S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         1049
                              2015-2016 Regular Sessions
                                   I N  S E N A T E
                                    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    S 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    S  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.