Virginia Assisted Living Providers Prepare for New Regulations

This regulatory action is a joint action to repeal the existing regulation for licensed assisted living facilities, 22VAC40-72, and adopt a new regulation, 22VAC40-73 to replace it. The new regulation is to be a comprehensive revision of the existing standards. A comprehensive revision is needed to provide greater protection for adults in care, improve the organization of the standards, increase clarity and consistency, and eliminate unnecessarily burdensome or intrusive requirements. The goals of the new regulation are to better meet the needs of an increasingly vulnerable population of residents who are aged, infirm or disabled and to do so in a cost effective manner.

The regulations will be published in the Virginia Register of Regulations.

The final regulations are detailed and include multiple education and training requirements for assisted living staff and  substantive provisions impacting assisted living facilities, including:

Infection Prevention and Control

Assisted living facilities are required to develop and implement an enhanced infection control program:

A staff person who has been trained in basic infection prevention shall participate in the annual review and serve as point of contact for the program. This person shall be responsible for on-going monitoring of the implementation of the infection control program.

The infection control program shall be applicable to all staff and volunteers and encompass all services as well as the entire premises.

The infection control program with procedures for the implementation of infection prevention measures by staff and volunteers to include:
Use of standard precautions;
Use of personal protective equipment; and
Means to ensure hand hygiene.

Determination of whether prospective or returning residents have acute infectious disease and use of appropriate measures to prevent disease transmission;
Use of safe injection practices and other procedures where the potential for exposure to blood or body fluids exists;
Blood glucose monitoring practices that are consistent with CDC recommendations. When assisted blood glucose monitoring is required, fingerstick devices shall not be used for more than one person;

The handling, storing, processing, and transporting of linens, supplies, and equipment in a manner that prevents the spread of infection;

Initial training as specified in and annual retraining of staff and volunteers in infection prevention methods, as applicable to job.

Administrators who are not registered medication aides, but supervise medication aides, must receive annual training in medication administration.

Education and Training

Annual training hours for direct care staff will be increased to 14 hours for facilities licensed for residential care only and 18 hours for facilities licensed for residential and assisted living care.

There is an exception for licensed health care professionals who are only required to attend 12 hours of training.

First aid and CPR certification must be present in each building of the assisted living facility, not merely on the premises.

Assisted living facilities are required to conduct a “fall risk rating” for residents meeting the criteria for assisted living services.

Any staff member completing a resident’s individualized service plan will be required to complete uniform assessment instrument training.

Updated rules for health care oversight to reduce the number of times health care oversight must occur annually if the facility employs a full-time licensed health care professional. It also requires that all residents be included annually for health care oversight, the evaluation of those residents who self-administer medication to determine if they can continue doing so safely, and additional oversight of restrained residents.

Prohibition on assisted living facilities from restricting visiting hours unless a resident chooses to do so.

Snacks must be made available to residents at all times. Reduced number of times that oversight of special diets must occur each year.

Facilities are permitted to maintain a master list of staff who administer medications instead of individualized medication administration documentation.

Prohibition of certain additional types of restraints. The regulation also requires a facility to review and revise a resident’s individualized service plan after the use of emergency restraints.

Residents are permitted to determine not to have certain furnishings in their room, even if the furniture would otherwise be required.

Residents residing alone in a bedroom with a thermostat may determine the temperature, even if it differs from what would otherwise be required.

Prohibition of more than two residents per bedroom for any new facility licensee.

The individualized service plan must reflect when residents are unable to use the call/signaling system and the frequency of rounds to check on the resident. The assisted living facility must conduct rounds a minimum of every two hours to check on residents after bed time unless a specified exception exists.

Requirement for a semi-annual review of the facility’s emergency plan with staff, residents, and volunteers.

First aid kits must be present in each building, and the facility must maintain 48 hours’ worth of emergency food and water.

Resident emergency procedures must be reviewed with all staff every six months, and the resident emergency practice exercise required every six months must be performed by the staff on duty at the time.

Elimination of the exception for facilities licensed for less than ten residents (with no more than three having serious cognitive impairment) from the requirements of mixed population. 

Increased training requirements for residents with cognitive impairment for direct care staff.

Increased number of hours per week of activities for residents in a safe, secure environment.

At least two direct care staff members are required to be on duty and awake when there are 20 or fewer residents present in a special care unit. An additional staff member is required for every additional ten residents or any portion thereof.

The administrator is required to have additional hours of cognitive impairment training.

Final regulations are available for review online at:  http://townhall.virginia.gov/L/ViewXML.cfm?textid=11359