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Food
Safety for Assisted Living Programs - (9-18-07)
Older
Adults are more vulnerable to food borne illnesses. Iowa State
University and the Department of Elder Affairs have developed
tools to help evaluate assisted living facilities in their role
for protecting food safety and the health of their tenants. Check
out: "Looking
at Assisted Living Facilities: Think about Food Safety"
and "Food
Safety Considerations when Choosing Assisted Living Facilities"
for more information.
Is Assisted Living right for you? Read the answers
to the following questions.
hat
exactly is Assisted Living anyway?
How do I choose an Assisted Living Program (ALP)
in Iowa?
So, what's the big deal with the Occupancy
Agreement?
How does an Arbitration Agreement apply to
my Occupancy Agreement?
Why should I care about Iowa's Tenant Landlord
Law?
What if I decide to terminate the Contract?
What if the Program decides to terminate
the Contract?
What is "managed risk"?
How will the coordination of my care be determined?
May I still manage my own medications?
Who supervises the staff that manage my medications
or provide my health related services?
What kind of staff are Assisted Living Programs
likely to employ?
Where do I eat?
What happens in an emergency situation?
What types of activities will be available
for my participation?
What exactly is Assisted Living anyway?
321-25.1(231C)
Assisted living means the provision of housing with services, which
may include but are not limited to health-related care, personal
care, and assistance with instrumental activities of daily living,
to three or more tenants in a physical structure, which provides
a homelike environment. Assisted living programs also includes encouragement
of family involvement, tenant self-direction, and tenant participation
in decisions that emphasize choice, dignity, privacy, individuality,
shared risk, and independence. Assisted living includes twenty-four
hours per day response staff to meet schedule and unscheduled or
unpredictable needs in a manner that promotes maximum dignity and
independence and provides supervision, safety, and security.
Assisted living includes the provision of housing and assistance
with instrumental activities of daily living only if personal care
or health-related care is also included. Individuals residing in
assisted living programs are referred to as tenants. Back
to Top
How do I choose an Assisted Living Program
(ALP) in Iowa?
Request a program brochure, a price list, and a copy of the Occupancy
Agreement (which providers are required by law to provide upon request)
so that you can review these items BEFORE you visit. You will also
want to visit as many different programs as you can. Take a tour,
talk independently with tenants and staff and ask questions. Bring
a friend or family member along to be an extra set of eyes and a
source of support. If possible visit the program during the day
and again in the evening to become familiar with the level of staffing
and activities that take place at different times of the day.
Be aware that some agencies or providers may receive a referral
fee from an Assisted Living Program for referring individuals to
their program. There are currently no laws preventing this practice.
The Department of Elder Affairs recommends you proceed with
caution if you are using an agency that accepts referral fees. You
may want to ask during your visit to the program if they pay referral
fees and to whom.
Educate yourself as much as you can on the laws that regulate assisted
living programs in Iowa. The Iowa
Code and Iowa
Administrative Rules for assisted living programs are both available
online for your review.
Familiarize yourself with the terminology used in the assisted living
environment. The information provided on this website can be a good
starting point for building your knowledge.
See the links to other websites with relevant consumer information
in the Self Advocacy Section
of this website.
Download the following checklist of things to survey when visiting
different programs: Assisted
Living Consumer Checklist
Back to Top
So, what's the big deal with the
Occupancy Agreement?
321-25.22(231C)
Before you move into an assisted living program, you or your legal
representative and the provider must sign a contract called an Occupancy
Agreement. This contract describes the rights and responsibilities
of both the tenant (you) and of the program. Essentially, it determines
what services you will receive and at what cost. This is the document
that will determine how much you will pay to the Assisted Living
Program. Occupancy Agreements are usually negotiated and individualized,
which means you have the power to negotiate the amount of money
you will pay by the amount and frequency of services you receive.
Scheduling personal care, health related care and other appointments
as well as arranging for transportation is usually considered an
extra service. All fees must be included in the occupancy agreement.
The Occupancy Agreement must be revised anytime there is a change
in content, which may include fees.
The Occupancy Agreement should be written in a size you are able
to read and in clear and understandable language. If you have questions
about the agreement, they need to be answered and explained in a
way that is understandable to you. Copies of the agreement need
to be provided to you or your legal representative.
You should not feel pressured to sign the occupancy agreement immediately.
In fact, it makes good sense to take a copy of the agreement home
with you to review. Iowa law requires the Assisted Living Program
to make a copy of their occupancy agreement available to you. You
can request occupancy agreements from multiple programs in order
to provide you with the opportunity to compare assisted living programs
and services. Give yourself enough time to review all of the information
and if you choose to you can have it reviewed by an attorney.
If you are 60 or older, the Legal Hotline for Older Americans may
be of assistance and can be reached by phone at: 1-800-992-8161.
Your local Area Agency on Aging may also be able to provide information
on how to access legal assistance to review an occupancy agreement.
The occupancy agreement must clearly outline the procedure for filing
a complaint. Complaints can be reported to Department of Inspections
and Appeals Complaint Hot line: 1-877-686-0027
The tenant advocate (otherwise known as the Longterm Care Ombudsman)
is also a valuable resource. Consumers may call at any time to ask
specific questions at 515-725-3327 or 1-800-532-3213.
Back to Top
How does an Arbitration Agreement
apply to my Occupancy Agreement?
Arbitration agreements require the tenant and the ALP to resolve
disputes that arise in binding arbitration, rather than in court
before a judge or jury. Binding arbitration involves the submission
of a dispute to a neutral party who renders a decision following
a hearing.
Arbitration takes the place of a trial before a judge
or jury. Grounds for appealing or setting aside the arbitration
decision are very limited and may frequently not be available at
all because the arbitration is binding. Occupancy agreements may
ask tenants to sign an arbitration agreement as part of the contract.
If a tenant signs a contract containing a binding arbitration agreement,
he or she gives up the right to go to court to have the claim resolved.
Some of the advantages to the tenant of binding arbitration are
that it provides a private forum, is less formal and technical than
court and may result in a quicker resolution. The disadvantages
of binding arbitration are: it can be more expensive than court,
it waives the tenant's right to have the claim decided in court,
it can be extremely hard to find a lawyer who will represent the
consumer on other than an hourly fee basis and it severely limits
the right to appeal.
If you are not willing to sign a pre-dispute arbitration agreement
as part of your occupancy agreement, you should request that the
arbitration clause be stricken. If the ALP is not willing to remove
the arbitration agreement from the contract, you may want to continue
looking at other Assisted Living Programs. The Department of
Elder Affairs recommends consumers proceed with caution and consider
seeking legal counsel before entering into an arbitration agreement
with an Assisted Living Program.
Back to Top
Why should I care about Iowa's Tenant
Landlord Law?
321-25.42(321C)
In Iowa, Tenant Landlord Law applies to tenants who live in Assisted
Living Programs. This serves as a protection to both the tenant
and the Assisted Living Program. It allows either you or the program
to terminate the contract after giving a 30 day notice.
Back to Top
What if I decide to terminate the
Contract?
The occupancy agreement should explain the process for termination
of the contract. If you wish to terminate the contract you must
give the provider 30 days notice. Your agreement should also explain
whether any portion of fees will be refunded and under what circumstances.
Back to Top
What If the Program decides
to terminate the Contract?
321-25.26(321C)
The occupancy agreement must also explain the circumstances under
which the program may discharge you. This is referred to as an involuntary
transfer. In cases of involuntary transfers, the Long-term Care
Ombudsman (also known as the Tenant Advocate) is available to assist
you through the process and can be reached by phone at 1-800-532-3213.
The ALP MUST:
- provide you with 30 days notice to any change in the occupancy
agreement except in a health emergency or if there is a substantial
risk to the health or safety of other residents or staff. The ALP
may do so without your agreement.
- explain the internal appeals process
- provide you with the number for the Tenant Advocate who can assist
you in your internal appeal process
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What is "managed risk"?
321-25.36(231D)
The managed or negotiated risk statement is a written agreement
to acknowledge all parties' agreement regarding your preferences
should they be contrary to medical advice or raise safety concerns
and how they will be accommodated by the Assisted Living Program.
One of the most valuable aspects of the agreement is that it enables
all invested parties to discuss and come to agreement on how to
handle something you choose to do that the program may not agree
with. A managed risk agreement may not circumvent any local, state
or federal laws and is only initiated when there is a perceived
need on a case by case basis for a specific, narrowly defined issue.
Back to Top
How will the coordination of my care
be determined?
321-25.28(231C)
A service plan will be completed by yourself or your legal representative,
others who you may choose to participate and the program staff based
on the initial evaluation. This evaluation assesses your functional,
cognitive and health status. All persons who develop the plan, yourself
included, must sign the service plan. The service plan is required
by law to be updated: within 30 days of moving in, annually, as
needed or upon your request.
Your service plan is very important as it specifies precisely what
services you will receive, when you will receive them, and how.
The service plan is to be individualized and at minimum include:
- Your identified needs including any services and care provided
as identified in the Occupancy Agreement
- Your requests for assistance
- Your expected outcomes
- Who will provide the services if they will be contracted outside
of the program
- Planned and spontaneous activities based on your abilities and
personal interests
Back to Top
May I still manage my own medications?
231C - 16A
An Assisted Living Program cannot prohibit you from self-administering
medications. However, if you or your legal representative wishes,
you may delegate medication setup to the Program. Medication setup
means assistance with various steps of medication administration
to support your autonomy, which may include but is not limited to
routine prompting, cueing and reminding, opening containers or packaging
at your direction, reading instructions or other label information,
or transferring medications from the original container into suitable
medication dispensing containers, reminder containers, or medication
cups.
If administration of medications (medication setup) is delegated
to the program by you or your legal representative, the medications
must be administered by a registered nurse, licensed practical nurse,
or advanced registered nurse practitioner licensed or registered
in Iowa or by the individual to whom such licensed or registered
individuals may properly delegate administration of medications.
This process is called nurse delegation and allows for a universal
worker to administer medications when trained and supervised by
a nurse as described above.
- Nurse delegation may be used.
- Nurses are not required to be on-site 24 hours a day or on a daily
basis.
Back
to Top
Who supervises the staff that manage
my medications or provide my health related services?
231C. 16A
Any program that administers your prescriptions or provides you
with health-related care are required to have a Registered Nurse
provide the following:
- monitor you for adverse reactions to program-administered medications
every 90 days or after a change in your condition
- ensure the prescription medication orders are current and the
prescription medications are administered according to orders
- check and document your health status and make recommendations
or referrals as appropriate every 90 days or after a change in
your condition
A Registered Nurse or a Licensed Practical Nurse are NOT required
to be on-site 24 hours a day or on a daily basis.
Back
to Top
What kind of staff are Assisted
Living Programs likely to employ?
321-25.33(231C)
Assisted Living Programs, by law, do not have to employ certified
medication aides or certified nurse aides, but many do.
Staff (sometimes called universal workers in the assisted living
industry) is trained by the assisted living program nurse specifically
to the needs of the assisted living program and the tenants who
live there. If you would like more information about the
training requirements for certified medication aides or certified
nurse aides call: (515) 241-8697 or visit
the Iowa
Caregivers Association website.
Staff should be trained to meet your identified needs at all times.
The definition of assisted living requires a 24 hour per day response
staff to meet scheduled and unscheduled or unpredictable needs
in a manner that promotes maximum dignity and independence and
provides supervision, safety, and security. This allows for staff
to be off-site, but within the proximate area (no more than 5
minutes away). Unless the program is dementia-specific, the program
is not required to have staff present 24 hours a day.
- Iowa law requires that you have access to a 24 hour personal
emergency response system. - Programs are not required to have
a social worker on staff.
- Staff is required by law to be able to implement the program's
emergency procedures.
- Health-care and personal care may be contracted to outside agencies
or organizations; however some programs may require you to use
their own on-site providers. If a program requires you to use
their own on-site provider, you are declaring your choice of provider
to be the program. If you later are not happy with the services
provided and no longer want the program to provide services you
may be discharged from the program.
Back to Top
Where do I eat?
321-25.32(231C)
Iowa law requires that you be provided with one hot or other appropriate
meal once per day, which may or may not be prepared by the program.
This meal is required by law to meet one third of the daily nutritional
standards as established by the Food and Nutrition Board of the
National Research Council. Staff are required to have food safety
training. Kitchens that prepare meals are required to have a Food
Establishment license. If you have concerns about the quality
of the food that is being served you may contact the Longterm
Care Ombudsman at 1-800-532-3213. If you have concerns with sanitation
or food safety you should contact the Department of Inspections
and Appeals at 1-877-686-0027.
Assisted living units vary from full to partial to no cooking
facilities and may include a stove, microwave oven or refrigerator.
If you wish to continue to cook some of your meals consider programs
with full service kitchens.
It's a good idea to find out if meals can be delivered to individual
rooms and if there is an extra cost for this service. Some programs
may require all meals provided by the program to be served in
the dining room. If you have special dietary needs you will want
to find a program that can accommodate your needs. Be sure to
ask during your visit if accommodations can be made for special
dietary needs and how these will be arranged.
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What happens in an emergency situation?
321-25.37(231C)
The program must have written emergency policies and procedures
which include:
- An emergency plan
- Fire safety procedures
- Training employees
- Fire Drills
- Monitoring smoke detectors
- An Evacuation plan
If you have concerns regarding the program's life safety procedures
direct your concerns to the fire marshal's office by phone at
(515) 281-5821.
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What types of activities will be available
for my participation?
25.39(231C)
You should be offered activities that consider your age, health
status, sensory deficits, lifestyle, ethnicity and cultural beliefs,
religious beliefs, values, experiences, needs interests, abilities
and skills. Activities should be planned to support your service
plan. A schedule of activities should be made available to you
on a monthly basis. You have the right to choose whether or not
to participate in the activities offered to you. The activities
program should be specifically for the assisted living program
and not merged with activities programs for other long term care
environments such as a nursing home, residential care facility
or adult day center.
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See the links to other websites with relevant consumer
information in the Self
Advocacy Section of this website.
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