Admission limits and move-out rules for Midlands assisted living

Who may a Columbia assisted living facility admit?

A CRCF may admit adults whose needs match the care and services it offers, judged by written admission criteria it applies to everyone, and it may not admit anyone who needs a hospital or nursing home level of care (Regulation 60-84, Section 801.A-C).

Paperwork starts before move-in. The new resident needs a physical exam within the 30 days before admission, and within 30 days after admission must have an attending physician licensed in South Carolina (Section 1101). The facility then has 72 hours to complete a written assessment and seven days to write an individual care plan with the resident and the responsible party, revisited at least twice a year (Sections 702-703). Read those documents; they record what the facility believes it has promised.

Which medical needs rule out a South Carolina CRCF?

Section 801.C bars a CRCF from admitting or keeping someone who needs daily skilled monitoring for an unstable condition, sliding-scale insulin given by staff, intravenous medication, treatment of stage 2 to 4 pressure ulcers, or catheter, tube-feeding or tracheostomy care the person cannot manage alone.

The full list in the regulation:

• A person likely to endanger themselves or others, as determined by a physician or other authorized healthcare provider
• A person needing hospitalization or nursing home care
• A person needing daily skilled monitoring for an unstable or complex medical condition (for example brittle diabetes)
• A person needing medications that require frequent dosage adjustment, such as sliding-scale insulin
• A person needing intravenous medications or fluids, or regular intramuscular or subcutaneous injections by staff (routine daily insulin is permitted)
• A person needing urinary catheter care they cannot manage independently
• A person needing treatment of stage 2, 3 or 4 pressure ulcers or widespread skin disorders
• A person needing nasogastric tube feeding, or gastrostomy feedings they cannot manage independently
• A person needing suctioning, or tracheostomy care they cannot manage independently
• A person receiving oxygen for the first time that requires adjustment and evaluation

Notice how often the test is independence. A man who handles his own catheter, or a woman who manages her own gastrostomy feedings, can be admitted; someone who needs staff to do it cannot. Routine insulin on a fixed daily schedule is permitted. Sliding-scale doses given by staff are not.

When does a CRCF resident have to leave?

A CRCF may not keep a resident whose aggressive or socially inappropriate behavior it cannot control, a resident completely dependent in every daily activity for more than 14 days in a row, or a resident who needs a licensed nurse's attention every day (Regulation 60-84, Section 801.D).

The 14-day clock is specific. If a resident is bedfast or totally dependent and not getting better, the facility must start a transfer plan on day 15. Short spells of nursing are allowed: up to 14 consecutive days of intermittent care from a staff nurse or a home health nurse while someone recovers from an illness or injury. That allowance is how many Midlands residents return from a stay at Prisma Health Richland or Lexington Medical Center without having to move.

Can hospice or home health serve someone living in a CRCF?

Yes. The regulation lets a CRCF combine its own care with properly licensed outside services such as hospice and home health on a physician's order; only when that combination stops meeting the resident's needs must the resident be moved, within 30 days (Section 801.F).

That is why so many Columbia-area residents receive hospice in their own apartment. Ask each facility for its written policy on outside agencies and private sitters; a family-hired sitter must go through the facility's formal sitter program with screening and orientation first (Section 506). DPH's data shows 18 licensed hospice programs with Midlands offices and 1 inpatient hospice house: Lexington Community Hospice House (Lexington, 30 beds).

What notice and help does a family get when a move is proposed?

When a resident's condition may require nursing home care, daily nursing or hospitalization, a physician or other authorized provider must examine the resident, and the administrator coordinates any transfer with the resident, family and sponsor (Regulation 60-84, Sections 801.E-F).

If the family disagrees, the regional long-term care ombudsman is a free, independent advocate for residents: Central Midlands Council of Governments for Richland, Lexington and Fairfield counties, Santee-Lynches for Kershaw, Lower Savannah for Calhoun and Upper Savannah for Saluda. The admission agreement must also spell out the refund policy when a resident leaves and give 30 days' notice of any fee change (Section 901.A).