, shall
14-11 perform on-site reviews of all assisted living facility
14-12 residents at least annually to determine if the residents
14-13 are appropriately placed in an assisted living facility.
14-14 The department shall utilize the procedures set forth in
14-15 Code Section 31-7-12.2 in determining if placement is
14-16 appropriate.
14-17 (g) Assisted living facilities shall be staffed with a
14-18 licensed practical nurse eight hours each day for seven
14-19 days each week. When a licensed practical nurse is not in
14-20 the facility, a certified nursing assistant shall be
14-21 available and in the facility. Licensed practical nurses
14-22 who provide limited nursing services to residents shall
14-23 maintain a written progress report in the resident's file
14-24 on each resident who receives limited nursing services
14-25 which describes the type, duration, amount, scope, and
14-26 outcome of services that are rendered and the general
14-27 status of the resident's health. All assisted living
14-28 facilities must maintain an agreement with a nursing home
14-29 that is no more than 30 minutes' drive time from the
14-30 assisted living facility. In the event that nursing
14-31 services are needed in the assisted living facility and a
14-32 licensed nurse is not on duty, the certified nursing
14-33 assistant or administrator of the assisted living facility
14-34 shall contact the skilled nursing facility with which the
14-35 assisted living facility has an agreement for assistance.
14-36 (h) The department shall promulgate rules and regulations
14-37 to govern assisted living facilities pursuant to Chapter 2
14-38 of this title.
14-39 31-7-12.2. (Index)
14-40 (a) The department or its designee shall determine the
14-41 appropriateness of all admissions to assisted living
14-42 facilities, as well as the appropriateness of the
14-43 continued residence of all individuals in such facilities.
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LC 11 8473
15- 1 If the department performs this function through a
15- 2 designee, such designee must be the same entity that
15- 3 performs preadmission approval screening and level of care
15- 4 determinations for nursing homes.
15- 5 (b) Each prospective resident shall be examined by a
15- 6 licensed physician within 60 days prior to admission to
15- 7 the assisted living facility. The physician shall sign
15- 8 and complete a medical examination report on a form
15- 9 created by the department. This form shall be submitted
15-10 to the owner or administrator of the assisted living
15-11 facility who shall utilize the information contained
15-12 therein in determining the appropriateness of the
15-13 prospective resident's admission to the facility. If the
15-14 assisted living facility owner or administrator determines
15-15 that admission to the facility is appropriate, he or she
15-16 shall provide the completed and signed report to the
15-17 department or its designee. The department or its
15-18 designee will then determine and certify the
15-19 appropriateness of the placement of the resident. If the
15-20 department or its designee concludes that placement is not
15-21 appropriate, then the resident shall have the right to
15-22 appeal that determination. Such appeal shall be a
15-23 contested case in accordance with Chapter 13 of Title 50.
15-24 (c) If, at any time after admission to an assisted living
15-25 facility, a resident appears to need care beyond that
15-26 which the facility is licensed to provide, the department
15-27 or its designee shall direct the facility owner or
15-28 administrator to require the resident to be physically
15-29 examined by a licensed physician. Pursuant to such
15-30 examination the examining physician shall complete and
15-31 sign a medical form provided by the department. After
15-32 consultation with the physician who performed the
15-33 examination, a medical review team designated by the
15-34 department shall then determine whether the resident is
15-35 appropriately residing in the facility. Such
15-36 determination shall be subject to appeal as provided in
15-37 Chapter 13 of Title 50. When the medical review team
15-38 concludes that a resident is inappropriately residing in a
15-39 facility, the owner or administrator of the facility shall
15-40 be given 30 days' written notice to relocate the resident;
15-41 provided, however, that if it is determined that the
15-42 resident's continued placement in the facility presents an
15-43 imminent danger to the health, safety, or welfare of the
15-44 resident or a substantial probability exists that death or
15-45 serious physical harm would result to the resident if
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LC 11 8473
16- 1 allowed to remain in the facility, then the resident shall
16- 2 be relocated immediately.
16- 3 (d) No physician employed by an assisted living facility
16- 4 to provide an initial examination for admission purposes
16- 5 may have financial interest in such facility.
16- 6 (e) Nurses employed by or under contract with an assisted
16- 7 living facility shall, on a routine basis or at least
16- 8 quarterly, perform an assessment of the residents for whom
16- 9 they are providing nursing services and shall document
16-10 such assessment, including any substantial changes in a
16-11 resident's status which may necessitate relocation to an
16-12 intermediate care facility, skilled nursing facility, or
16-13 hospital. Such records shall be maintained in the
16-14 facility for inspection by the department."
SECTION 10.
16-15 Said title is further amended by striking paragraph (1) of
16-16 subsection (a) of Code Section 31-7-111, relating to
16-17 legislative findings regarding residential care facilities
16-18 for the elderly, and inserting in its place the following:
16-19 "(1) There exists in this state a seriously inadequate
16-20 supply of and a critical need for facilities which can
16-21 furnish the comprehensive services required by elderly
16-22 persons in a single location, including, without
16-23 limitation, residential care and the types of services
16-24 provided in skilled nursing homes, intermediate care
16-25 homes, adult residential homes, and personal care homes
16-26 assisted living facilities (hereinafter referred to as
16-27 'residential care facilities for the elderly');".
SECTION 11.
16-28 Said title is further amended by striking subparagraph (A)
16-29 of paragraph (7) of Code Section 31-7-112, relating to
16-30 definitions regarding authorities created for residential
16-31 care facilities for the elderly, and inserting in its place
16-32 the following:
16-33 "(A) Any one or more buildings or structures to be
16-34 used in providing at a single location the
16-35 comprehensive services required by the elderly,
16-36 including, without limitation, residential care and
16-37 the types of services provided in skilled nursing
16-38 homes, intermediate care homes, assisted living
16-39 facilities, and personal care homes adult residential
16-40 homes supplied with all necessary or useful
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LC 11 8473
17- 1 furnishings, machinery, equipment, parking facilities,
17- 2 landscaping, and facilities for outdoor storage, all
17- 3 as determined by the authority, which determination
17- 4 shall be final and not subject to review; provided,
17- 5 however, that no single project or residential care
17- 6 facility shall be required to render all types of
17- 7 services and levels of care referred to above. There
17- 8 may be included as part of any such project all
17- 9 improvements necessary to the full utilization
17-10 thereof, including, without limitation, site
17-11 preparation; roads and streets; sidewalks; water
17-12 supply; outdoor lighting; belt line railroad; railroad
17-13 sidings and lead tracks; bridges; causeways; terminals
17-14 for railroad, automotive, and air transportation;
17-15 transportation facilities incidental to the project;
17-16 and the dredging and improving of harbors and
17-17 waterways. However, none of the aforementioned
17-18 improvements shall be the primary purpose of any
17-19 project;".
SECTION 12.
17-20 Said title is further amended by striking paragraph (1) of
17-21 Code Section 31-7-250, relating to criminal records checks
17-22 of personal care home employees, and inserting in its place
17-23 the following:
17-24 "(1) 'Adult residential care home' means a facility
17-25 required to be licensed or permitted under Code Section
17-26 31-7-12.
17-27 (1.1) 'Assisted living facility' means a facility
17-28 required to be licensed or permitted under Code Section
17-29 31-7-12.1.
17-30 (1)(1.2) 'Conviction' means a finding or verdict of
17-31 guilty or a plea of guilty regardless of whether an
17-32 appeal of the conviction has been sought."
SECTION 13.
17-33 Said title is further amended by striking paragraphs (5),
17-34 (6), (10), and (11) of said Code Section 31-7-250, relating
17-35 to criminal records checks of personal care home employees,
17-36 and inserting in their respective places the following:
17-37 "(5) 'Employee' means any person, other than a director,
17-38 employed by a personal care home an adult residential
17-39 home or assisted living facility to perform at any
17-40 facilities of the personal care home adult residential
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LC 11 8473
18- 1 home or assisted living facility any duties which
18- 2 involve personal contact between that person and any
18- 3 paying resident of the personal care home adult
18- 4 residential home or assisted living facility.
18- 5 (6) 'Facility' means real property of a personal care
18- 6 home an adult residential home or assisted living
18- 7 facility where residents reside."
18- 8 "(10) 'License' means the permit or document issued by
18- 9 the department to authorize the personal care home adult
18-10 residential home or assisted living facility to which it
18-11 is issued to operate a facility under this chapter.
18-12 (11) 'Personal care home' or 'home' means a home
18-13 required to be licensed or permitted under Code Section
18-14 31-7-12. Reserved."
SECTION 14.
18-15 Said title is further amended by striking Code Sections
18-16 31-7-256 and 31-7-257, relating to the expiration of certain
18-17 personal care home licenses and the issuance of temporary
18-18 licenses therefore, and inserting in their respective places
18-19 the following:
18-20 "31-7-256. (Index)
18-21 All licenses issued to facilities prior to July 1, 1985,
18-22 shall expire December 31, 1985. Upon the expiration of
18-23 any license issued prior to July 1, 1985, the personal
18-24 care home to which such license was issued shall be
18-25 required to obtain a separate license for each of the
18-26 personal care home's existing facilities and shall have a
18-27 separate director for each such facility. An existing
18-28 facility whose license so expires may only be issued a
18-29 temporary license until that facility qualifies for a
18-30 regular license, unless that facility submits evidence,
18-31 satisfactory to the department, that within the
18-32 immediately preceding 12 months the director received a
18-33 satisfactory fingerprint records check determination and
18-34 each employee received a satisfactory preliminary records
18-35 check determination, in which event that facility may be
18-36 issued a regular license without first having to obtain a
18-37 temporary license. A temporary or regular license may
18-38 only be issued if the facility otherwise qualifies for a
18-39 license pursuant to Article 1 of this chapter. Any new
18-40 facility in this state first owned or operated on or after
18-41 July 1, 1985, by a personal care home already licensed in
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LC 11 8473
19- 1 this state shall be required to have a new license issued
19- 2 pursuant to Code Sections 31-7-251 through 31-7-255.
19- 3 Reserved.
19- 4 31-7-257. (Index)
19- 5 After a temporary license is issued to an existing
19- 6 facility pursuant to Code Section 31-7-256, the personal
19- 7 care home to whom the license was issued shall furnish to
19- 8 the department a fingerprint records check application for
19- 9 the director and a preliminary records check application
19-10 for each employee of each of the personal care home's
19-11 facilities for which a temporary license was issued.
19-12 After receiving those applications, the department shall
19-13 proceed to have made records check determinations based
19-14 upon such applications and may only issue a regular
19-15 license to any such facility under the conditions and
19-16 procedures provided in Code Sections 31-7-252 through
19-17 31-7-255. Reserved."
SECTION 15.
19-18 Said title is further amended by striking subsections (b)
19-19 and (c) of Code Section 31-7-258, relating to changes of
19-20 facility directors, and inserting in their respective places
19-21 the following:
19-22 "(b) If the department determines under subsection (a) of
19-23 this Code section that there has ever been an
19-24 unsatisfactory preliminary or fingerprint records check
19-25 determination of the newly designated director, the
19-26 personal care home adult residential home or assisted
19-27 living facility and that director shall be notified
19-28 thereof. The license for that director's facility shall
19-29 be indefinitely suspended unless the personal care home
19-30 adult residential home or assisted living facility
19-31 designates another director for whom it has not received
19-32 or made an unsatisfactory preliminary or fingerprint
19-33 records check determination and proceeds pursuant to the
19-34 provisions of this Code section relating to a change of
19-35 director.
19-36 (c) If the department determines under subsection (a) of
19-37 this Code section that there has been no fingerprint
19-38 records check determination regarding the newly designated
19-39 director within the immediately preceding 12 months, the
19-40 department shall so notify the personal care home adult
19-41 residential home or assisted living facility. The
19-42 personal care home adult residential home or assisted
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LC 11 8473
20- 1 living facility shall furnish to the department the
20- 2 records check application of the newly designated director
20- 3 or the license of that facility shall be indefinitely
20- 4 suspended. If that records check application is so
20- 5 received, unless the department has within the immediately
20- 6 preceding 12 months made a satisfactory preliminary
20- 7 records check determination regarding the newly designated
20- 8 director, the department shall perform a preliminary
20- 9 records check and determination of the newly designated
20-10 director; and the applicant and that director shall be
20-11 notified thereof. If that determination is
20-12 unsatisfactory, the provisions of subsection (b) of this
20-13 Code section regarding procedures after notification shall
20-14 apply. If that determination is satisfactory, the
20-15 department shall perform a fingerprint records check and
20-16 determination for that director as provided in Code
20-17 Sections 31-7-254 and 31-7-255. If that determination is
20-18 satisfactory, the personal care home adult residential
20-19 home or assisted living facility and director for whom the
20-20 determination was made shall be so notified, and the
20-21 license for the facility at which that person is the newly
20-22 designated director shall not be adversely affected by
20-23 that change of director. If that determination is
20-24 unsatisfactory, the provisions of subsection (b) of this
20-25 Code section shall apply."
SECTION 16.
20-26 Said title is further amended by striking subsection (d) of
20-27 Code Section 31-7-259, relating to employment at personal
20-28 care homes which have received licenses, and inserting in
20-29 its place the following:
20-30 "(d) No personal care home adult residential home or
20-31 assisted living facility may have any person as an
20-32 employee after January 1, 1986, this subsection becomes
20-33 effective unless there is on file in the personal care
20-34 home adult residential home or assisted living facility an
20-35 employment history for that person."
SECTION 17.
20-36 Said title is further amended by striking paragraph (2) of
20-37 Code Section 31-8-51, relating to definitions regarding the
20-38 long-term care ombudsman program, and inserting in its place
20-39 the following:
20-40 "(2) 'Long-term care facility' means any skilled nursing
20-41 home, intermediate care home, or personal care home
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LC 11 8473
21- 1 adult residential home, or assisted living facility now
21- 2 or hereafter subject to regulation and licensure by the
21- 3 department."
SECTION 18.
21- 4 Said title is further amended by striking paragraph (3) of
21- 5 Code Section 31-8-81, relating to definitions regarding
21- 6 reports of abuse of residents in long-term care facilities,
21- 7 and inserting in its place the following:
21- 8 "(3) 'Long-term care facility' or 'facility' means any
21- 9 skilled nursing home, intermediate care home, or
21-10 personal care home adult residential home, or assisted
21-11 living facility now or hereafter subject to regulation
21-12 and licensure by the department."
SECTION 19.
21-13 Code Section 37-4-21 of the Official Code of Georgia
21-14 Annotated, relating to admission of mentally retarded
21-15 persons for respite care, is amended by striking subsection
21-16 (c) thereof and inserting in its place the following:
21-17 "(c) An admission for respite care shall be for no longer
21-18 than two weeks, provided that a person may be admitted for
21-19 additional periods of respite care; provided, further,
21-20 that there shall be no more than two admissions for
21-21 respite care within any six-month period, counted from the
21-22 first day of such an admission. Any such admission which
21-23 exceeds limits provided in this Code section must be in
21-24 accordance with the procedure in Code Section 37-4-20 or
21-25 37-4-40. This Code section shall not apply when the person
21-26 sought to be admitted is living in a nursing home or
21-27 personal care home, as defined in paragraph (2) of Code
21-28 Section 43-27-1, or adult residential home or assisted
21-29 living facility."
SECTION 20.
21-30 Code Section 38-4-2 of the Official Code of Georgia
21-31 Annotated, relating to powers of the Department of Veterans
21-32 Service Board, is amended by striking paragraph (4) of
21-33 subsection (a) thereof and inserting in its place the
21-34 following:
21-35 "(4) To construct and operate hospitals, nursing homes,
21-36 nursing care homes, assisted living facilities, and
21-37 personal care homes adult residential homes for the use
21-38 and care of war veterans discharged under other than
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22- 1 dishonorable conditions and to pay the cost of
22- 2 construction of the hospitals, nursing homes, nursing
22- 3 care homes, assisted living facilities, and personal
22- 4 care homes adult residential homes. The term 'cost of
22- 5 the construction' as used in this paragraph shall
22- 6 embrace the cost of construction; the cost of all lands,
22- 7 properties, rights, and easements acquired; the cost of
22- 8 all machinery and equipment; and the cost of
22- 9 engineering, architectural, and legal expenses and of
22-10 plans and specifications and other expenses necessary or
22-11 incident to determining the feasibility or
22-12 practicability of the construction of any hospitals,
22-13 nursing homes, nursing care homes, assisted living
22-14 facilities, and personal care homes adult residential
22-15 homes. The term shall also include administrative
22-16 expense and such other expenses as may be necessary or
22-17 incident to the construction of any hospitals, nursing
22-18 homes, nursing care homes, assisted living facilities,
22-19 and personal care homes adult residential homes; the
22-20 placing of the same in operation; and the condemnation
22-21 of property necessary for such construction and
22-22 operation."
SECTION 21.
22-23 Code Section 48-13-9 of the Official Code of Georgia
22-24 Annotated, as enacted by an Act approved April 15, 1993 (Ga.
22-25 L. 1993, p. 1292), relating to local government regulatory
22-26 fees, is amended by striking paragraph (14) of subsection
22-27 (b) thereof and inserting in its place the following:
22-28 "(14) Nursing and personal care homes, assisted living
22-29 facilities, and adult residential homes;".
SECTION 22.
22-30 Article 5 of Chapter 6 of Title 49 of the Official Code of
22-31 Georgia Annotated, related to community care and services
22-32 for the elderly, is amended by striking Code Section 49-6-60
22-33 and inserting in its place a new Code Section 49-6-60 to
22-34 read as follows:
22-35 "49-6-60. (Index)
22-36 The purpose of this article is to assist functionally
22-37 impaired elderly persons in living dignified and
22-38 reasonably independent lives in their own homes, or in the
22-39 homes of relatives or caregivers, or in homelike,
22-40 noninstitutional settings through the development,
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LC 11 8473
23- 1 expansion, reorganization, and coordination of various
23- 2 community-based services. In recognition of the desire of
23- 3 older Georgians to reside at home, or with their families,
23- 4 or in homelike, noninstitutional settings as long as
23- 5 possible, the General Assembly intends that a continuum of
23- 6 care be established so that functionally impaired elderly
23- 7 persons age 60 and older may be assured the least
23- 8 restrictive environment suitable to their needs. The
23- 9 General Assembly further intends to maximize the
23-10 utilization of existing community social and health
23-11 services in order to prevent unnecessary placement of
23-12 individuals in long-term care facilities inappropriate
23-13 settings. Two categories of homelike facilities shall be
23-14 created, adult residential homes and assisted living
23-15 facilities, to assist in reaching this goal. The
23-16 development of innovative approaches to program
23-17 management, staff training, and service delivery that
23-18 impact on cost avoidance, cost effectiveness, and program
23-19 efficiency shall be encouraged. It is further the intent
23-20 of the General Assembly that the Department of Human
23-21 Resources shall serve as the agency responsible for
23-22 planning and implementing the provision of community-based
23-23 services to the elderly reimbursable under Article 7 of
23-24 Chapter 4 of this title, the 'Georgia Medical Assistance
23-25 Act of 1977.'"
SECTION 23.
23-26 Said article is further amended by striking subsection (c)
23-27 of Code Section 49-6-63, relating to services to be
23-28 coordinated by the lead agency, and inserting in its place a
23-29 new subsection (c) to read as follows:
23-30 "(c) Services to be coordinated by the lead agency shall
23-31 include, without being limited to, the following:
23-32 (1) Case management;
23-33 (2) Assessment of functional impairment and needed
23-34 community services;
23-35 (3) Homemaker services;
23-36 (4) Home health care services;
23-37 (5) In-home personal care services Services in adult
23-38 residential homes;
23-39 (6) Adult day health services;
23-40 (7) Adult day care;
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LC 11 8473
24- 1 (8) Habilitation services;
24- 2 (9) Respite care;
24- 3 (10) Older Americans Act services, including
24- 4 transportation, nutritional, social, and other services;
24- 5 (11) Title XX services;
24- 6 (12) Senior center services;
24- 7 (13) Protective services;
24- 8 (14) Financial assistance services, including, but not
24- 9 limited to, food stamps, Medicaid, medicare, and
24-10 Supplemental Security Income;
24-11 (15) Health maintenance services; and
24-12 (16) Assisted living services; and
24-13 (16)(17) Other community services."
SECTION 24.
24-14 This Act shall become effective upon its approval by the
24-15 Governor or upon its becoming law without such approval.
SECTION 25.
24-16 All laws and parts of laws in conflict with this Act are
24-17 repealed.
-24- (Index)
Office of the Clerk of the House
Robert E. Rivers, Jr., Clerk of the House
Last Updated on 01/02/97