HB 817

1
A bill to be entitled
2An act relating to assisted living facilities; amending s.
3429.28, F.S.; revising and specifying certain conditions
4in an assisted living facility's resident bill of rights
5for a resident's relocation or termination of residency;
6requiring grievance procedures to be written; creating s.
7429.285, F.S.; prohibiting resident relocation or
8termination of residency in the absence of certain
9specified conditions; requiring the administrator or a
10designated employee of a facility to sign a notice of
11relocation or termination of residency and requiring a
12physician's signature under certain circumstances;
13requiring a licensee to provide advance written notice to
14the resident and other specified persons regarding
15relocation or termination of residency; providing that the
16notice contain certain information; providing for the
17creation of a form to submit relocation or termination of
18residency information and specifying information to be
19included therein; requiring a licensee to report
20relocation or termination of residency to the Office of
21State Long-Term Care Ombudsman within a specified time;
22permitting residents to seek the assistance of the local
23long-term care ombudsman council in reviewing a notice of
24relocation or termination of residency; providing for
25emergency relocation and termination of residency;
26authorizing the department to adopt rules; amending ss.
27429.07 and 429.31, F.S.; conforming cross-references;
28providing an effective date.
29
30Be It Enacted by the Legislature of the State of Florida:
31
32     Section 1.  Paragraphs (k) and (l) of subsection (1),
33subsection (2), and paragraph (b) of subsection (3) of section
34429.28, Florida Statutes, are amended to read:
35     429.28  Resident bill of rights.-
36     (1)  No resident of a facility shall be deprived of any
37civil or legal rights, benefits, or privileges guaranteed by
38law, the Constitution of the State of Florida, or the
39Constitution of the United States as a resident of a facility.
40Every resident of a facility shall have the right to:
41     (k)  Receive at least 45 days' written notice of relocation
42or termination of residency from the licensee as provided in s.
43429.285, unless the relocation or termination of residency is
44initiated by the resident or the resident's designee facility
45unless, for medical reasons, the resident is certified by a
46physician to require an emergency relocation for medical reasons
47to a facility providing a more skilled level of care, or the
48resident engages in a pattern of conduct that is harmful or
49offensive to other residents. In the case of a resident who has
50been adjudicated mentally incapacitated, the guardian shall be
51given at least 45 days' written notice of a nonemergency
52relocation or residency termination. Reasons for relocation
53shall be set forth in writing. In order for a licensee facility
54to terminate the residency of an individual without notice as
55provided in this paragraph herein, the licensee facility shall
56show good cause in a court of competent jurisdiction. Admission
57to a facility licensed under this part may not be conditioned
58upon a waiver of such right, and any document or provision in a
59document that purports to waive or preclude such right is void
60and unenforceable.
61     (l)  Present grievances and recommend changes in policies,
62procedures, and services to the staff of the facility, governing
63officials, or any other person without restraint, interference,
64coercion, discrimination, or reprisal. Each licensee facility
65shall establish a written grievance procedure to facilitate the
66residents' exercise of this right. This right includes access to
67ombudsman volunteers and advocates and the right to be a member
68of, to be active in, and to associate with advocacy or special
69interest groups.
70     (2)  The administrator of a facility shall ensure that a
71written notice of the rights, obligations, and prohibitions set
72forth in this part is posted in a prominent place in each
73facility and read or explained to residents who cannot read.
74This notice shall include the name, address, and telephone
75numbers of the local ombudsman council and central abuse hotline
76and, when applicable, the Advocacy Center for Persons with
77Disabilities, Inc., and the Florida local advocacy council,
78where complaints may be lodged. The licensee facility must
79ensure a resident's access to a telephone to call the local
80ombudsman council, central abuse hotline, Advocacy Center for
81Persons with Disabilities, Inc., and the Florida local advocacy
82council.
83     (3)
84     (b)  In order to determine whether the licensee facility is
85adequately protecting residents' rights, the biennial survey
86shall include private informal conversations with a sample of
87residents and consultation with the ombudsman council in the
88planning and service area in which the facility is located to
89discuss residents' experiences within the facility.
90     Section 2.  Section 429.285, Florida Statutes, is created
91to read:
92     429.285  Resident relocation or termination of residency;
93requirements and procedures.-
94     (1)  A facility licensed under this part must permit a
95resident to remain in the facility unless the conditions
96specified in this subsection apply. Relocation or termination of
97residency of a resident may occur only if:
98     (a)  The relocation or termination of residency is
99necessary for the resident's welfare and the resident's needs
100cannot be met in the facility;
101     (b)  The relocation or termination of residency is
102appropriate because the resident's health has improved or
103deteriorated to the extent that the resident no longer needs the
104services provided by the facility and the resident's health
105condition is documented by a physician's order, as required
106under subsection (2);
107     (c)  The health and safety of other residents or facility
108employees would be endangered;
109     (d)  The resident has failed, after at least 30 days'
110written notice, to provide payment for his or her stay in the
111facility;
112     (e)  The facility ceases to operate; or
113     (f)  There is a documented pattern of harmful or offensive
114behavior by the resident.
115     (2)  When a relocation or termination of residency is
116initiated by the licensee:
117     (a)  The licensee must provide at least 45 days' written
118notice by certified mail of the proposed relocation or
119termination of residency to the affected resident and, if known,
120to a family member or the resident's legal guardian or
121representative, unless, for medical reasons, the resident is
122certified by a physician to require an emergency relocation to a
123facility that provides a more skilled level of care.
124     (b)  The administrator who is relocating the resident or
125terminating residency, or an individual employed by the facility
126who is designated by the administrator to act on behalf of the
127administration, must sign the notice of relocation or
128termination of residency.
129     (3)  A notice indicating a medical reason for relocation or
130termination of residency must be signed by the resident's
131physician or include an attached written order for the
132relocation or termination of residency signed by a physician.
133     (a)  The notice must be in writing and contain all
134information required by department rules and state laws.
135     (b)  A copy of the notice must be signed by the resident
136upon receipt and placed in the resident's file.
137     (c)  The department shall develop a standard form for the
138notice to be used by all facilities licensed under this part for
139the purpose of notifying residents of a relocation or
140termination of residency. In addition to any other pertinent
141information included, the form shall:
142     1.  Specify the reason allowed under state law justifying
143the relocation or termination of the residency, with an
144explanation to support this action.
145     2.  State the effective date of the relocation or
146termination of residency and the location to which the resident
147is being relocated.
148     3.  State the right and specify the means to request the
149local long-term care ombudsman council to review the notice of
150relocation or termination of residency.
151     (4)  A relocation or termination of residency notice
152initiated by a licensee must be reported to the Office of State
153Long-Term Care Ombudsman by mail, e-mail, or facsimile within 2
154business days after a resident's receipt of a notice to relocate
155or terminate residency. A resident may request that the local
156long-term care ombudsman council review any notice of relocation
157or termination of residency given to the resident.
158     (5)  In the event of an emergency relocation or termination
159of residency, as provided under s. 429.28(1)(k), notice shall be
160provided as soon as practicable, but no later than 2 business
161days after the emergency relocation or termination, to the
162resident, the resident's legal guardian or representative, and
163the Office of State Long-Term Care Ombudsman by telephone or in
164person. If possible, the written notice shall be given before
165the relocation or termination of residency, as required under
166subsection (2), no later than 5 business days after the
167relocation or termination of residency. The resident's file must
168include documentation indicating who was contacted, whether the
169contact was by telephone or in person, and the date and time of
170the contact.
171     (6)  The department may adopt rules pursuant to ss.
172120.536(1) and 120.54 to administer this section.
173     Section 3.  Paragraphs (b) and (c) of subsection (3) of
174section 429.07, Florida Statutes, are amended to read:
175     429.07  License required; fee.-
176     (3)  In addition to the requirements of s. 408.806, each
177license granted by the agency must state the type of care for
178which the license is granted. Licenses shall be issued for one
179or more of the following categories of care: standard, extended
180congregate care, limited nursing services, or limited mental
181health.
182     (b)  An extended congregate care license shall be issued to
183facilities providing, directly or through contract, services
184beyond those authorized in paragraph (a), including acts
185performed pursuant to part I of chapter 464 by persons licensed
186thereunder, and supportive services defined by rule to persons
187who otherwise would be disqualified from continued residence in
188a facility licensed under this part.
189     1.  In order for extended congregate care services to be
190provided in a facility licensed under this part, the agency must
191first determine that all requirements established in law and
192rule are met and must specifically designate, on the facility's
193license, that such services may be provided and whether the
194designation applies to all or part of a facility. Such
195designation may be made at the time of initial licensure or
196relicensure, or upon request in writing by a licensee under this
197part and part II of chapter 408. Notification of approval or
198denial of such request shall be made in accordance with part II
199of chapter 408. Existing facilities qualifying to provide
200extended congregate care services must have maintained a
201standard license and may not have been subject to administrative
202sanctions during the previous 2 years, or since initial
203licensure if the facility has been licensed for less than 2
204years, for any of the following reasons:
205     a.  A class I or class II violation;
206     b.  Three or more repeat or recurring class III violations
207of identical or similar resident care standards as specified in
208rule from which a pattern of noncompliance is found by the
209agency;
210     c.  Three or more class III violations that were not
211corrected in accordance with the corrective action plan approved
212by the agency;
213     d.  Violation of resident care standards resulting in a
214requirement to employ the services of a consultant pharmacist or
215consultant dietitian;
216     e.  Denial, suspension, or revocation of a license for
217another facility under this part in which the applicant for an
218extended congregate care license has at least 25 percent
219ownership interest; or
220     f.  Imposition of a moratorium pursuant to this part or
221part II of chapter 408 or initiation of injunctive proceedings.
222     2.  Facilities that are licensed to provide extended
223congregate care services shall maintain a written progress
224report on each person who receives such services, which report
225describes the type, amount, duration, scope, and outcome of
226services that are rendered and the general status of the
227resident's health. A registered nurse, or appropriate designee,
228representing the agency shall visit such facilities at least
229quarterly to monitor residents who are receiving extended
230congregate care services and to determine if the facility is in
231compliance with this part, part II of chapter 408, and rules
232that relate to extended congregate care. One of these visits may
233be in conjunction with the regular survey. The monitoring visits
234may be provided through contractual arrangements with
235appropriate community agencies. A registered nurse shall serve
236as part of the team that inspects such facility. The agency may
237waive one of the required yearly monitoring visits for a
238facility that has been licensed for at least 24 months to
239provide extended congregate care services, if, during the
240inspection, the registered nurse determines that extended
241congregate care services are being provided appropriately, and
242if the facility has no class I or class II violations and no
243uncorrected class III violations. Before such decision is made,
244the agency shall consult with the long-term care ombudsman
245council for the area in which the facility is located to
246determine if any complaints have been made and substantiated
247about the quality of services or care. The agency may not waive
248one of the required yearly monitoring visits if complaints have
249been made and substantiated.
250     3.  Facilities that are licensed to provide extended
251congregate care services shall:
252     a.  Demonstrate the capability to meet unanticipated
253resident service needs.
254     b.  Offer a physical environment that promotes a homelike
255setting, provides for resident privacy, promotes resident
256independence, and allows sufficient congregate space as defined
257by rule.
258     c.  Have sufficient staff available, taking into account
259the physical plant and firesafety features of the building, to
260assist with the evacuation of residents in an emergency, as
261necessary.
262     d.  Adopt and follow policies and procedures that maximize
263resident independence, dignity, choice, and decisionmaking to
264permit residents to age in place to the extent possible, so that
265moves due to changes in functional status are minimized or
266avoided.
267     e.  Allow residents or, if applicable, a resident's
268representative, designee, surrogate, guardian, or attorney in
269fact to make a variety of personal choices, participate in
270developing service plans, and share responsibility in
271decisionmaking.
272     f.  Implement the concept of managed risk.
273     g.  Provide, either directly or through contract, the
274services of a person licensed pursuant to part I of chapter 464.
275     h.  In addition to the training mandated in s. 429.52,
276provide specialized training as defined by rule for facility
277staff.
278     4.  Facilities licensed to provide extended congregate care
279services are exempt from the criteria for continued residency as
280set forth in rules adopted under s. 429.41. Facilities so
281licensed shall adopt their own requirements within guidelines
282for continued residency set forth by rule. However, such
283facilities may not serve residents who require 24-hour nursing
284supervision. Facilities licensed to provide extended congregate
285care services shall provide each resident with a written copy of
286facility policies governing admission and retention.
287     5.  The primary purpose of extended congregate care
288services is to allow residents, as they become more impaired,
289the option of remaining in a familiar setting from which they
290would otherwise be disqualified for continued residency. A
291facility licensed to provide extended congregate care services
292may also admit an individual who exceeds the admission criteria
293for a facility with a standard license, if the individual is
294determined appropriate for admission to the extended congregate
295care facility.
296     6.  Before admission of an individual to a facility
297licensed to provide extended congregate care services, the
298individual must undergo a medical examination as provided in s.
299429.26(4) and the facility must develop a preliminary service
300plan for the individual.
301     7.  When a facility can no longer provide or arrange for
302services in accordance with the resident's service plan and
303needs and the facility's policy, the facility shall make
304arrangements for relocating the person in accordance with s.
305429.285 429.28(1)(k).
306     8.  Failure to provide extended congregate care services
307may result in denial of extended congregate care license
308renewal.
309     9.  No later than January 1 of each year, the department,
310in consultation with the agency, shall prepare and submit to the
311Governor, the President of the Senate, the Speaker of the House
312of Representatives, and the chairs of appropriate legislative
313committees, a report on the status of, and recommendations
314related to, extended congregate care services. The status report
315must include, but need not be limited to, the following
316information:
317     a.  A description of the facilities licensed to provide
318such services, including total number of beds licensed under
319this part.
320     b.  The number and characteristics of residents receiving
321such services.
322     c.  The types of services rendered that could not be
323provided through a standard license.
324     d.  An analysis of deficiencies cited during licensure
325inspections.
326     e.  The number of residents who required extended
327congregate care services at admission and the source of
328admission.
329     f.  Recommendations for statutory or regulatory changes.
330     g.  The availability of extended congregate care to state
331clients residing in facilities licensed under this part and in
332need of additional services, and recommendations for
333appropriations to subsidize extended congregate care services
334for such persons.
335     h.  Such other information as the department considers
336appropriate.
337     (c)  A limited nursing services license shall be issued to
338a facility that provides services beyond those authorized in
339paragraph (a) and as specified in this paragraph.
340     1.  In order for limited nursing services to be provided in
341a facility licensed under this part, the agency must first
342determine that all requirements established in law and rule are
343met and must specifically designate, on the facility's license,
344that such services may be provided. Such designation may be made
345at the time of initial licensure or relicensure, or upon request
346in writing by a licensee under this part and part II of chapter
347408. Notification of approval or denial of such request shall be
348made in accordance with part II of chapter 408. Existing
349facilities qualifying to provide limited nursing services shall
350have maintained a standard license and may not have been subject
351to administrative sanctions that affect the health, safety, and
352welfare of residents for the previous 2 years or since initial
353licensure if the facility has been licensed for less than 2
354years.
355     2.  Facilities that are licensed to provide limited nursing
356services shall maintain a written progress report on each person
357who receives such nursing services, which report describes the
358type, amount, duration, scope, and outcome of services that are
359rendered and the general status of the resident's health. A
360registered nurse representing the agency shall visit such
361facilities at least twice a year to monitor residents who are
362receiving limited nursing services and to determine if the
363facility is in compliance with applicable provisions of this
364part, part II of chapter 408, and related rules. The monitoring
365visits may be provided through contractual arrangements with
366appropriate community agencies. A registered nurse shall also
367serve as part of the team that inspects such facility.
368     3.  A person who receives limited nursing services under
369this part must meet the admission criteria established by the
370agency for assisted living facilities. When a resident no longer
371meets the admission criteria for a facility licensed under this
372part, arrangements for relocating the person shall be made in
373accordance with s. 429.285 429.28(1)(k), unless the facility is
374licensed to provide extended congregate care services.
375     Section 4.  Subsection (1) of section 429.31, Florida
376Statutes, is amended to read:
377     429.31  Closing of facility; notice; penalty.-
378     (1)  In addition to the requirements of part II of chapter
379408, the facility shall inform each resident or the next of kin,
380legal representative, or agency acting on each resident's
381behalf, of the fact and the proposed time of discontinuance of
382operation, following the notification requirements provided in
383s. 429.285 429.28(1)(k). In the event a resident has no person
384to represent him or her, the facility shall be responsible for
385referral to an appropriate social service agency for placement.
386     Section 5.  This act shall take effect July 1, 2010.


CODING: Words stricken are deletions; words underlined are additions.