Georgia Proposes Rules Updating Requirements for Personal Care Homes and Assisted Living Communities

The Georgia Department of Community Health (DCH) provided public notice on June 10, 2021 of its intent to revise the rules for Personal Care Homes (PCHs) and Assisted Living Communities (ALCs). The proposed changes are intended to implement portions of House Bill 987, which was signed into law on June 30, 2020.  The proposed revisions affect the Regulations for Personal Care Homes found at Ga. Comp. Rules & Regs., R. 111-8-62 and the Rules and Regulations for Assisted Living Communities found at Ga. Comp. Rules & Regs., R. 111-8-63. The following is a summary of the primary proposed changes.

Required Certification of Memory Care Centers

PCHs and ALCs that operate memory care centers must now obtain a certification issued by DCH. The term “memory care center” replaced “memory care unit,” throughout the regulations, and is now defined as a freestanding or incorporated specialized unit that either (i) holds itself out as providing additional or specialized care to persons with diagnoses of probable Alzheimer’s or other dementias or with cognitive deficits that may place the resident at risk; or (ii) charges higher rates for care for residents with Alzheimer’s or other dementias than for care to other residents. The previous requirements for Memory Care Services remain in the regulations, but are now identified as Precautions for Residents at Risk of Elopement. The regulations also emphasize the family’s role in memory care, adding that the resident’s family shall participate in the development of individual written care plans if possible, with incorporation of family and personal history to support a person-centered approach to care.

Staffing Requirements

The proposed rules include changes to both general staffing requirements for PCHs and ALCs as well as changes for staffing in PCH and ALC Memory Care Centers. The qualifications for full-time administrators now require that the administrator of an ALC or a PCH licensed for twenty-five (25) or more beds hold a valid license from the State Board of Long-Term Care Facility Administrators with an effective date no later than 60 days from the date of hire.

Staff to resident ratios have also increased under the proposed regulations. Below is a summary of the proposed staffing requirements. Average monthly minimum staffing levels will be calculated and documented using methods and forms specified by DCH. Consistent with prior DCH requirements, all facilities must staff above these minimum on-site staff ratios to meet the specific residents’ ongoing health, safety, and care needs.

Assisted Living Communities (ALCs):

• At least two (2) staff persons who have completed the minimum training requirements must be present in the assisted living community at all times when any residents are present, with at least one (1) staff person on each occupied floor.

• At least two (2) on-site direct care staff persons must be on the premises 24 hours per day providing supervision whenever residents are present, with at least one (1) staff person on each occupied floor.

• Maintain average monthly minimum on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours and one awake direct care staff person per 20 residents during non-waking hours where the residents have minimal care needs.

• A registered professional nurse or licensed practical nurse be on-site to support care and oversight of the residents, as follows:
  • For communities with one to 30 residents, a minimum of 8 hours per week;
  • For communities with 31 to 60 residents, a minimum of 16 hours per week;
  • For communities with 61 to 90 residents, a minimum of 24 hours per week;
  • For communities with more than 90 residents, a minimum of 40 hours per week;

Personal Care Homes (PCHs)

• A PCH licensed for less than 25 beds must maintain a minimum on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours, and one awake direct care staff person per 25 residents during non-waking hours where the residents have minimal care needs.

• At least one administrator, on-site manager, or a responsible staff personnel must be on the premises 24 hours per day and available to respond to resident needs, with a minimum of one staff person per occupied floor.

Certified Memory Care Centers (ALCs and PCHs)

• At least one dementia trained direct care staff person for every 12 residents on-site during all waking hours, or for every 15 residents on-site during all non-waking hours based on a monthly average;

• One registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times;

• Two direct care staff persons are required to be on-site at all times, with at least one on each occupied floor; and

• One registered professional nurse or licensed practical nurse on-site available in the building at all times as follows:
  • For memory care centers with one to 12 residents, a minimum of 8 hours per week;
  • For memory care centers with 13 to 30 residents, a minimum of 16 hours per week;
  • For memory care centers with 31 to 40 residents, a minimum of 24 hours per week; or
  • For memory care centers with more than 40 residents, a minimum of 40 hours per week.

Training Requirements

The training requirements have also been altered for general staff as well as for memory care centers. The proposed PCH regulations require all direct care staff, including the administrator or on-site manager to satisfactorily complete continuing education (at least 16 hours) each year. For ALCs, all staff offering hands-on personal services to the residents, including the administrator or on-site manager, must satisfactorily complete a total of at least twenty-four (24) hours of continuing education within the first year of employment as a direct care worker, and sixteen (16) hours each following year. These courses must be relevant to the individual’s job duties, such as courses pertaining to working with residents with Alzheimer’s or other cognitive impairments, working with the mentally ill and developmentally disabled, social and recreational activities, legal issues, physical maintenance and fire safety, housekeeping, or other topics as needed or as determined by the DCH.

Memory care centers have additional training requirements. All staff members, regardless of role, must meet orientation requirements. Direct care staff must undergo a separate orientation and keep up with annual training requirements. For homes with memory care centers, the direct care staff shall complete a minimum of eight (8) hours of specialized competency-based training in dementia care on an annual basis using forms specified by the department.

Limited Nursing Services

Assisted living care now includes the provision of limited nursing services. “Limited nursing services” is defined as “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…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.”

Licensure and Change Notification

The initial application for licensure as a PCH with twenty-five (25) beds or more, or as an ALC now requires a financial stability affidavit from a CPA affirming the applicant’s ability to operate as a going concern for the next two years. Also, a home or community must now provide timely notification of the relocation address to the residents, their family contacts and representatives, and the department whenever an emergency situation arises which disrupts the provision of room and board for the residents at the licensed location. Owners must provide the department 60 days’ notice of bankruptcy or property eviction. In the event of a change of ownership, owners must provide 30 days’ notice by way of an application.

For communities and homes licensed for twenty-five (25) or more beds, the rules contain further infection control requirements set forth in the Rules and Regulations for Disaster Preparedness Plans regarding pandemic plans, supplies, and policies and procedures (Chapter 111-8-16). Communities and homes licensed for twenty-five (25) or more beds must notify residents of infectious disease outbreaks or incidents.

Changes Specific to Personal Care Homes

The proposed rules provide that each PCH must have its name displayed so as to be easily visible from the street. The rules also include new aging-in-place exceptions. Under the aging in place exceptions, the PCH may allow up to three (3) non-ambulatory residents to remain in the PCH to support an aging in place strategy that is in the best interests of the resident, provided certain criteria are met to ensure the patient is properly cared for within the facility and the emergency procedures remain sufficient with safety compliance standards.

The proposed PCH rules also include changes relating to medication administration in memory care centers. Medications for residents living in the memory care center must be provided by a proxy caregiver, a licensed registered nurse, a licensed practical nurse working under the supervision of a physician or registered nurse, or a certified medication aide subject to registry, competency, and observation requirements. A certified medication aide can only administer medication within his or her authorized tasks as a certified medication aide and must undergo an annual competency review. The home must document any administration of liquid morphine by a certified medication aide in the resident’s record. Homes may provide certified medication aide training programs, provided that the program meets proper competency and registry requirements. Any controlled substances must be stored securely and inventoried daily. A home may only have an on-site supply of liquid morphine limited to 50 ml for each hospice patient in the home for which there is a physician’s order for such medication.

An opportunity for public comment will be held on July 14, 2021 at 10:00 AM EDT via WebEx audio. Comments to the proposed rule made in writing may be submitted on or before July 16, 2021. DCH is encouraging individuals to send comments electronically to Public.comment@dch.ga.gov. The Public Notices can be found here. If you have any questions, please contact Hedy S. Rubinger, Jessica T. Grozine, or Laura S. Dona.