SPECIAL CARE UNITS
§ 2800.231. Admission.
(a) Special care units. This section and § § 2800.232—2800.239 apply to special care units. These provisions are in addition to the other provisions of this chapter. A special care unit is a residence or portion of a residence that provides one or both of the following:
(1) Specialized care and services for residents with Alzheimer’s disease or dementia in the least restrictive manner consistent with the resident’s support plan to ensure the safety of the resident and others in the residence while maintaining the resident’s ability to age in place.
(i) Admission of a resident shall be in consultation with the resident’s family or designated person.
(ii) Prior to admission other service options that may be available to a resident shall be considered.
(2) Intense neurobehavioral rehabilitation for residents with severely disruptive and potentially dangerous behaviors as a result of brain injury in the least restrictive manner consistent with the resident’s rehabilitation and support plan to ensure the safety of the resident and others in the residence.
(i) Each resident of a special care unit for INRBI shall have a rehabilitation and support plan that supports independence and promotes recovery and thereby discharge to a less restrictive setting.
(ii) Special care units for INRBI shall provide for each resident to age in place.
(iii) Admission of a resident shall be in consultation with the resident or potential resident and, when appropriate, the resident’s designated person or the resident’s family, or both.
(iv) Prior to admission other less restrictive service options that may be available to a resident or potential resident shall be considered.
(b) Medical evaluation. A resident or potential resident shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior to admission.
(1) Documentation for a special care unit for residents with Alzheimer’s disease or dementia must include the resident’s diagnosis of Alzheimer’s disease or dementia and the need for the resident to be served in a special care unit.
(2) Documentation for a special care unit for INRBI must include the resident’s or potential resident’s diagnosis of brain injury and need for residential services to be provided in a special care unit for INRBI. The evaluation must include visual function, hearing, swallowing, mobility and hand function.
(c) Preadmission screening.
(1) Special care unit for residents with Alzheimer’s disease or dementia.
(i) A written cognitive preadmission screening completed in collaboration with a physician or a geriatric assessment team and documented on the Department’s cognitive preadmission screening form shall be completed for each resident within 72 hours prior to admission to a special care unit.
(ii) A geriatric assessment team is a group of multidisciplinary specialists in the care of adults who are older that conducts a multidimensional evaluation of a resident and assists in developing a support plan by working with the resident’s physician, designated person and the resident’s family to coordinate the resident’s care.
(2) Special care unit for INRBI.
(i) A written CPB preadmission screening completed in collaboration with a physician, neuropsychologist or cognitive, physical, behavioral assessment team and documented on the Department’s CPB preadmission screening form shall be completed for each resident or potential resident within 72 hours prior to admission to a special care unit for INRBI.
(ii) A cognitive, physical, behavioral specialist with brain injury experience shall assist in developing a rehabilitation and support plan by working with the resident’s physician, neuropsychologist and, when appropriate, the resident’s designated person or the resident’s family, or both to develop the resident’s rehabilitation and support plan. This plan must include a high level of nursing and behavioral supervision, medication management, occupational therapy, cognitive therapy, behavioral therapy, vocational services, support for social reentry, and a personalized treatment plan.
(d) Resident admission to special care unit. Each resident record must have documentation that the resident or potential resident and, when appropriate, the resident’s designated person or the resident’s family have agreed to the resident’s admission or transfer to the special care unit.
(e) Additional assessments.
(1) In addition to the requirements in § 2800.225 (relating to additional assessments), residents of a special care unit for Alzheimer’s disease or dementia shall also be assessed quarterly for the continuing need for the special care unit for Alzheimer’s disease or dementia.
(2) In addition to the requirements in § 2800.225, residents of a special care unit for INRBI shall also be assessed at least semiannually or more frequently as necessary to assure the continuing need for residence in the special care unit for INRBI.
(f) Additional resident in special care unit. A spouse, friend or family member who does not have a primary diagnosis of Alzheimer’s disease or dementia or brain injury may reside in the special care unit if desired by the resident or his designated person.
(1) The spouse, friend or family member shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner, documented on a form provided by the Department within 60 days prior to admission to the residence or 15 days after admission to the residence.
(2) The spouse, friend or family member shall have access to and be able to follow directions for the operation of the key pads or other lock-releasing devices to exit the special care unit.
(g) Disclosure of services. The resident-residence contract specified in § 2800.25 (relating to resident-residence contract) must also include a disclosure of services, admission and discharge criteria, change in condition policies, special programming and costs and fees.
(h) Alzheimer’s disease or dementia. When the residence holds itself out to the public as providing services or housing for individuals with Alzheimer’s disease or dementia, the residence shall disclose to individuals and provide materials that include the following:
(1) The residence’s written statement of its philosophy and mission which reflects the needs of individuals with Alzheimer’s disease or dementia.
(2) A description of the residence’s physical environment and design features to support the functioning of individuals with Alzheimer’s disease or dementia.
(3) A description of the frequency and types of individual and group activities designed specifically to meet the needs of individuals with Alzheimer’s disease or dementia.
(4) A description of the security measures provided by the residence.
(5) A description of the training provided to staff regarding provision of care to individuals with Alzheimer’s disease or dementia.
(6) A description of availability of family support programs and family involvement.
(7) The process used for assessment and establishment of a plan of services for the individual, including methods by which the plan of services will remain responsive to changes in the individual’s condition.
(i) Special care unit for INRBI. When an assisted living residence holds itself out to the public as a special care unit for INRBI, the residence shall disclose and provide materials to individuals and, when appropriate, the individual’s designated person or the individual’s family, or both, that include the following information:
(1) The residence’s written statement of its philosophy and mission which reflects the needs of individuals with brain injury for intense neurobehavioral rehabilitation and support.
(2) A description of the residence’s physical environment and design features that support and promote the functioning and rehabilitation of individuals who need INRBI.
(3) A description of the types of individual and group activities that have been designed specifically to meet the requirements of the rehabilitation and support plans of specific residents with brain injury.
(4) A description of the security measures provided by the residence.
(5) A description of the credentials and experience required and the training provided to staff regarding the provision of rehabilitation and support for individuals who require INRBI.
(6) A description of availability of family support programs, family education programs, and family involvement.
(7) The process used for assessment and establishment of a plan of services for the resident, including methods by which the plan of services will remain responsive to progress in the resident’s recovery.
(j) Residents who wander. The residence shall identify measures to address individuals with Alzheimer’s disease or dementia or with INRBI who have tendencies to wander.
(k) Individuals with INRBI. The residence with a special care unit for INRBI shall identify measures to address individuals who require INRBI who have problems that may actually impede rehabilitation such as:
(1) Anger.
(2) Self-control.
(3) Aggression toward others.
(4) Self-injury.
(5) Deficient judgment and problem solving due to cognitive deficits.
(6) Frequent agitation.
(7) Prolonged confusional state.
(8) Seizure disorders and related behavioral problems.
(9) Significant memory and learning problems.
(10) Disruption of sleep and wake cycles.
(11) Problems with attention.
(12) Filtering and focusing.
(13) Emergence of mental health problems or exacerbation of preexisting mental health issues.
(14) Emergence of substance abuse problems or exacerbation of preexisting substance abuse issues.
(15) Other cognitive and behavioral problems which have or would prevent successful completion of traditional rehabilitation programs.
(l) Professionals caring for individuals requiring INRBI. The residence with a special care unit for INRBI shall identify at a minimum the following professionals with expertise in providing care for individuals requiring INRBI.
(1) Onsite behavioral specialist.
(2) Onsite cognitive rehabilitation therapist.
(3) A consulting physiatrist; a consulting neuro-psychologist.
(4) A consulting neuropsychiatrist or psychiatrist for prescribing and monitoring the psychiatric medications that may be needed for residents with behavioral health issues.
Cross References This section cited in 55 Pa. Code § 2800.202 (relating to prohibitions).
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