STATE OF NEW YORK
________________________________________________________________________
1049
2015-2016 Regular Sessions
IN SENATE
January 8, 2015
___________
Introduced by Sens. MONTGOMERY, HOYLMAN -- read twice and ordered print-
ed, and when printed to be committed to the Committee on Aging
AN ACT to amend the public health law, in relation to requiring a regis-
tered nurse on staff at facilities certified for enhanced assisted
living or special needs assisted living
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 4655 of the public health law, as added by chapter
2 2 of the laws of 2004, is amended to read as follows:
3 § 4655. Certification procedures and requirements. 1. Notwithstanding
4 any other provision of law, an assisted living operator may apply to the
5 department to obtain an enhanced assisted living certificate pursuant to
6 this section.
7 (a) Such application shall be on a form approved by the department.
8 (b) An assisted living operator may apply for such a certificate for
9 the entire facility or any number of beds at the facility.
10 (c) To obtain an enhanced assisted living certificate, the applicant
11 must submit a plan to the department setting forth how the additional
12 needs of residents will be safely and appropriately met at such resi-
13 dence. Such plan shall include, but need not be limited to, a written
14 description of services, staffing levels, staff education and training,
15 work experience, and any environmental modifications that have been made
16 or will be made to protect the health, safety and welfare of such
17 persons in the residence. The plan shall describe how the facility will
18 meet the registered nurse staffing requirement.
19 (d) In addition to any other requirements of assisted living, an oper-
20 ator of enhanced assisted living may hire care staff directly pursuant
21 to standards developed by the department or contract with a home care
22 services agency which has been approved to operate pursuant to article
23 thirty-six of this chapter.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02691-01-5
S. 1049 2
1 (e) No assisted living residence shall be certified as enhanced
2 assisted living unless and until the applicant obtains the written
3 approval of the department.
4 (f) (i) To obtain or renew an enhanced assisted living certificate,
5 the applicant shall be required to have a registered nurse onsite to
6 assess and monitor the condition of residents.
7 (ii) The registered nurse shall be at the facility a minimum of one
8 shift per day, five days per week. The principal duties of the regis-
9 tered nurse shall be coordinating resident care, providing ongoing resi-
10 dent assessment and monitoring, and ensuring that all residents are
11 receiving appropriate care.
12 (iii) Facilities with resident populations that do not necessitate the
13 monitoring or oversight services of a registered nurse on a full time
14 basis may also employ the registered nurse in an administrative or other
15 capacity, as appropriate for the facility. Facilities choosing this
16 option must demonstrate that residents are receiving adequate assessment
17 and monitoring.
18 (iv) Existing enhanced assisted living residences shall be required to
19 furnish proof of compliance with this paragraph no later than eighteen
20 months after this paragraph shall have become a law.
21 2. No resident shall be permitted to continue to age in place under
22 the terms of an enhanced assisted living certificate unless the opera-
23 tor, the resident's physician, the facility's staff registered nurse,
24 and, if applicable, the resident's licensed or certified home care agen-
25 cy, agree that the additional needs of the resident can be safely and
26 appropriately met at the residence. A resident eligible for enhanced
27 assisted living or his or her representative shall submit to the resi-
28 dence a written report from a physician, which report shall state that:
29 (a) the physician has physically examined the resident within the last
30 month; and
31 (b) the resident is not in need of twenty-four hour skilled nursing
32 care or medical care which would require placement in a hospital or
33 residential health care facility.
34 3. The residence must notify a resident that, while the residence will
35 make reasonable efforts to facilitate the resident's ability to age in
36 place pursuant to an individualized service plan, there may be a point
37 reached where the needs of the resident cannot be safely or appropriate-
38 ly met at the residence, requiring the transfer of the resident to a
39 more appropriate facility in accordance with the provisions of this
40 article.
41 4. If a resident reaches the point where he or she is in need of twen-
42 ty-four hour skilled nursing care or medical care required to be
43 provided by facilities licensed pursuant to article twenty-eight of this
44 chapter or article nineteen, thirty-one or thirty-two of the mental
45 hygiene law, as determined by the patient's physician or the facility's
46 staff resident nurse, then the resident must be discharged from the
47 residence and the operator shall initiate proceedings for the termi-
48 nation of the residency agreement of such resident in accordance with
49 the provisions of section four hundred sixty-one-h of the social
50 services law. Provided, however, a resident may remain at the residence
51 if each of the following conditions are met:
52 (a) a resident in need of twenty-four hour skilled nursing care or
53 medical care hires appropriate nursing, medical or hospice staff to care
54 for his or her increased needs;
55 (b) the resident's physician [and], home care services agency [both]
56 and the facility's staff registered nurse all determine and document
S. 1049 3
1 that, with the provision of such additional nursing, medical or hospice
2 care, the resident can be safely cared for in the residence, and would
3 not require placement in a hospital, nursing home or other facility
4 licensed under article twenty-eight of this chapter or article nineteen,
5 thirty-one or thirty-two of the mental hygiene law;
6 (c) the operator agrees to retain the resident and to coordinate the
7 care provided by the operator and the additional nursing, medical or
8 hospice staff; and
9 (d) the resident is otherwise eligible to reside at the residence.
10 5. In addition to the requirements otherwise required for licensure as
11 assisted living, any residence that advertises or markets itself as
12 serving individuals with special needs, including, but not limited to,
13 individuals with dementia or cognitive impairments, must submit a
14 special needs plan to the department setting forth how the special needs
15 of such residents will be safely and appropriately met at such resi-
16 dence. Such plan shall include, but need not be limited to, a written
17 description of specialized services, staffing levels, staff education
18 and training, work experience, professional affiliations or special
19 characteristics relevant to serving persons with special needs, and any
20 environmental modifications that have been made or will be made to
21 protect the health, safety and welfare of such persons in the residence.
22 In approving an application for special needs certification, the depart-
23 ment shall develop standards to ensure adequate staffing and training in
24 order to safely meet the needs of the resident. The standards shall be
25 based upon recommendations of the task force established by section five
26 of [the] chapter two of the laws of two thousand four [which added this
27 section]. In addition to any other standards which the department may
28 develop, applicants for special needs assisted living certificates shall
29 be subject to the same registered nurse staffing requirements detailed
30 in paragraphs (c) and (f) of subdivision one of this section. No resi-
31 dence shall market [themselves] itself as providing specialized services
32 unless and until the department has approved such applicant for a
33 special needs assisted living certificate. Existing special needs
34 assisted living residences shall be required to furnish proof of compli-
35 ance with the new staffing requirements no later than eighteen months
36 after this sentence shall have become a law.
37 6. An enhanced assisted living certificate shall not be required of an
38 adult care facility, or part thereof, which has obtained approval by the
39 department to operate an assisted living program pursuant to section
40 four hundred sixty-one-l of the social services law. Provided, however,
41 such exemption shall only apply to those beds at the facility which are
42 subject to the assisted living program.
43 § 2. This act shall take effect on the ninetieth day after it shall
44 have become a law; provided that any rules and regulations, and any
45 other actions necessary to implement the provisions of this act on its
46 effective date are authorized and directed to be completed on or before
47 such date.
