Georgia Assisted Living Communities and Personal Care Homes Now Must Contend with Additional Compliance Obligations and Larger Fines

New measures intended to increase protection of residents in Georgia assisted living communities and personal care homes were signed into law on June 30, 2020.  House Bill 987 (“HB 987”) amends Title 31 of the O.C.G.A. and is seen as a direct response to the Atlanta Journal-Constitution’s investigation into alleged deficient practices in some of Georgia’s long-term care facilities.  HB 987 had been introduced prior to the COVID-19 pandemic and was then amended to address certain requirements relating to the pandemic, including mandatory baseline testing of residents and staff.

The following is a summary of the new requirements under HB 987:

• Fines: Increased maximum fines for violations cited by the Department of Community Health (“DCH”) to up to $2,000 per day for each violation, and up to a total of $40,000. HB 987 also imposes a mandatory fine of no less than $5,000 for a violation that has caused death or serious physical harm to a resident.

• Nursing Services: Provides for the provision of limited nursing services in assisted living communities. HB 987 defines “Limited nursing Services” to mean “the assessment of the physical, mental, and emotional status to determine the appropriate level of care for an individual; the performance of health maintenance activities, as [currently defined by statute]; and the provision of any nursing care within the direct care staff person’s scope of practice that can be completed within seven days or intermittently.”

• Staffing Requirements, Training, and Financial Stability Requirements, effective July 1, 2021:
  • Staffing Requirements:
    • Personal care homes with 25 or more beds and assisted living communities are required to have an average monthly minimum on-site staffing ratio of one direct care staff person for every 15 residents during all waking hours, and one direct care staff person for every 20 residents during all non-waking hours.
    • A personal care home that operates a memory care center may employ certified medication aides (“CMAs”) for the purpose of performing the technical aspects of administration of certain medications. If a personal care home employs one or more CMAs, it must also secure the services of a licensed pharmacist to perform certain duties.
    • Assisted living communities must have at least two on-site direct care staff persons at all times.
    • Assisted living communities must have a registered professional nurse or licensed practical nurse on-site, as follows:
      • 1-30 residents: a minimum of eight hours per week
      • 31-60 residents: a minimum of 16 hours per week
      • 61-90 residents: a minimum of 24 hours per week
      • More than 90 residents: a minimum of 40 hours per week
  • Training Requirements: Each direct care staff person is required to receive initial and annual training covering topics specified by DCH to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults.
  • Financial Requirements:
    • Applicants for licensure are required to provide a financial stability affidavit from a certified public accountant affirming the applicant’s ability to operate for two years.
    • Requires minimum of 60 days’ written notice to DCH and all residents of “any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight.”
    • Requires a minimum of 14 days’ advance written notice to DCH and all residents of any change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight.

• Memory Care Requirements
  • Requires a certificate issued by DCH to operate a memory care center beginning July 1, 2021. A memory care center is defined to mean a freestanding or incorporated specialized unit within an assisted living community or personal care home that either holds itself out as providing additional or specialized memory care or charges a higher rate for such care. The Department of Community Health is required to promulgate rules and regulations to address the new memory care requirements.
    • Staffing for Memory Care:
      • Minimum on-site staffing ratio of one dementia trained direct care staff person for every 12 residents on-site during all waking hours and for every 15 residents on-site during all non-waking ours based on a monthly average.
      • Two on-site direct care staff persons at all times.
      • One registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times; and
      • One registered professional nurse or licensed practical nurse on-site or available in the building at all times as follows:
        • 1-12 residents: a minimum of eight hours per week
        • 13-30 residents: a minimum of 16 hours per week
        • 31-40 residents: a minimum of 24 hours per week
        • More than 40 residents: a minimum of 40 hours per week
    • Staff Training: All staff, regardless of role, are required to have at least four hours of dementia-specific orientation within the first 30 days of working in the center. All direct care staff are required complete a minimum of 16 hours of specialized training in dementia care within the first 30 days of working independently with residents with Alzheimer’s or other dementias, and a minimum of eight hours of such specialized training in dementia care annually thereafter.

• Administrator Licensing: HB 987 establishes a licensure requirement for assisted living community administrators and certain personal care home administrators effective July 1, 2021, within 60 days of the date of hire.  The bill also changes the name of the State board of Nursing Home Administrators to the State Board of Long-Term Care Facility Administrators, and changes the composition of the board.

• Retaliation: HB 987 amends the “Disabled Adults and Elder Persons Protection Act” to provide that “No person shall discriminate or retaliate in any manner against: (1) Any person who makes a report pursuant to this chapter, who testifies in any judicial proceeding arising from the report, who provides protective services, who participates in an investigation, or who participates on an Adult Abuse, Neglect, and Exploitation Multidisciplinary Team under the provisions of this chapter; or (2) Any disabled adult or elder person who is the subject of a report.”

• COVID-19 and Pandemic Preparedness Requirements: The Senate added language to HB 987 to address reporting of COVID-19 and pandemic preparedness, which includes the following requirements for personal care homes with 25 or more beds and assisted living communities:
  • Mandatory Baseline Testing: No later than 90 days after June 30, 2020, each resident and direct care staff person in a personal care home with 25 or more beds, an assisted living community, or a nursing home must “receive an initial baseline molecular SARS CoV-2 test as outlined by the federal Centers for Disease Control and Prevention; provided, however, that residents and direct care staff persons tested prior to [June 30, 2020] shall not be required to receive such test.”  DCH is authorized to promulgate rules and regulations to require testing.
  • Required Notifications: Inform residents and representatives of residents by 5:00 p.m. the next calendar day following either a single confirmed COVID-19 infection “or another airborne infectious disease identified by the department or the federal Centers for Disease Control and Prevention as a threat to public health, or three or more residents or staff with new onset of respiratory symptoms occurring within 72 hours of each other.” HB 987 includes specific requirements for such notification and cumulative updates.
  • PPE Supply Requirements: Maintain a minimum of a seven-day supply of certain personal protective equipment.
  • Infection Control: Maintain and provide to residents policies and procedures relating to infection control.
  • Pandemic Preparedness: Include certain pandemic response items in the facility’s disaster preparedness plan.

To view HB 987 in its entirety, please click here.