Title 22 §87628 & 87629
Diabetes is an on-going medical condition and without proper management can result in serious medical complications. RCFEs are licensed as non-medical facilities and are not required to have on staff a licensed skilled professional. Therefore, the consumer should know what is legally allowed within the RCFE setting regarding diabetes care, and compare that to the current and potential needs of the resident.
Facilities are allowed to accept or retain a resident who has diabetes if:
(1) the resident is able to perform his/her own glucose testing with blood or urine specimens and is able to administer his/her own medication (which includes both oral and injections)
(2) or if the resident has the medication administered by an appropriately skilled professional.
If the resident is able to manage her condition independently, then there is no need to read further. If the resident requires assistance in managing her diabetes and there is a skilled professional (i.e. an RN) on-staff available 24/7 to assist, then you will want to be sure there is good communication between yourself/the resident, the skilled professional and other staff members. If the resident requires assistance in managing her diabetes, and there is not a skilled professional on staff and readily available, then review the remainder of this FAQ to review that placement in such a facility will meet the resident's specific needs.
Regarding injections, unless they are a licensed skilled professional, staff cannot mix medication, fill a syringe, nor can they administer injections.
Facilities are charged with the responsibility of ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility.
Facilities must also ensure that syringes and needles are disposed of properly (per California Code of Regulations, Title 8, §5193 & Title 22 § 87303(f)(2).
Managing diabetes is not simply medication management; proper diet and sufficient physical activity are important as well. Title 22, §87628 states that the facility is responsible for providing modified diets as prescribed by a resident's physician. Discuss with the facility its ability to consistently accommodate dietary needs. Deviations from established/pre-approved menus are known to occur in some facilities. Equally important: double-check that the physical activities scheduled on the facility's activities calendar are sufficient and actually take place.
Contact the LPA assigned to the facility if you have concerns regarding your diabetic resident; in many cases, facility personnel are unclear as to what they are allowed and not allowed, to do.
If you experience unlicensed personnel performing functions reserved for skilled professionals, report the incident to CCLD immediately. LPAs are required to issue a notice of deficiency to the facility immediately, citing Regulations §87629(a) and (b)(1), and §87465 (a)(6), per CCLD's Evaluators Manual.