What is a “Nonresident Individual” And What Services Can Assisted Living Facilities Offer Them?

Many assisted living facilities reserve several apartments for independent living residents, referred to in the assisted living regulations as “nonresident individuals.” The definition of a nonresident individual, as outlined in WAC 388-78A-2020 is: “An individual who resides in independent senior housing, independent living units in continuing care retirement communities, other similar living environment, or an unlicensed room located within an assisted living facility. A nonresident individual must not receive from the assisted living facility domiciliary care (directly or indirectly) or items or services listed in the definition of “general responsibility for the safety and well-being of the resident,” except as allowed under WAC 388-78A-2032 or when the person is receiving adult day services.”

Nonresident individuals cannot receive any activities of daily living assistance from staff, nor can staff assume general responsibility for these nonresident individuals’ well-being. This article aims to capture what services you legally can offer nonresident individuals, and what expectations are involved when renting apartments to these tenants.

DEFINITIONS*

*Services in italics below may be provided to nonresident individuals and will be discussed in the next section of this article. WAC 388-78A-2020 includes several definitions that help to delineate the differences in services for assisted living vs. independent living residents.

Domiciliary care: Assistance with activities of daily living provided by the assisted living facility either directly or indirectly; health support services, if provided directly or indirectly by the assisted living facility, or intermittent nursing services, if provided directly or indirectly by the assisted living facility.

General responsibility for the safety and well-being of the resident: The provision of any one or more of the following: prescribed general low sodium diets; prescribed general diabetic diets; prescribed mechanical soft foods; emergency assistance; monitoring of the resident; arranging health care appointments with outside health care providers and reminding residents of such appointments as necessary; coordinating health care services with outside health care providers; assisting the resident to obtain and maintain glasses, hearing aids, dentures, canes, crutches, walkers, wheelchairs, and assistive communication devices; observation of the resident for changes in overall functioning; blood pressure checks as scheduled; responding appropriately when there are observable or reported changes in the resident’s physical, mental or emotional functioning; and medication assistance.

Activities of daily living: The following tasks related to basic personal care: Bathing; toileting; dressing; personal hygiene; mobility; transferring; and eating.

Health support services: Any of the following optional services: blood glucose testing; puree diets; calorie controlled diabetic diets; dementia care; mental health care; developmental disabilities care.

Intermittent nursing services: Medication administration, administration of health treatments, diabetic management, nonroutine ostomy care, tube feeding, and nurse delegation.

EXPECTATIONS AND REQUIREMENTS FOR ASSISTED LIVINGS SERVING NONRESIDENT INDIVIDUALS

Nonresident individuals living in an assisted living are considered tenants, and thus their residency is governed by the Residential Landlord-Tenant Act, chapter 59.18 RCW. These individuals, then, require a landlord-tenant agreement, not an assisted living residency agreement. All required landlord-tenant services, notices and eviction laws pertain to nonresident individuals. WAC 388-78A-2035 requires the assisted living provide nonresident individuals a disclosure statement upon moving in and at the time any additional services are requested by the nonresident individual. That disclosure statement, which has not been standardized by DSHS, must notify the nonresident individual that the resident rights laws in 70.129 RCW do not apply to these individuals, that licensing requirements for assisted living facilities do not pertain to nonresident units/apartments, and the jurisdiction of the long-term care ombuds does not apply to nonresident individuals and nonresident units/apartments.

WHAT EXTRA SERVICES CAN AN ASSISTED LIVING PROVIDE TO A NONRESIDENT INDIVIDUAL? WAC 388-78A-2032 highlights what services a licensed assisted living may legally choose to provide to nonresident individuals upon their request and include:

· Emergency assistance. This includes actions that would customarily be offered under the Good Samaritan law, such as assisting someone who has fallen, or offering first aid after a sudden injury, or calling 911 or family on behalf of the individual.

· Monitoring device systems for emergency purposes. This typically includes a call or pendant system that allows staff to respond to potential emergencies.

· Blood pressure checks. These can be either scheduled or unscheduled.

· Nursing assessment to determine if a referral to an outside health care provider is recommended.

· Making and reminding of health care appointments.

· Preadmission assessment, for the purpose of transitioning to a licensed care setting. This might include a preadmission assessment to transition to assisted living care within the same facility where the individual currently lives.

· Medication assistance. This may include reminding or coaching the nonresident individual, opening the medication container for the individual, using an enabler, and handing a prefilled insulin syringe to the individual.

· Prefilling insulin syringes (by a licensed nurse only).

· Assessment to determine the cause of a fall.

· Nutrition management and education services.

· Dental services.

· Wellness programs. These are considered educational programs aimed to assist the individual in achieving optimal levels of health, social, and emotional functioning. These programs do not include medical care or interventions.

· The provision of additional written information to individuals and/or their families on available community resources.

While an assisted living facility may choose to provide any of the above-mentioned allowable services for nonresident individuals, it is important to note that at no time can the facility’s staff monitor a nonresident individual for changes in condition or take action on any of the information gathered during any of the above-mentioned service deliveries; this would be viewed as the assisted living provider assuming the general responsibility for the safety and well-being of the resident, and is allowed for assisted living residents only.

Service creep can be a serious concern when assisted living and nonresident individuals live in an assisted living. The facility must have strong systems in place to ensure that staff know the difference between the types of residents living in the facility, and not inadvertently assume responsibility for or monitor a nonresident’s well-being. Questions about assisted living? Email Vicki McNealley or call 360-352-3304 extension 107.