§ 21.55. AAA placement activities.
(a) Limitation.
(1) In a home which is certified on or after January 6, 1990 or which had a certified capacity of three or fewer clients under a certification or recertification made prior to January 6, 1990, the AAA shall conduct its placement activities so that no more than three clients reside in the home at one time.
(2) A domiciliary care home which had a certified capacity of four or more clients prior to January 6, 1990 may continue to operate with more than three clients, if applicable State and local laws are observed in conjunction with the applicable sections of this chapter.
(b) Selection of home. The AAA shall, in consultation with the specialized service agency having primary care management responsibilities, if one has been assigned, select a home for the client from the central registry of certified domiciliary care homes located in the PSA.
(c) Approval required. The domiciliary care home selected shall have the approval of the client prior to placement. Recipients of SSI shall be given the opportunity to accept placement in a domiciliary care home, subject to provider approval, prior to the offering of placement to private pay clients.
(d) Provider approval. The client selected for the domiciliary care home shall have the approval of the provider prior to placement.
(e) Department certification. The domiciliary care home shall have been certified by the Department under § 21.28 (relating to provider application and home certification process).
(f) Follow-up by other agency. In selecting a domiciliary care home for a client, the AAA shall insure, if the follow-up is to be assigned to another agency, that every effort is made to minimize the number of agencies and staff which will be relating to a single domiciliary care home.
(g) Visit prior to placement. A visit shall be made to the domiciliary care home by the client and the designated agency staff person responsible for the placement prior to placement for the purpose of acquainting the client with the home, the provider and the surrounding community. During this visit, the rights and responsibilities of both the client and the provider shall be reviewed by the designated staff person in the presence of the client and provider. Other elements necessary for a successful placement shall also be reviewed prior to placement, including the following:
(1) Client and provider preferences.
(2) Acceptable behaviors.
(3) Smoking and consumption of alcohol.
(4) Pets.
(h) Decision by client. The decision of the client to accept or reject the placement shall be made following the visit and out of the presence of the provider. The AAA is required to show only a reasonable number of homes to a client before placement activity with that client is suspended.
(i) Notification of impending move. If appropriate, the AAA shall encourage and assist the client in notifying all concerned; for example, the client’s family or designate and the post office, of the impending move to a domiciliary care home.
(j) Information to provider. The AAA shall provide the domiciliary care home provider with the following written information about a client:
(1) Name.
(2) Sex.
(3) Date of birth.
(4) Social security number.
(5) Religious affiliation, if the client chooses to disclose.
(6) Date of entry into the home.
(7) The name of the referring agency.
(8) The names, addresses and telephone numbers of the client’s family.
(9) The name and telephone number of the person to be called in case of emergency.
(10) A copy of the provider/client agreement.
(11) An inventory of personal property which the client brings to the facility, on an inventory form developed by the AAA.
(12) Dietary restrictions.
(13) A full disclosure of medical problems or history of medical problems.
(14) Medication regimen.
(15) The name and telephone number of the client’s personal physician and dentist. In the absence of a personal physician or dentist, the client shall participate in the selection of a physician or dentist.
(16) The guardian’s name, address and telephone number, if applicable.
(k) Follow-up agency and information. The AAA shall inform the provider, in writing, of the agency and person responsible for follow-up and the telephone number of the person or agency responsible for follow-up.
(l) Placement. A mutually agreeable time and date for the placement shall be determined by the provider, the client and the agency responsible for placement. The agreement between the client and the provider shall be developed and completed at the time of placement on a form provided by the Department.
(m) Domiciliary care house rule approval. The AAA shall, before placement, approve the house rules of the domiciliary care home and assure that the client has a written copy of the rules and that the rules are explained to the client. The house rules shall be incorporated into the agreement between the client and provider specified in § 21.75 (relating to the client and provider agreement). The house rules shall, at a minimum, contain an agreement outlining when the client is expected to be present in the home and when the client is expected to be away from the home. The purpose of this agreement is to allow the client and provider the necessary freedom to participate in activities not related to the domiciliary care home. A dispute regarding the interpretation of house rules shall be decided by the AAA.
(n) Follow-up assessment. Follow-up, ongoing assessment and monitoring of the care plan and placement shall be conducted as follows:
(1) The AAA shall evaluate or designate another agency to evaluate the client’s adjustment to the domiciliary care home within 15 days of the placement and shall insure that indicated modifications to the care plan are made. Follow-up of a client placed in a domiciliary care home shall be performed by a home visit at least once every 6 months thereafter, the results of which shall be recorded in writing.
(2) An evaluation shall include a visit to the home and shall be based on discussion with the client outside the provider’s presence, and then with the client and provider together.
(3) The AAA shall reassess the continuing adequacy of the placement and care plan at least every 6 months using the reassessment form provided by the Department and shall insure that indicated modifications are made to the care plan. Additionally, when the care plan calls for the provider to manage a client’s financial affairs under § 21.81(c) (relating to provider financial accountability), the AAA shall review the financial records of the provider at 6-month intervals.
(4) A complete and comprehensive reassessment of need, utilizing forms prescribed by the Department, shall be performed annually, at minimum, or more frequently, as may be indicated by a significant change in the client’s health or a demonstrated change in the client’s level of functioning.
(5) If the follow-up, ongoing assessment and monitoring of the placement is performed by an agency other than the AAA, the AAA shall obtain periodic reports and otherwise monitor these activities to insure that they are being performed.
(o) Notification upon unusual incident. The AAA shall notify promptly the client’s family or designate, if these persons are available, in the event of an unusual incident involving the client.
(p) Investigation of reports. A report of an unusual incident in the domiciliary care home shall be thoroughly investigated by representatives of the AAA as follows:
(1) The investigation shall include a home visit which shall take place within 72 hours of the date the report was received by the AAA. One copy of the investigation report shall be kept by the AAA as part of the case record and one copy sent to the agency with primary care plan responsibilities, if this agency is not the AAA.
(2) Investigations performed by the AAA as part of a protective services intervention under the Older Adults Protective Services Act (35 P. S. § § 10211—10224) and Chapter 15 (relating to protective services for older adults) satisfy the requirements in paragraph (1).
(q) Grounds for removal and decertification. One or more of the following reported and documented occurrences shall be grounds for removal and relocation of the client from a domiciliary care home and, if appropriate, decertification of the home or removal of provider eligibility by the AAA:
(1) Neglect, mistreatment or physical or mental abuse of a client.
(2) Violation of a client’s rights as cited in § 21.91 (relating to client rights).
(3) Failure of the provider to comply with § 21.26 or § § 21.71—21.83 (relating to provider rights and responsibilities), or the domiciliary care home’s failure to meet the standards in § 21.27 or § 21.28 (relating to domiciliary care home certification and recertification standards; and provider application and home certification process).
(4) Relocation for the client’s physical or mental health and welfare when it is determined, in consultation with the client, to be necessary.
(5) A client becomes nonmobile. In this case, the provider shall immediately inform the AAA and make arrangements for the client to be examined by a physician. If the physician finds that the medical and health needs of the client cannot be met in the domiciliary care home, the AAA and provider shall cooperate to transfer the client to the appropriate level of care. The AAA shall ensure the safety of the client pending transfer to the appropriate level of care by providing or making available other services and supports considered necessary or appropriate by the AAA.
(r) Neglect, mistreatment or abuse of client. Reports of neglect, mistreatment or abuse shall be made as follows:
(1) The AAA shall report to the Department, within 72 hours, a documented instance of client neglect, mistreatment or abuse, or a major fire or structural damage in a domiciliary care home and an associated client injury or death.
(2) Reports which are related to protective services cases and are made by the AAA under the Older Adults Protective Services Act and Chapter 15 satisfy the requirements in paragraph (1).
(s) Relocation of client. The AAA is responsible for the relocation of a client in the event of home closure. However, with regard to joint certifications, the agency which has primary care plan responsibility for a client is responsible for relocation of that client.
(t) Relatives excluded. The AAA may not place a client into the home of a provider who is a relative of that client.
Cross References This section cited in 6 Pa. Code § 21.33 (relating to decertification of domiciliary care homes and removal of provider eligibility); 6 Pa. Code § 21.60 (relating to recordkeeping); 6 Pa. Code § 21.75 (relating to client and provider agreement); 6 Pa. Code § 21.77 (relating to provider and AAA related activities); and 6 Pa. Code § 21.91 (relating to client rights).
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