PRINTER'S NO. 282
No. 259 Session of 2005
INTRODUCED BY WATSON, HESS, PISTELLA, SATHER, E. Z. TAYLOR,
GINGRICH, ADOLPH, ARMSTRONG, BAKER, BALDWIN, BASTIAN, BEBKO-
JONES, CALTAGIRONE, CAPPELLI, CAWLEY, CORRIGAN, CRAHALLA,
CREIGHTON, FABRIZIO, FLICK, FREEMAN, GEIST, GEORGE,
GILLESPIE, GOODMAN, HARHART, HARPER, HENNESSEY, HERMAN,
JAMES, LEDERER, MANDERINO, McILHATTAN, MILLARD, NAILOR,
O'NEILL, PALLONE, PETRONE, PICKETT, REICHLEY, RUBLEY,
SANTONI, SCAVELLO, SCHRODER, B. SMITH, SOLOBAY, THOMAS,
TIGUE, WALKO, WRIGHT, J. EVANS, MAHER AND BROWNE,
FEBRUARY 8, 2005
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
FEBRUARY 8, 2005
AN ACT
1 Providing for the licensure and regulation of adult living
2 residences; conferring powers and duties on the Department of
3 Public Welfare; adding members to the Intra-Governmental
4 Council on Long-Term Care; providing for an increase to State
5 supplemental assistance for persons in personal care homes;
6 and providing for penalties.
7 The General Assembly finds and declares as follows:
8 (1) Assisted living residences and services are a
9 rapidly growing long-term care alternative across the nation.
10 (2) Assisted living residences are a combination of
11 housing and supportive services as needed. They are widely
12 accepted by the general public because they allow people to
13 age in place, maintain their independence and exercise
14 decision making and personal choice.
15 (3) Consumers continue to say that the three things they
1 want most are:
2 (i) to stay independent and live at home and in
3 their community as long as possible;
4 (ii) respect and dignity for the individual; and
5 (iii) a choice of long-term care and supportive
6 services options.
7 (4) In Pennsylvania, assisted living residences and
8 supportive services are a private market phenomenon. There
9 is:
10 (i) no uniform definition of assisted living
11 residence;
12 (ii) no public oversight of entities which hold
13 themselves out as assisted living residences, although
14 many are licensed as personal care homes;
15 (iii) no uniform way of assuring quality; and
16 (iv) limited access for persons with lower incomes.
17 (5) It is in the best interest of all Pennsylvanians
18 that a system of licensure and regulation be established for
19 assisted living residences in order to ensure accountability
20 and a balance of availability between institutional and home-
21 based and community-based long-term care for older persons
22 and persons with disabilities.
23 TABLE OF CONTENTS
24 Section 1. Short title.
25 Section 2. Definitions.
26 Section 3. Intra-Governmental Council on Long-Term Care.
27 Section 4. Powers and duties of Commonwealth departments and
28 agencies.
29 Section 5. Rules and regulations.
30 Section 6. Criminal history and reporting of suspected abuse.
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1 Section 7. License required.
2 Section 8. Application for license.
3 Section 9. Issuance of licenses.
4 Section 10. Standards for admission.
5 Section 11. Right to enter and inspect.
6 Section 12. Relocation of consumers in assisted living
7 residences.
8 Section 13. Assisted living residence administrators.
9 Section 14. Staff orientation and training in assisted living
10 residences.
11 Section 15. Staffing levels and training.
12 Section 16. Persons with special needs.
13 Section 17. Violations.
14 Section 18. Reasons for denial, nonrenewal or revocation of a
15 license.
16 Section 19. Licensure appeals.
17 Section 20. Effect of departmental orders.
18 Section 21. Actions against violations of law and regulations.
19 Section 22. Injunction or restraining order when appeal is
20 pending.
21 Section 23. Annual report.
22 Section 24. Legislative Budget and Finance Committee study.
23 Section 25. Committee regulation review.
24 Section 26. Increase to State supplemental assistance for
25 persons in personal care homes.
26 Section 27. Severability.
27 Section 28. Repeal.
28 Section 29. Effective date.
29 The General Assembly of the Commonwealth of Pennsylvania
30 hereby enacts as follows:
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1 Section 1. Short title.
2 This act shall be known and may be cited as the Adult Living
3 Residence License Act.
4 Section 2. Definitions.
5 The following words and phrases when used in this act shall
6 have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "Activities of daily living." Activities including eating,
9 bathing, dressing, toileting, transferring in and out of bed or
10 a chair and personal hygiene.
11 "Adult." A person who is 18 years of age or older.
12 "Adult living residence." A residential premises that
13 provides housing, food, assistance with activities of daily
14 living and scheduled or unscheduled supervision available on a
15 24-hour basis, through contract for more than three adults who
16 are unrelated to the operator of the residential premises and
17 who do not require care in a licensed long-term care nursing
18 facility as that term is defined in the act of July 19, 1979
19 (P.L.130, No.48), known as the Health Care Facilities Act,
20 regardless of whether the operator provides or allows
21 supplemental services such as additional assistance with
22 activities of daily living and intermittent health care services
23 provided by certified, registered or licensed health care
24 professionals. The term shall include a personal care home that
25 has a Category I license and an assisted living residence that
26 has a Category II license. The term shall not include
27 intermediate care facilities exclusively for the mentally
28 retarded, commonly referred to as ICF/MR.
29 "Adult living residency contract." A written agreement, in
30 the form of a contract or contracts between a provider and a
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1 consumer needing adult living residence services, regarding the
2 provision and terms of those services.
3 "Aging in place." The process of providing increased or
4 adjusted supportive services to a consumer to compensate for the
5 physical or mental decline that occurs with the aging process
6 over time in order to maximize individual dignity and
7 independence and to permit the person to remain in a familiar,
8 living environment of the person's choice for as long as
9 possible, where such supportive services are provided by a
10 licensed facility or a third party, in a home or community or
11 through volunteers, friends or family.
12 "Area agency on aging." The single local agency designated
13 by the Department of Aging within each planning and service area
14 to administer the delivery of a comprehensive and coordinated
15 plan of social and other services and activities.
16 "Assisted living." Activities as determined and self-
17 directed by a consumer or by a legal representative that permit
18 and assist the consumer to live in a community, including such
19 housing assistance or residency in an assisted living residence
20 that permits the consumer to safely be supported in a residence
21 in which the consumer's independence, dignity and ability to
22 make choices are maintained, to the extent of the consumer's
23 capabilities.
24 "Assisted living residence." A residential setting that:
25 (1) Offers, provides or coordinates a combination of
26 personal care services, recreation and social activities, 24-
27 hour supervision and assisted living services, whether
28 scheduled or unscheduled and that coordinates other health-
29 related services for consumers.
30 (2) Has a supportive service program and physical
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1 environment designed to minimize the need for consumers to
2 move within or from the setting in order to accommodate
3 changing needs and preferences.
4 (3) Has an organized mission, service programs and a
5 physical environment designed to maximize consumer dignity,
6 autonomy, privacy and independence and encourages family and
7 community involvement.
8 (4) Provides that costs for housing and services may be
9 independent of one another.
10 (5) Provides consumers with the ability to choose the
11 services to be provided, their service provider and the
12 services to the extent that the assisted living residence
13 does not offer particular services to consumers.
14 (6) Has a goal of fostering aging in place and promoting
15 consumer self-direction and active participation in decision
16 making while emphasizing consumer privacy and dignity.
17 (7) Will disclose services offered, provided or
18 coordinated and the costs thereof.
19 This term does not include a residential living unit maintained
20 by a continuing care provider who is certified by the Insurance
21 Department, a residential unit in a subsidized housing
22 apartment, unless required to be licensed under the Department
23 of Housing and Urban Development Assisted Living Conversion
24 Program, or a boarding home which merely provides room, board
25 and laundry services to persons who do not need personal care
26 services.
27 "Assisted living services." A combination of supportive
28 services, personal care services, personalized assistance
29 services, assistive technology and health-related services
30 designed to respond to the individual needs of consumers who
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1 need assistance with activities of daily living and instrumental
2 activities of daily living. The term may include publicly funded
3 home-based and community-based services available through the
4 medical assistance program and the Federal Medicaid Waiver
5 Program and State-funded options for home-based and community-
6 based services authorized through the Department of Aging and
7 the Department of Public Welfare.
8 "Assisted living services agreement." The contract or
9 contracts between a provider and a consumer needing assisted
10 living services regarding the provision and terms of the
11 assisted living services. This term includes contracts between
12 assisted living service providers and entities contracting for
13 services for consumers using public funding.
14 "Assistive technology." Devices and services, whether
15 medically necessary or not, that are used to increase, maintain
16 or improve the functional capabilities of persons with
17 disabilities which may or may not be needed to permit the
18 persons to live independently. The term shall include, but not
19 be limited to, reachers, adapted telephones, reading aids and
20 other nonmedical devices.
21 "Bureau." The Bureau of Hearings and Appeals within the
22 Department of Public Welfare of the Commonwealth.
23 "Category I license." An adult living residence license
24 issued under this act to a personal care home.
25 "Category II license." An adult living residence license
26 issued under this act to an assisted living residence.
27 "Cognitive support services." Services provided as part of a
28 comprehensive plan of care to individuals who have memory
29 impairments and other cognitive problems which significantly
30 interfere with their ability to carry out activities of daily
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1 living without assistance and who require that supervision,
2 monitoring and programming be available to them 24 hours a day,
3 seven days a week, in order for them to reside safely in the
4 setting of their choice. The term includes assessment, health
5 support services and a full range of dementia-capable activity
6 programming and crisis management.
7 "Comprehensive assessment." A thorough review and analysis
8 of a consumer's functional status. The term includes a personal
9 history, assessment of physical and emotional health, ability to
10 carry out activities of daily living, informal supports,
11 environmental factors and cognitive functioning, including
12 immobility assessment.
13 "Comprehensive service plan." A plan developed to meet a
14 consumer's individual needs, as determined by a comprehensive
15 assessment, and that is developed by an interdisciplinary team
16 that includes the consumer, the consumer's legal representative
17 and the consumer's family member.
18 "Consumer." A person who receives services in an adult
19 living residence, is in need of assisted living services or
20 personal care services and who lives in either an adult living
21 residence with a Category I license or a Category II license.
22 "Department." The Department of Public Welfare of the
23 Commonwealth.
24 "Direct service staff." A person who provides services in an
25 adult living residence, is 18 years of age or older and meets
26 the requirements of this act.
27 "Immobile person." An individual who is unable to move from
28 one location to another or has difficulty in understanding and
29 carrying out instructions without the continued full assistance
30 of another person or is incapable of independently operating a
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1 device such as a wheelchair, prosthesis, walker or cane to exit
2 to a point of safety.
3 "Instrumental activities of daily living." The term
4 includes, but is not limited to, meal preparation, using the
5 telephone, handling finances, banking and shopping, light
6 housekeeping, heavy housekeeping and getting to appointments.
7 "License." A Category I license or a Category II license.
8 "Long-term care ombudsman." An agent of the Department of
9 Aging who, pursuant to section 2203-A of the act of April 9,
10 1929 (P.L.177, No.175), known as The Administrative Code of
11 1929, investigates and seeks to resolve complaints made by or on
12 behalf of older individuals or adults with disabilities who are
13 consumers of adult living residences, which complaints may
14 relate to action, inaction or decisions of providers of assisted
15 living services or residences or of personal care homes or of
16 public agencies or of social service agencies or their
17 representatives and which complaints may adversely affect the
18 health, safety, welfare, interests, preferences or rights of
19 consumers.
20 "Options." The Long-Term Care Pre-Admission Assessment
21 Program and the Community Services for Nursing Facility
22 Eligibility Program administered by the Department of Aging and
23 operated by the local area agencies on aging.
24 "Personal care home." A premises in which food, shelter and
25 personal assistance or supervision are provided for a period
26 exceeding 24 hours for four or more consumers who are not
27 relatives of the operator of the premises, who do not require
28 the services in or of a licensed long-term care facility, but
29 who require assistance or supervision in such matters as
30 dressing, bathing, diet, financial management, evacuation of a
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1 residence in the event of an emergency or medication prescribed
2 for self-administration.
3 "Personal care services." Assistance or supervision in
4 dressing, bathing, diet, financial management or evacuation of a
5 consumer in a personal care home, in the event of an emergency,
6 or medication prescribed for self-administration.
7 Section 3. Intra-Governmental Council on Long-Term Care.
8 (a) Additional members.--In addition to the members
9 appointed to the Intra-Governmental Council on Long-Term Care in
10 accordance with section 212 of the act of June 13, 1967 (P.L.31,
11 No.21), known as the Public Welfare Code, the Governor shall
12 appoint four representatives of the assisted living community,
13 one of whom shall be an owner or administrator of a licensed
14 assisted living residence and one of whom shall be a consumer of
15 a licensed assisted living residence, one of whom shall be a
16 licensed provider of assisted living services and one of whom
17 shall be a consumer of assisted living services from a licensed
18 provider of assisted living services.
19 (b) Recommendations to be considered.--In developing rules
20 and regulations for licensure of assisted living residences, the
21 Department of Public Welfare shall work in cooperation with the
22 Department of Aging and shall take into consideration
23 recommendations of the Intra-Governmental Council on Long-Term
24 Care.
25 Section 4. Powers and duties of Commonwealth departments and
26 agencies.
27 (a) General rule.--Within one year of the effective date of
28 this act, the following Commonwealth departments shall work in
29 consultation and in cooperation with each other to develop a
30 program of licensure and regulation to govern adult living
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1 residences in this Commonwealth:
2 (1) The Department of Public Welfare shall serve as the
3 lead agency in the development and implementation of a
4 program for licensing and regulating adult living residences,
5 to include a Category I license and a Category II license.
6 The department shall coordinate with other State and local
7 agencies having statutory responsibilities relating to adult
8 living residences and providers of assisted living services.
9 (2) The Department of Aging shall formulate and provide
10 to the Aging and Youth Committee of the Senate and the Aging
11 and Older Adult Services Committee of the House of
12 Representatives, within one year of the effective date of
13 this act, recommendations for changes in existing State law
14 and regulations to extend provisions of the act of November
15 6, 1987 (P.L.381, No.79), known as the Older Adults
16 Protective Services Act, to adult living residences and
17 providers of assisted living services and the consumers
18 thereof.
19 (3) The Department of Health shall formulate and provide
20 to the Aging and Youth Committee of the Senate and the Aging
21 and Older Adult Services Committee of the House of
22 Representatives, within six months of the effective date of
23 this act, recommendations for changes in existing State law
24 and regulations to license providers of assisted living
25 services who are not already licensed by the department. Such
26 changes shall include, at a minimum, the following
27 components:
28 (i) The Department of Health shall license assisted
29 living services providers.
30 (ii) Direct service staff employed by assisted
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1 living services providers or providing direct care
2 services to consumers in their homes shall meet all
3 training and testing requirements in this act relating to
4 assisted living residences that are not specific to
5 assisted living residence care. Prior to start of
6 training and testing, the applicant shall pass a criminal
7 history background check conducted by the training and
8 testing agency. Direct service staff shall present to
9 assisted living services recipients documentation from
10 the Department of Health that they have passed a criminal
11 history check and have completed the required training.
12 (iii) Entities that do not provide personal care
13 services, but that solely provide assistance with
14 instrumental activities of daily living shall be exempt
15 from the requirements of this act.
16 (4) Within one year of the effective date of this
17 section, the Department of Labor and Industry shall
18 promulgate rules and regulations applicable to assisted
19 living residences in accordance with the act of November 10,
20 1999 (P.L.491, No.45), known as the Pennsylvania Construction
21 Code Act, and in accordance with this section. The
22 regulations shall apply to all assisted living residences not
23 currently licensed by the Department of Public Welfare as a
24 personal care home and to all personal care homes making an
25 application to the department for a Category II license.
26 (b) Construction.--Nothing in this section shall be
27 construed to preclude the role of any additional Commonwealth
28 departments or agencies in the licensing and regulation of adult
29 living residences, as designated by the Governor.
30 Section 5. Rules and regulations.
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1 The department shall promulgate rules and regulations for
2 adult living residences that:
3 (1) Provide that any regulations specifically related to
4 personal care homes, adopted prior to the effective date of
5 this act, set forth in 55 Pa. Code Ch. 2620 (relating to
6 personal care home licensing), and promulgated in accordance
7 with the act of June 13, 1967 (P.L.31, No.21), known as the
8 Public Welfare Code, shall continue to be applied to an owner
9 or administrator of a personal care home under a Category I
10 license. The department shall ensure consistency between such
11 currently existing regulations governing personal care homes
12 and any regulations promulgated in accordance with this act.
13 (2) Develop standards for a Category II license for
14 assisted living residences.
15 (3) Within 90 days of the effective date of this
16 section, adopt rules relating to the conduct of owners and
17 employees of assisted living residences relative to the
18 endorsement or delivery of public or private welfare, pension
19 or insurance checks by a consumer of an assisted living
20 residence.
21 (4) Within 90 days of the effective date of this
22 section, and in consultation with the Department of Aging,
23 the Department of Health, the Intra-Governmental Council on
24 Long-Term Care and the Personal Care Home Advisory Committee,
25 adopt rules for: classification of violations; enforcement
26 measures for violations, including closure of adult living
27 residences with extensive patterns of serious violations or
28 those which are found to have severe violations which
29 constitute a risk to safety of current or potential
30 residents; closure of adult living residences that have
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1 failed to obtain a license and that have residents receiving
2 services covered by this act; responding to the needs of
3 residents with cognitive impairments; and protecting
4 residents' rights. Such rules shall be in effect until the
5 adoption of final regulations that cover the same subject
6 matter.
7 (5) Exempt from regulation under this act boarding homes
8 which merely provide room, board and laundry services to
9 persons who do not need adult living residence services.
10 (6) Promote the cost efficiency and effectiveness of
11 visitations and inspections.
12 (7) Delegate to other state and local agencies, as
13 appropriate, responsibility for visitations, inspections,
14 referral, placement and protection of consumers residing in
15 adult living residences or receiving assisted living services
16 from a provider of assisted living services.
17 (8) Evaluate the State's fire and panic laws as applied
18 to adult living residences.
19 (9) Create a uniform standard policy for the discharge
20 of a consumer from an adult living residence, including, at a
21 minimum, advance notice provisions for the consumer.
22 (10) Create a listing of medical conditions or care
23 needs that shall preclude adult living residences from
24 admitting or retaining consumers whose service needs exceed
25 the level of those services available at Category I or
26 Category II residences.
27 (11) Provide for the implementation of fire and safety
28 and consumer care standards relating to adult living
29 residences by cities of the first class, second class and
30 second class A.
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1 (12) Ensure that any regulations established in
2 accordance with this section shall be consistent with
3 regulations of the department relating to the funding of
4 residential care for the mentally ill or mentally retarded
5 adults and any regulations of the Department of Aging
6 relating to domiciliary care.
7 (13) Develop standards and qualifications for assisted
8 living residence administrators.
9 (14) Develop standards for orientation and training for
10 all direct service staff in an assisted living residence.
11 (15) Provide for the posting in adult living residences
12 of information regarding the Long-Term Care Ombudsman
13 Program, including the process whereby the services of the
14 local ombudsman can be readily accessed including the
15 telephone number, and name of the contact person. Such
16 information shall be posted in a conspicuous location that is
17 readily accessible and shall be presented in a form easily
18 understood and read by consumers.
19 (16) Develop standards, for admission to adult living
20 residences and for provision of assisted living services,
21 including:
22 (i) Completion of a comprehensive assessment process
23 and development of a comprehensive service plan for each
24 consumer.
25 (ii) Requirements for information which must be
26 provided to consumers of adult living residences and
27 assisted living services.
28 (iii) Requirements for adult living residency
29 contracts, including development of a standardized adult
30 living residency contract.
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1 Section 6. Criminal history and reporting of suspected abuse.
2 The requirements of Chapters 5 and 7 of the act of November
3 6, 1987 (P.L.381, No.79), known as the Older Adults Protective
4 Services Act, shall apply to adult living residences and
5 providers of assisted living services.
6 Section 7. License required.
7 No person shall establish, maintain, operate or hold itself
8 out as authorized to establish, maintain or operate:
9 (1) A personal care home without first having obtained a
10 Category I license issued by the department.
11 (2) An assisted living residence without first having
12 obtained a Category II license issued by the department.
13 Section 8. Application for license.
14 (a) Submission to department.--Any provider desiring to
15 secure a Category I license or Category II license shall submit
16 an application on a form prescribed by the department and shall
17 submit any other information required by the department.
18 (b) Fees.--The following fee shall accompany an application
19 for a license or for renewal of a license until modified by the
20 department by regulation:
21 (1) Residences with less than 20 beds - $50.
22 (2) Residences with 20-50 beds - $100.
23 (3) Residences with 51-100 beds - $250.
24 (4) Residences with more than 100 beds - $500.
25 Section 9. Issuance of licenses.
26 A license issued by the department under this act shall:
27 (1) Be issued for a period not to exceed one year.
28 (2) Be issued only to the applicant.
29 (3) Be issued only when the applicant has achieved
30 compliance with the rules and regulations of the Commonwealth
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1 departments provided for under sections 4 (relating to powers
2 and duties of Commonwealth departments and agencies) and 5
3 (relating to rules and regulations).
4 (4) Not be transferable unless the department approves
5 the transfer of license. The department may deny transfers to
6 friends, relatives or business associates, if it appears that
7 the purpose of the transfer is to avoid licensure action or
8 if it appears that the previous owner will continue to have
9 involvement in the residence or business.
10 (5) Be posted at all time in a conspicuous and readily
11 accessible place on the premises of the adult living
12 residence.
13 Section 10. Standards for admission.
14 The rules and regulations for the licensing of adult living
15 residences promulgated by the department not later than one year
16 after the effective date of this section shall provide that:
17 (1) Prior to admission to an adult living residence, an
18 initial standardized screening instrument shall determine the
19 appropriateness of the admission and shall be completed for
20 all consumers. This standardized screening instrument shall
21 be developed by the Department of Public Welfare, in
22 cooperation with the Department of Aging, the Department of
23 Health and the Intra-Governmental Council on Long-Term Care.
24 In no way shall the utilization of this standardized
25 instrument be in lieu of an options assessment for any
26 consumer who may need publicly funded services.
27 (2) In addition to the screening, a medical evaluation
28 shall be completed and signed by a physician prior to
29 admission to an adult living residence, using a form approved
30 by the department. Thereafter, an annual screening and a
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1 medical evaluation shall be administered to each consumer
2 annually and when there is a significant change in condition
3 of the consumer. A subsequent screening and evaluation may be
4 prompted by a request from the consumer, the residence, the
5 consumer's family or their legal representative, where
6 applicable.
7 (3) Following completion of a comprehensive assessment,
8 an appropriately trained person at the residence shall work
9 in cooperation with an interdisciplinary team that includes
10 the consumer, the consumer's legal representative or the
11 consumer's family member to develop a written comprehensive
12 service plan consistent with the consumer's unique physical
13 and psychosocial needs with recognition of the consumer's
14 capabilities and preferences.
15 (4) Adult living residences may not admit a consumer
16 before a determination has been made that the needs of the
17 consumer can be met based upon:
18 (i) The completed screening instrument.
19 (ii) The medical evaluation report.
20 (iii) An interview between the adult living
21 residence and the consumer, and if applicable, the
22 consumer's family, legal representative, or both.
23 (5) Assisted living residences with a Category II
24 license shall:
25 (i) Foster aging in place and promote consumer self-
26 direction and active participation in decision making
27 while emphasizing a consumer's privacy and dignity.
28 (ii) Permit consumers to live independently in the
29 residential environment of their choice with privacy and
30 dignity.
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1 (iii) Promote integration of consumers into the
2 community and participation in the mainstream of
3 activities.
4 (iv) Maximize consumer choice to promote and support
5 the consumer's changing needs and preferences.
6 (v) Be consumer oriented and meet professional
7 standards of quality.
8 (6) An assisted living residence administrator shall
9 refer a consumer whose needs cannot be met by an assisted
10 living residence for a standardized screening.
11 (7) A comprehensive service plan shall be on file for
12 each consumer and shall be strictly adhered to in the
13 provision of care and services provided to the consumer.
14 (8) Each consumer, or the consumer's legal
15 representative, shall receive an information packet at the
16 time of application which shall include the following items,
17 to be presented in a form easily understood and read by the
18 consumer:
19 (i) A copy of the adult living residence's policies.
20 (ii) Advance directive information, including
21 information on the right to have or not have an advance
22 directive.
23 (iii) Information regarding licensure status.
24 (iv) Telephone numbers of the local long-term care
25 ombudsman program and the local area agency on aging.
26 (v) A copy of the adult living residency contract
27 used by the adult living residence and all rates charged.
28 (vi) A copy of the internal complaint resolution
29 mechanism used by the adult living residence.
30 (vii) A disclosure stating the rights of consumers
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1 under this act.
2 (viii) Information regarding the discharge policy of
3 the adult living residence.
4 (9) All consumers shall receive a standard written adult
5 living residency contract which shall include the actual rent
6 and other charges for services provided by the adult living
7 residence. The contract shall also include a disclosure
8 statement which shall include the following:
9 (i) That the consumer shall have 24 hours from the
10 time of presentation to sign the contract.
11 (ii) That if the contract is signed upon
12 presentation, the consumer shall have 72 hours to rescind
13 the contract.
14 (10) A consumer shall have the right to leave and return
15 to the adult living residence, receive visitors, have access
16 to a telephone and mail and participate in religious
17 activities.
18 (11) Adult living residence owners, administrators and
19 direct service staff shall be prohibited from being assigned
20 power of attorney or guardianship for consumers.
21 Section 11. Right to enter and inspect.
22 (a) General rule.--The department shall have the right to
23 enter and inspect any adult living residence that is licensed or
24 required to be licensed under this act, with or without prior
25 notice. The department shall have the right to free and full
26 access to inspect and examine the assisted living residence and
27 its grounds and the records of the residence and the licensee.
28 The department shall also have immediate and full opportunity to
29 privately interview any member of the direct service staff. The
30 department shall contact the Long-term care ombudsman and shall
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1 utilize any consumer-related information available to be
2 provided by that office when conducting inspections under this
3 section.
4 (b) Initial licensure inspection.--Before an adult living
5 residence is licensed and permitted to open, operate or admit
6 residents and before assisted living services are provided to
7 consumers, it shall be inspected by the department and be found
8 in compliance with the requirements set forth in this act and
9 the resulting regulations.
10 (c) Annual unannounced inspections required.--The department
11 shall annually conduct at least one onsite, unannounced
12 inspection of each adult living residence.
13 (d) Special unannounced inspections.--Within 24 hours, upon
14 receipt of a complaint from any person alleging an immediate
15 serious risk to the health or safety of a consumer in an adult
16 living residence, the department shall conduct an onsite
17 unannounced inspection of the adult living residence. Complaints
18 prompting an inspection pursuant to this subsection may include
19 severe injury or death of a consumer in the adult living
20 residence, reports of abuse or conditions or practices that
21 create an immediate and serious risk to a consumer.
22 (e) Time period for unannounced inspections.--Except for
23 complaints under subsection (d), the department shall determine
24 the acceptable time period in which complaints shall be
25 investigated based upon the seriousness of the complaint.
26 (f) Annual report.--The department shall submit on an annual
27 basis a report to the Aging and Youth Committee of the Senate
28 and the Aging and Older Adult Services Committee of the House of
29 Representatives regarding the findings of the inspections
30 required by this section.
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1 (g) Administrative search warrants.--Notwithstanding the
2 inspection and access powers of the department under subsection
3 (a), upon showing probable cause that there is a violation of
4 this act or regulations under this act, a court of competent
5 jurisdiction or a district justice where the residence is
6 located shall issue an administrative search warrant to the
7 department. The warrant shall identify the address of the adult
8 living residence to be searched, the hours during which the
9 search will occur and any documents or objects to be seized.
10 Section 12. Relocation of consumers in assisted living
11 residences.
12 (a) Conditions.--Except as provided in subsection (c), the
13 department, in conjunction with appropriate local authorities,
14 shall relocate consumers from an assisted living residence if
15 any of the following conditions exist:
16 (1) The assisted living residence is operating without a
17 license.
18 (2) The licensee is voluntarily closing the assisted
19 living residence and relocation is necessary for the health
20 and safety of the consumers.
21 (3) The licensee is being involuntarily closed or has
22 engaged in conduct that endangers the health and safety of
23 consumers.
24 (b) Assistance.--The department shall offer relocation
25 assistance to consumers relocated under this section. Except in
26 an emergency, consumers shall be involved in planning their
27 transfer to another placement and shall have the right to choose
28 among the available alternative placements. The department may
29 make temporary placement until final placement can be arranged.
30 Consumers shall be provided with an opportunity to visit
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1 alternative placement before relocation or following temporary
2 emergency relocation. Consumers shall choose their final
3 placement and shall be given assistance in transferring to such
4 place.
5 (c) When prohibited.--Consumers may not be relocated
6 pursuant to this section if the department determines in writing
7 that such relocation is not in the best interest of the
8 consumers.
9 Section 13. Assisted living residence administrators.
10 (a) Appointment.--No later than 90 days after the effective
11 date of this act, all assisted living residences shall identify
12 and appoint an assisted living residence administrator or
13 administrators who meet, within one year of the effective date
14 of the regulations promulgated under section 5 (relating to
15 rules and regulations), at a minimum, the qualifications
16 provided in this section.
17 (b) Qualification.--An assisted living residence
18 administrator shall satisfy either of the following
19 qualifications:
20 (1) (i) be 21 years of age or older and be of good
21 moral character;
22 (ii) have a high school diploma or a GED
23 equivalency; and
24 (iii) have knowledge, education and training, as it
25 pertains to assisted living residences, in all of the
26 following:
27 (A) Fire prevention and emergency planning.
28 (B) First aid and cardiopulmonary resuscitation
29 (CPR) certification, medications, medical terminology
30 and personal hygiene.
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1 (C) Federal, State and local laws and
2 regulations.
3 (D) Nutrition, food handling and sanitation.
4 (E) Recreation.
5 (F) Matters relating to dementia, including
6 normal aging, cognitive, psychological and function
7 abilities of older persons.
8 (G) Mental health issues.
9 (H) Assisted living philosophy.
10 (I) Use and benefits of assistive technology.
11 (J) Team building and stress reduction for
12 assisted living residence staff.
13 (K) Working with family members.
14 (L) Awareness, identification, prevention and
15 reporting of abuse and neglect.
16 (M) Mission and purpose of services to
17 individuals with cognitive impairments.
18 (N) Communication skills and management of
19 behavioral challenges.
20 (O) Community resources and social services.
21 (P) Staff supervision, budgeting, financial
22 recordkeeping and training; or
23 (2) Be a licensed nursing home administrator or
24 certified personal care home administrator who has completed
25 a course of instruction in the administration of an assisted
26 living residence, including instruction in all areas
27 enumerated under paragraph (1)(iii).
28 (c) Training.--All administrators shall complete a
29 department-approved training course of a minimum of 120 hours.
30 All administrators shall pass a test which has been approved by
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1 the department and administered by an entity approved by the
2 department at the end of training to demonstrate proficiency in
3 the application of skills and knowledge.
4 (d) Continuing education.--Every two years, all
5 administrators shall complete 36 hours of continuing education
6 that has been approved by the department and is applicable to
7 the practice of assisted living administrators.
8 Section 14. Staff orientation and training in assisted living
9 residences.
10 (a) General rule.--The department shall promulgate
11 regulations, not later than 90 days after the effective date of
12 this act to develop standards for orientation and training for
13 all direct service staff in assisted living residences. Such
14 orientation and training shall include the following areas:
15 (1) Fire prevention and emergency planning.
16 (2) First aid and CPR certification, medications,
17 medical terminology and personal hygiene.
18 (3) Federal, State and local laws and regulations.
19 (4) Nutrition, food handling and sanitation.
20 (5) Recreation.
21 (6) Matters relating to dementia, including normal
22 aging, cognitive, psychological and functional abilities of
23 older persons.
24 (7) Mental health issues.
25 (8) Assisted living philosophy.
26 (9) Use and benefits of assistive technology.
27 (10) Team building and stress reduction for assisted
28 living residence staff.
29 (11) Working with family members.
30 (12) Awareness, identification, prevention and reporting
20050H0259B0282 - 25 -
1 of abuse and neglect.
2 (13) Mission and purpose of services to individuals with
3 cognitive impairments.
4 (14) Communication skills and management of behavioral
5 challenges.
6 (15) Community resources and social services.
7 (b) Department-administered training.--If not otherwise
8 available, the department shall schedule and offer, at cost,
9 training and educational programs for a person to meet the
10 knowledge, educational and training requirements established by
11 this act.
12 Section 15. Staffing levels and training.
13 (a) General rule.--The department shall establish staffing
14 levels for assisted living residences depending upon the
15 facility population, mobility of residents and cognitive
16 impairments to insure:
17 (1) Direct service staff to meet the unplanned and
18 unscheduled needs of consumers.
19 (2) Direct service staff to meet consumers' planned and
20 scheduled needs as required in their comprehensive service
21 plans.
22 (3) Additional staff or contracted services to meet
23 laundry, food service, housekeeping, transportation and
24 maintenance needs of the assisted living residence.
25 (b) Training.--All direct service staff shall complete a
26 department approved education and training program and obtain a
27 certificate of completion. Direct service staff shall complete
28 training and demonstrate proficiency in a manner approved by the
29 department in each training component prior to independent work
30 in that area.
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1 Section 16. Persons with special needs.
2 (a) Immobile persons.--Immobile persons who do not require
3 the services of a licensed long-term care facility, but who
4 require assisted living residence services, shall be permitted
5 to reside in an adult living residence with a Category II
6 license, provided that the design, construction, staffing or
7 operation of the assisted living residence allows for safe
8 emergency evacuation.
9 (b) Alzheimer's disease, dementia and cognitive
10 impairment.--For consumers with Alzheimer's disease or dementia
11 or where the adult living residence holds itself out to the
12 public as providing services or housing for persons with
13 cognitive impairments, adult living residences shall disclose to
14 consumers and provide:
15 (1) the residence's written statement of its philosophy
16 and mission which reflects the needs of individuals with
17 cognitive impairments;
18 (2) a description of the residence's physical
19 environment and design features to support the functioning of
20 adults with cognitive impairments;
21 (3) a description of the frequency and types of
22 individual and group activities designed specifically to meet
23 the needs of residents with cognitive impairments;
24 (4) a description of security measures provided by the
25 facility;
26 (5) a description of training provided to staff
27 regarding provision of care to consumers with cognitive
28 impairments;
29 (6) a description of availability of family support
30 programs and family involvement; and
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1 (7) the process used for assessment and establishment of
2 a plan of services for the consumer, including methods by
3 which the plan of services will remain responsive to changes
4 in the consumer's condition.
5 (c) Cognitive support services.--
6 (1) An adult living residence shall provide to a
7 cognitively impaired consumer cognitive support services,
8 including dementia-specific activity programming.
9 (2) Within 30 days of admission of a cognitively
10 impaired consumer, the adult living residence shall register
11 the consumer with the Commonwealth's Safe Return Program for
12 individuals with cognitive impairments and tendencies to
13 wander.
14 Section 17. Violations.
15 (a) Notice of violations.--Upon finding a violation of this
16 act or the department's regulations, the department shall issue
17 a notice of violation to the licensee. The notice shall indicate
18 the class of violation, the fine due, the date by which an
19 acceptable plan of correction must be submitted to the
20 department and the date by which the violation must be corrected
21 to avoid additional fines.
22 (b) Classification of violations.--The department shall
23 classify violations into three classes of violations: Class I,
24 II and III with Class I being the most dangerous or harmful to
25 health, safety and well-being and Class III being the least.
26 Violations shall be classified based on scope and severity,
27 including impact and potential impact.
28 (c) Fines.--
29 (1) The department shall:
30 (i) Develop a process for assessing fines which
20050H0259B0282 - 28 -
1 shall provide that the most serious violations or a
2 pattern of noncompliance shall lead to imposition of a
3 set fine per resident without an opportunity for the
4 licensee to correct.
5 (ii) Impose an additional set fine for each class of
6 violation per resident per day that the violation remains
7 uncorrected beyond the correction date called for by the
8 department.
9 (2) Fines shall also be imposed for failure to comply
10 with an approved plan of correction and offering false proof
11 of correction.
12 (3) Money collected by the department under this section
13 shall be used to defray the expenses incurred by consumers
14 relocated under this act. Any moneys remaining shall be used
15 by the department for enforcing the provisions of this act.
16 Fines collected pursuant to this act shall not be subject to
17 the provisions of 42 Pa.C.S. § 3733 (relating to deposits
18 into account).
19 (d) Correction of violations.--When cited for violation, a
20 licensee shall submit a plan of correction indicating how it
21 will remedy the problem and prevent recurrence. The department
22 shall determine whether the plan of correction is acceptable as
23 a tool which, upon implementation, will bring the facility into
24 compliance. Correction must be achieved, in accordance with the
25 plan of correction or department instructions, prior to the
26 issuance or renewal of a license. The licensee must demonstrate
27 implementation of the plan and provide verification to the
28 department that compliance has been achieved in order to
29 maintain licensure status and avoid additional fines. Submission
30 of a plan of correction shall not amount to correction.
20050H0259B0282 - 29 -
1 (e) Complaints.--
2 (1) The department shall receive complaints 24 hours a
3 day. Complaints submitted to the department shall be
4 investigated swiftly based on the threat the allegation, if
5 true, poses to the complainant and other residents. In
6 determining the threat posed and the time frame within which
7 to investigate, the department shall presume the facts
8 alleged to be true.
9 (2) Investigations shall be through unannounced
10 inspections conducted by department staff who have received
11 training in complaint investigation techniques or a separate
12 delegated complaint investigation team.
13 (3) In no circumstances shall the complaint
14 investigation be completed by the licensing representative
15 assigned to the annual licensing inspections for the
16 facility.
17 (f) Provisional license.--
18 (1) Where a licensee has uncorrected Class III
19 violations, but an acceptable plan of correction has been
20 submitted, the licensee may be issued a provisional license
21 for a period of up to six months. Any subsequent provisional
22 license may only be issued for different Class III violations
23 than were the cause of the previous provisional license.
24 (2) A licensee may receive up to four consecutive
25 provisional licenses, however, the licensee must then achieve
26 full compliance or no license shall be issued. No subsequent
27 provisional license shall be issued in the case of recurrence
28 of the same violations.
29 (g) Criminal penalties.--A licensee that intentionally
30 commits a violation or continues to operate an adult living
20050H0259B0282 - 30 -
1 residence without a license by the department commits a
2 misdemeanor of the second degree and shall, upon conviction, be
3 sentenced to pay a fine of $5,000 or to imprisonment for not
4 more than two years, or both.
5 Section 18. Reasons for denial, nonrenewal or revocation of a
6 license.
7 The department may deny, refuse or renew or revoke a license
8 for all or any portion of an adult living residence or may
9 suspend or restrict admissions to the residence for any of the
10 following reasons:
11 (1) Failure of a licensee to submit an acceptable plan
12 of correction with a reasonable timetable to correct
13 violations.
14 (2) The existence of a pattern of violations.
15 (3) Failure to comply with a plan of correction or to
16 report violations in accordance with a timetable submitted by
17 the applicant and agreed upon by the department.
18 (4) Fraud or deceit in obtaining or attempting to obtain
19 a license.
20 (5) Lending, borrowing or using the license of another
21 or in any way knowingly aiding or abetting the improper
22 granting of a license.
23 (6) Incompetence, negligence or misconduct in operating
24 the adult living residence.
25 (7) Mistreatment or abuse of a consumer of the adult
26 living residence.
27 (8) Violation of the provisions of this act or the
28 regulations promulgated under this act.
29 (9) Violation of other applicable Federal or State laws.
30 Section 19. Licensure appeals.
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1 (a) Nature of proceeding.--A licensee aggrieved by a
2 decision of the department under this act shall have the right
3 to an appeal. The appeal shall be conducted in accordance with 2
4 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
5 Commonwealth agencies) to the bureau.
6 (b) Time for hearing.--
7 (1) Except as provided in paragraph (2), a hearing shall
8 be held by the bureau within 90 days of receipt of the notice
9 of request for a hearing.
10 (2) If the bureau determines that continued operation,
11 pending administrative review, poses an immediate threat to
12 the consumers in the assisted living residence or if the
13 department has implemented an emergency action pursuant to
14 section 21(c) (relating to actions against violations of law
15 and regulations) and a timely request for a hearing has been
16 made, a hearing shall be held within 15 days after the
17 receipt of the response or request for a hearing.
18 (3) Hearing dates specified in this subsection may be
19 extended by the bureau for good cause if agreed to by all
20 parties.
21 (c) Decisions.--A decision shall be issued within 60 days
22 after the final day of the hearing. In the case of an expedited
23 hearing under subsection (b)(2), a decision shall be issued
24 within five days after the final date of the hearing.
25 (d) Subpoenas.--The presiding officer may issue a subpoena
26 at the request of either party.
27 (e) Discovery.--Discovery shall be limited to reasonable
28 requests for production of documents and identification of
29 witnesses. All other discovery shall be by mutual agreement of
30 the parties.
20050H0259B0282 - 32 -
1 Section 20. Effect of departmental orders.
2 Orders of the department from which no appeal is taken to the
3 bureau and orders of the bureau from which no timely appeal is
4 taken to the court shall be final orders and may be enforced by
5 a court of competent jurisdiction.
6 Section 21. Actions against violations of law and regulations.
7 (a) Violations.--Whenever any person, regardless of whether
8 such person is a licensee, has violated any of the provisions of
9 this act or the regulations issued pursuant thereto, the
10 department may maintain an action in the name of the
11 Commonwealth for an injunction or other process restraining or
12 prohibiting such person from engaging in such activity.
13 (b) Residence closure for threat to health or safety.--
14 Whenever the department determines that a violation poses an
15 immediate and serious threat to the health or safety of the
16 consumers of an adult living residence, the department may
17 direct the closure of the residence and the transfer of the
18 consumers to other adult living residences with either a
19 Category I or a Category II license or other locations that are
20 determined to appropriately meet the care needs of the displaced
21 consumers. The department may petition the Commonwealth Court or
22 the court of common pleas of the county in which the adult
23 living residence is located to appoint the department temporary
24 management of the adult living residence. If granted, the
25 department shall assume operation of the adult living residence
26 at the licensee's expense until there is an orderly closure of
27 the adult living residence.
28 (c) Unlicensed adult living residences.--
29 (1) Whenever a license is required by this act, the
30 department may maintain an action in a court of competent
20050H0259B0282 - 33 -
1 jurisdiction in the name of the Commonwealth for an
2 injunction or other process restraining or prohibiting any
3 person from establishing, maintaining or operating an adult
4 living residence that does not possess a Category I license
5 or Category II license.
6 (2) If a person who is refused a license or the renewal
7 of a license to operate or conduct an adult living residence,
8 or whose license to operate or conduct an adult living
9 residence is revoked, fails to appeal, or should such appeal
10 be decided finally favorable to the department, then the
11 court shall issue a permanent injunction upon proof that the
12 person is operating or conducting an adult living residence
13 without a license as required by this act.
14 Section 22. Injunction or restraining order when appeal is
15 pending.
16 Whenever the department refuses to renew or revokes a license
17 or orders a person to refrain from violating this act or the
18 regulations promulgated under this act and the person, deeming
19 himself aggrieved by the refusal, revocation or order, appeals
20 from the action of the department to the board or from the order
21 of the bureau to the court, the court may during pendency of the
22 appeal:
23 (1) issue a restraining order or injunction upon a
24 showing that the continued operation of the adult living
25 residence adversely affects the health, safety or care of the
26 consumers of the adult living residence; or
27 (2) authorize continued operation of the residence or
28 make such other order, pending final disposition of the case,
29 as justice and equity require.
30 Section 23. Annual report.
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1 (a) Contents of.--The Department of Public Welfare shall,
2 after consulting with the Department of Aging and the Department
3 of Health, provide an annual report to the Intra-Governmental
4 Council on Long-Term Care. The annual report shall include, at a
5 minimum, the following:
6 (1) The total number of adult living residences and
7 assisted living services providers in this Commonwealth as
8 well as the numbers of residences and providers newly
9 licensed within the previous year. Such report shall also
10 include information presented separately regarding Category I
11 personal care homes and Category II assisted living
12 residences.
13 (2) Complaints received by the licensing departments,
14 the ombudsman program or the protective services units in
15 each area agency on aging and the outcome of any
16 investigations.
17 (3) Commonwealth costs associated with the licensing,
18 inspection and payment of assisted living services.
19 (4) The availability of assisted living residences and
20 assisted living services to consumers and any barriers
21 experienced by consumers in accessing assisted living
22 residences and assisted living services.
23 (5) General profile information regarding the types of
24 consumers accessing assisted living residences and assisted
25 living services.
26 (6) The costs experienced by consumers in assisted
27 living residences and by consumers using assisted living
28 services.
29 (7) Recommendations for additional legislative or
30 regulatory action to improve the quality, affordability or
20050H0259B0282 - 35 -
1 accessibility of assisted living in this Commonwealth.
2 (b) Review process.--The Intra-Governmental Council on Long-
3 Term Care shall have 30 days to review the report and to prepare
4 written comments thereto. Such comments shall include
5 recommendations regarding legislation or regulations and
6 reporting methods. After the 30-day review and comment period,
7 the council shall forward the department's report and their
8 written comments to the Governor, the Aging and Youth Committee
9 of the Senate and the Aging and Older Adult Services Committee
10 of the House of Representatives.
11 Section 24. Legislative Budget and Finance Committee study.
12 Within nine months after the effective date of this section,
13 the Legislative Budget and Finance Committee shall report to the
14 General Assembly on existing Federal and other states'
15 initiatives and programs that provide financial assistance for
16 assisted living. This study shall include information on other
17 Federal or state assisted living programs that are effectively
18 administered and can be considered a model.
19 Section 25. Committee regulation review.
20 In accordance with the act of June 25, 1982 (P.L.633,
21 No.181), known as the Regulatory Review Act, all regulations
22 promulgated pursuant to this act shall be referred to the Aging
23 and Youth Committee of the Senate and the Aging and Older Adult
24 Services Committee of the House of Representatives.
25 Section 26. Increase to State supplemental assistance for
26 persons in personal care homes.
27 (a) General rule.--Notwithstanding any other provision of
28 the act of June 13, 1967 (P.L.31, No.21), known as the Public
29 Welfare Code, or regulations of the department to the contrary,
30 the amount of the State supplemental assistance payable to a
20050H0259B0282 - 36 -
1 person who is eligible under section 432(2)(ii) of the Public
2 Welfare Code and who is a resident of a personal care home shall
3 be increased by an amount of $15 per day.
4 (b) Consumer Price Index Adjustment.--The amount of State
5 supplemental assistance payable under subsection (a) shall be
6 increased beginning July 1, 2006, by an amount equal to the
7 increase in the Consumer Price Index for Urban Wage Earners for
8 the immediately preceding calendar year, which amount shall be
9 published in the Pennsylvania Bulletin annually by the
10 department on or before the preceding November 30.
11 Section 27. Severability.
12 If any provision of this act or the application thereof to
13 any person or circumstances is held invalid, such invalidity
14 shall not affect other provisions or applications of the act
15 which can be given effect without the invalid provision or
16 application, and to this end the provisions of this act are
17 declared to be severable.
18 Section 28. Repeal.
19 All acts and parts of acts are repealed insofar as they are
20 inconsistent with this act.
21 Section 29. Effective date.
22 This act shall take effect in one year.
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