Section 1057.3 - Rules and regulations for personal care home and assisted living residences(a) The rules and regulations for the licensing of personal care homes and assisted living residences promulgated by the department shall require that: (1)(i) Prior to a resident's admission to a personal care home or assisted living residence, an initial standardized screening instrument be completed for that resident by the provider or a human service agency. Such standardized screening instrument shall be developed by the department.(ii) For a personal care home, the screening will be done to determine that the potential resident does not require the services in or of a long-term care facility and whether the potential resident requires the services of a personal care home and, if so, the nature of the services and supervision necessary.(iii) For an assisted living residence, the screening will be done to determine whether the potential resident requires the services provided by an assisted living residence. A resident who currently does not require assistance in obtaining supplemental health care services, but who may require such services in the future or who wishes to obtain assistance in obtaining such services or reside in a facility in which such services are available, may be admitted to the assisted living residence, provided the resident is only provided service required or requested by the resident. Where services are required, the assisted living residence shall develop a support plan as defined in 55 Pa. Code § 2600 (relating to personal care homes) and any other regulations applicable to assisted living residences.(iv) An initial screening shall not be required to commence supplemental health care services to a resident of an assisted living residence who was not receiving such services at the time of the resident's admission, to transfer a resident from a portion of an assisted living residence that does not provide supplemental health care services to a portion of the residence that provides such service or to transfer a resident from a personal care home to an assisted living residence licensed by the same operator.(2) In addition to the screening, each resident receive a complete medical examination by a physician prior to, or within thirty days of, admission and that once admitted, each resident receive a screening and medical evaluation at least annually.(3) A personal care home or assisted living residence administrator refer an applicant whose needs cannot be met by the home or residence to an appropriate assessment agency.(3.1) Prospective or current residents for whom placement in a skilled nursing facility is imminent shall be given priority for assisted living residence services funded through a home-and community-based waiver.(3.2) All individuals receiving services under the home-and community-based waivers shall have a comprehensive assessment of their needs using an instrument that provides comparable data elements and at comparable time intervals as specified by the State for Medicaid for nursing facilities.(4) Each resident be provided by the administrator with notice of any Class I or Class II violations uncorrected after five days.(5) All residents sign a standard written admission agreement which shall include the disclosure to each resident of the actual rent and other charges for services provided by the personal care home or assisted living residence.(6) For residents eligible for Supplemental Security Income (SSI) benefits, actual rent and other charges not exceed the resident's actual current monthly income reduced by a personal needs allowance for the resident in an amount to be determined by the department, but not less than twenty-five dollars ($25).(7) A personal care home or assisted living residence not seek or accept any payments from a resident who is a Supplemental Security Income (SSI) recipient in excess of one-half of any funds received by the resident under the act of March 11, 1971 (P.L. 104, No. 3), known as the "Senior Citizens Rebate and Assistance Act."(8) A personal care home or assisted living residence not seek or accept from a resident who is eligible for Supplemental Security Income (SSI) benefits any payment from any funds received as lump sum awards, gifts or inheritances, gains from the sale of property, or retroactive government benefits: Provided, however, That an owner or operator may seek and accept payments from funds received as retroactive awards of Social Security or Supplemental Security Income (SSI) benefits, but only to the extent that the retroactive awards cover periods of time during which the resident actually resided in the personal care home or assisted living residence.(9) Each resident who is a recipient of, or an eligible applicant for, Supplemental Security Income (SSI) benefits be provided, at no additional charge to the resident, necessary personal hygiene items and personal laundry services. This requirement does not include cosmetic items.(10) All residents may leave and return to a personal care home or assisted living residence, receive visitors, have access to a telephone and mail and participate in religious activities.(11) Personal care home and assisted living residence owners, administrators or employees be prohibited from being assigned power of attorney or guardianship for any resident.(12) Each assisted living residence demonstrate the ability to provide supplemental health care services in a manner duly protective of the health, safety and well-being of its residents utilizing employes, independent contractors or contractual arrangements with other health care facilities or practitioners licensed, registered or certified to the extent required by law to provide such service. To the extent prominently disclosed in a written admission agreement, an assisted living residence may require residents to use providers of supplemental health care services designated by the assisted living residence.(13) A personal care home not provide supplemental health care services to residents, provided, however, that a personal care home may assist residents in obtaining health care services in the manner provided by 55 Pa. Code §§ 2600.29 (relating to hospice care and services), 2600.142 (relating to assistance with health care) and 2600.181 (relating to self-administration) through 2600.191 (relating to medications) or as otherwise provided by regulations adopted by the department not inconsistent with the requirements of this section.(b) Subject to subsection (a)(13), the department shall not prohibit immobile persons who do not require the services of a licensed long-term care facility from residing in a personal care home, provided that appropriate personal care services and health care services are available to the resident and the design, construction, staffing or operation of the personal care home allows for safe emergency evacuation. Persons requiring the services of a licensed long-term care facility, including immobile persons, may reside in an assisted living residence, provided that appropriate supplemental health care services are provided such residents and the design, construction, staffing and operation of the assisted living residence allows for their safe emergency evacuation.(c) For consumers with Alzheimer's disease or dementia, or where the assisted living residence holds itself out to the public as providing services or housing for consumers with cognitive impairments, assisted living residences shall disclose to consumers and provide: (1) The residence's written statement of its philosophy and mission which reflects the needs of consumers with cognitive impairments.(2) A description of the residence's physical environment and design features to support the functioning of consumers with cognitive impairments.(3) A description of the frequency and types of individual and group activities designed specifically to meet the needs of consumers with cognitive impairments.(4) A description of security measures provided by the residence.(5) A description of training provided to staff regarding provision of care to consumers with cognitive impairments.(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 consumer, including methods by which the plan of services will remain responsive to changes in the consumer's condition.(d) Cognitive support services.--(1) An assisted living residence shall provide to consumers with cognitive impairments cognitive support services, including dementia-specific activity programming.(2) Assisted living residences shall identify measures to address consumers with cognitive impairments who have tendencies to wander.(3) If national accreditation of secured assisted living residences for persons in need of cognitive support services becomes available, the department may deem all assisted living residences accredited by accrediting bodies that have standards that equal or exceed those in this act and regulations as meeting the special care designation under this act.(e) An assisted living residence may not admit, retain or serve a consumer with any of the following conditions or health care needs unless an exception, upon the written request of the assisted living residence, is granted by the department: (1) Ventilator dependency.(2) Stage III and IV decubiti and vascular ulcers that are not in a healing stage.(3) Continuous intravenous fluids.(4) Reportable infectious diseases, such as tuberculosis, in a communicable state that require isolation of the consumer or require special precautions by a caretaker to prevent transmission of the disease unless the Department of Health directs that isolation be established within the assisted living residence.(7) Continuous skilled nursing care twenty-four hours a day.(f) Any of the following individuals may certify that a consumer may not be admitted or retained in an assisted living residence and the department shall by regulation establish the standards required for the certification:(1) The assisted living residence administrator acting in consultation with supplemental health care providers.(2) A consumer's physician or certified registered nurse practitioner.(3) The medical director of the assisted living residence.(g) An assisted living residence may admit, retain or serve a consumer for whom a determination is made by the department, upon the written request of the assisted living residence, that the consumer's specific health care needs can be met by a provider of assisted living services or within an assisted living residence, in conformity with standards set by the department through regulation, including a consumer requiring: (1) gastric tubes, except that a determination shall not be required if the consumer is capable of self-care of the gastric tube or a licensed health care professional or other qualified individual cares for the gastric tube;(2) tracheostomy, except that a determination shall not be required if the consumer is independently capable of self-care of the tracheostomy;(3) skilled nursing care twenty-four hours a day, except that a determination shall not be required if the skilled nursing care is provided on a temporary or intermittent basis;(4) a sliding scale insulin administration, except that a determination shall not be required if the consumer is capable of self-administration or a licensed health care professional or other qualified individual administers the insulin;(5) intermittent intravenous therapy, except that a determination shall not be required if a licensed health care professional manages the therapy;(6) insertions, sterile irrigation and replacement of a catheter, except that a determination shall not be required for routine maintenance of a urinary catheter if the consumer is capable of self-administration or a licensed health care professional administers the catheter;(7) oxygen, except a determination shall not be required if the consumer is capable of self-administration or a licensed health care professional or other qualified individual administers the oxygen;(8) inhalation therapy, except that a determination shall not be required if the consumer is capable of self-administration or a licensed health care professional or other qualified individual administers the therapy;(9) other types of supplemental health care services that an assisted living residence administrator, acting in consultation with supplemental health care providers, determines can be provided in a safe and effective manner by the assisted living residence; or(10) other types of care that can be provided in a safe and effective manner in an assisted living residence as determined by regulations adopted by the department.(h)(i) Subject to subsection (a)(12), an assisted living residence may admit or retain a resident who does not require supplemental health care services or who, subject to any restrictions provided in the written resident agreement, makes alternative arrangements for such services.(ii) Portions or sections of an assisted living residence may be designated for use by residents not requiring supplemental health care services, or an assisted living residence may provide services both to residents receiving supplemental health care services and to residents not receiving such service within the same portions or sections of the assisted living residence.(i) No person, organization or program shall use the term "assisted living" in any name or written material, except as a licensee in accordance with this article.1967, June 13, P.L. 31, No. 21, art. 10, § 1057.3, added 1988, Dec. 21, P.L. 1883, No. 185, § 6, imd. effective. Amended 2007, July 25, P.L. 402, No. 56, §7, effective in 90 days [ 10/23/2007].