Sec. 1001.7. Admission and retention standards

(a) Unless stated otherwise in this section, an operator of an assisted living residence shall admit and retain only those individuals who meet the admission and retention standards prescribed in 18 NYCRR section 487.4(a)-(e) or 488.4(a)-(d), depending upon the facility's certification under 18 NYCRR.

(b) An adult home certified pursuant to 18 NYCRR Part 487 or an enriched housing program certified pursuant to 18 NYCRR Part 488 in possession of a retention standards waiver for one or more residents as of June 3, 2005 shall not be required to apply for and obtain enhanced assisted living certification pursuant to section 1001.4(n) of this Part with respect to the residents included in such existing waiver, and limited to the conditions of such waiver; however, such waiver expires when such resident or residents either are discharged from the facility or die.

(c) Any resident of an adult home certified pursuant to 18 NYCRR Part 487 or an enriched housing program certified pursuant to 18 NYCRR Part 488 or an assisted living residence licensed pursuant to this Part who is currently occupying a bed under the retention standards waiver shall be allowed to continue to occupy such bed so long as the resident is within the conditions of the waiver granted; provided, no other resident shall be allowed to occupy a bed within such facility or residence under such retention standards waiver once the bed has been vacated.

(d) An operator possessing an enhanced assisted living certificate issued by the department pursuant to section 1001.4(n) of this Part may admit persons either from an assisted living residence or from the community, and may retain persons who exceed the admission and retention standards of an assisted living residence, provided that the enhanced assisted living residence can provide or arrange an adequate and safe plan of care in accordance with the ISP. Such individuals may include those who:

(1) are chronically chairfast and unable to transfer, or chronically require the physical assistance of one or more person(s) to transfer;

(2) chronically require the physical assistance of one or more person(s) to walk;

(3) chronically require the physical assistance of one or more person(s) to climb or descend stairs;

(4) are dependent on medical equipment and require more than intermittent or occasional assistance from medical personnel; or

(5) have chronic unmanaged urinary or bowel incontinence.

(e) Twenty-four hour skilled nursing or medical care.

(1) An operator shall not admit individuals in need of 24-hour skilled nursing care or medical care provided by facilities licensed pursuant to article 28 of the Public Health Law or articles 19, 31 or 32 of the Mental Hygiene Law.

(2) If a resident reaches the point where (s)he is in need of 24-hour skilled nursing care or medical care provided by facilities licensed pursuant to article 28 of the Public Health Law or article 19, 31 or 32 of the Mental Hygiene Law, then the resident shall be discharged from the residence and the operator shall initiate proceedings for the termination of the residency agreement of such resident in accordance with the provisions of section 461-h of the Social Services Law and of 18 NYCRR section 487.5(f) or 488.5(e), as applicable; provided, however, a resident may remain at a residence certified as an enhanced assisted living residence if each of the following conditions are met

(i) the resident's physician and home care services agency, if applicable, and hospice medical director, if applicable, determine and document that, with the provision of additional nursing, medical and/or hospice care, the resident can be safely cared for in the residence and would not require placement in a hospital, nursing home or other facility licensed under article 28 of the Public Health Law or article 19, 31 or 32 of the Mental Hygiene Law;

(ii) the resident hires appropriate nursing, medical or hospice staff to care for his or her increased needs;

(iii) the operator agrees to retain the resident and to coordinate the care provided by the enhanced assisted living residence and other provider staff; and

(iv) the resident is otherwise eligible to reside in the facility.

(f) Prior to admission, or upon request, an operator must disclose, on a separate information sheet in plain language and in 12-point type, the information set forth in section 1001.8(f)(5) of this Part, to any individual who expresses an interest in residing in the residence, and to his or her designated representative and his or her legal representative, if any, and any current resident and to his or her designated representative and his or her legal representative, if any, if such information has not previously been disclosed to them.

(g) Pre-admission evaluation.

The operator shall conduct a pre-admission evaluation of each prospective resident within 30 days prior to admission, using the personal data and resident evaluation form, to determine whether or not the individual is appropriate for admission. Such evaluation shall be conducted by the operator, through its administrator or case manager, and if necessary, in conjunction with either a home care services agency approved under Public Health Law, article 36 or an appropriately licensed and trained employee of the operator, such as a registered professional or licensed practical nurse, a physical or occupational therapist, or a social worker.

(h) Medical evaluation.

The operator shall assure that a medical evaluation, on a department form or a department-approved substitute, is conducted for every prospective resident. The medical evaluation shall be conducted within 30 days prior to the date of admission; and whenever a change in the resident's condition warrants, but no less than once in every 12 months. Such medical evaluation shall be a written and signed report from a physician, physician assistant or nurse practitioner, which includes:

(1) the date of examination, significant medical history and current conditions, known allergies, the prescribed medication regimen, including information on the applicant's ability to self-administer medications, recommendations for diet, exercise, recreation, frequency of medical examinations, cognitive and mental health status, and assistance needed in the activities of daily living;

(2) a statement that the individual is or is not medically suited for care in the assisted living residence and, if applicable, the enhanced assisted living residence or special needs assisted living residence;

(3) a statement that the individual is or is not mentally suited for care in the assisted living residence, and, if applicable, the enhanced assisted living residence or special needs assisted living residence;

(4) a statement that the individual is or is not in need of long-term medical or nursing care or supervision, which would require placement in a hospital or nursing home; and

(5) a statement that the individual is or is not in need of 24-hour skilled nursing care.

(i) Information collected through the required prospective resident interview, mental health evaluation if required, medical evaluation, the pre-admission evaluation including the personal data and resident evaluation form, and any other information as needed, on forms approved by the department, must be used to determine whether the individual is appropriate for admission to the assisted living residence.

(j) The operator shall not admit any individual if the operator is not able to meet the individual's care needs within the scope of services authorized to be provided by the assisted living residence and the individualized service plan.

(k) Individualized service plan.

(1) A written individualized service plan shall be developed for each resident upon admission.

(2) The individualized service plan shall be developed with the resident, the resident's representative and resident's legal representative, if any, the assisted living operator, and if necessary a home care services agency approved under Public Health Law, article 36 or equivalent staff as authorized by Public Health Law, section 465.5(1)(d). The initial individualized service plan shall be developed in consultation with the resident's physician and such consultation shall be documented in writing by the residence. If a resident is determined by his or her physician not to be in need of home care services, as documented in the medical evaluation or otherwise, the participation of a home care services agency in the development of the individualized service plan shall not be necessary.

(3) The individualized service plan shall be developed in accordance with the medical, nutritional, rehabilitation, functional, cognitive and other needs of the resident and shall be implemented within 30 days of admission of the resident.

(4) The individualized service plan shall include the services to be provided, and how and by whom services will be provided and accessed.

(5) The individualized service plan shall be reviewed and revised every six months and whenever ordered by the resident's physician or as frequently as necessary to reflect the changing care needs of the residents. To the extent necessary, such review and revision shall be undertaken in consultation with the resident's physician.

(l) No residence or agent, consultant, employee or representative thereof, shall make any payment to any party as compensation for referring a resident for admission without having obtained a signed agreement with the referring party, that provides that:

(1) the referring party will be compensated by the referred residence; and

(2) the referring party is responsible for disclosing to its clients that the referring party will be compensated by the referred residence.