The admissions process is the critical point at which you, the consumer, can identify if the facility you have chosen will be able to meet all of the resident's needs and expectations. Prior to accepting a resident, the regulations stipulate that a facility must evaluate the appropriateness of the resident for the facility. This evaluation typically consists of an interview, a pre-admissions appraisal, a medical assessment, and presentation of the Admissions Agreement (Title 22 § 87456). Presented here is what you can expect from each of these events.
If at any point a facility conveys a sense of urgency, for example "Act now or your spot may be taken", it is important for consumers to be aware that in many cases facilities are operating below capacity and this sentiment could simply be a part of their marketing strategy.
Consumers can view the entire admissions process as YOUR chance to evaluate the appropriateness of the facility for the resident.
You can expect the following from the facility:
(1) An interview with the Licensee/Administrator (§87457)
According to Title 22, during this interview, sufficient information must be provided regarding the facility and its services such that all persons involved in the placement can make an informed decision regarding admission. Topics for discussion include the prospective resident's desires, expectations, their personal and medical background, and any specific resident needs. Topics should be discussed in detail and in reference to how the facility anticipates achieving the care requested and required by this resident.
(2) A pre-admission appraisal (§ 87457)
The LIC 603 created by CCL and is used by facilities to document the appraisal. This form can be used as a tool to assist you in your interview of the facility. By reviewing these questions ahead of time, you will be prepared to ask the facility more specifically how it plans to address the resident's needs.
Furthermore, Title 22 requires that if the initial appraisal (or any reappraisal) identifies a service need which is not being met by the general program of the facility, the facility must then obtain advice from a physician, social worker or other appropriate consultant to determine if the needs can be met by the facility, and then they must create a plan outlining the specifics of how those needs will be accommodated should the individual become/remain a resident. The plan is required to include time frames, objectives, responsible parties, and methods for evaluating progress. It is imperative that this plan be documented and signed by both parties and a copy maintained in and outside the resident's file to avoid confusion when/if concerns arise.
Facilities are not required to accept every resident. It is their responsibility to accept and retain only those residents whose needs can be met.
(3) The request for a recent medical assessment (Title 22 § 87458)
The form LIC 602A, is known as the Physician's Report. This assessment must be completed and signed by a physician. It is important to reiterate that RCFEs are non-medical facilities. The staff employed by RCFEs are not required to have any medical experience aside from general training requirements (Title 22 § 87411). If you feel the resident may need medical support, even intermittently, you will want to investigate the following:
- the medical experience of the caregivers employed by the facility
- the medical experience and critical thinking skills of the administrator/licensee
- the availability of an RN or LVN (either one employed by the facility or available for consult)
- and/or you might want to verify whether a higher level of care might not be more appropriate, in that it may provide more experience, more oversight, and more attention to certain conditions and changes in status.
(4) Presentation of the Admissions Agreement
Community Care Licensing offers LIC 604A for facilities to use as their Admissions Agreement. Based on CARR's review of the files, many smaller facilities use this standard form. Larger, corporate-owned facilities tend to use their own Admissions Agreement crafted by an attorney.
Admission Agreement Summary (Title 22 § 87507)
1) Facility and Licensee Contact Information
2) Resident Information
Providing your Social Security Number is voluntary
Providing information pertaining to financial status, property ownership and (life) insurance information are not required per regulation
3) Basic Services
A detailed list and description of what constitutes the basic services provided by the facility must be in the admissions agreement (To see what is required to be provided at a minimum see Title 22 § 87464)
The monthly private pay rate for basic services must be stated in the admissions agreement
The monthly SSI/SSP rate for basic services must be stated in the admissions agreement and cannot be in excess of the SSI/SSP rate. Per CCLD's Evaluator Manual (§ 87464): It is a violation of law for a licensee to purposely obtain an SSI/SSP beneficiary's personal and incidental needs allowance to pay for basic services. CARR is unsure about what is acceptable with regard to requiring family members to pay additional expenses for SSI/SSP residents. Title 22 § 87464 states that voluntary payments are allowed. Should this issue arise, CARR recommends contacting Community Care Licensing for guidance.
4) Optional Items and Services
Those services not included under basic services, but are available to residents should they choose to receive them must be listed in the admissions agreement alongside the costs associated with each optional item or service. The resident must agree to purchases these services at an extra charge in the admission agreement.
Typical optional items/services include incontinence products, cosmetology services, special food services or products (such as kosher food), etc.
Verify the facility's policy on notifying resident's and/or their responsible party should these services become necessary and the policy on arranging payment.
Verify the facility's policy on implementing these services should they be desired and the policy on arranging payment
Facility's are allowed to post these services in an accessible location if they are not included in the admissions agreement; therefore verifying policies regarding implementation of services and fees is helpful
5) Policies on Rate Changes
- Facilities must provide 60 days written notice to resident of any basic rate change
- For SSI/SSP rate changes, residents must be notified as soon as facility is notified.
6) Refund Conditions
7) Eviction Procedures (Title 22 § 87224)
As with any contract, read it entirely and be mindful of:
- Hidden fees (levels of care or itemized services when additional assistance becomes necessary)
- Pre-admission fees (non-refundable)
- Terms of agreement tucked inside residential Handbooks that must be signed and dated.
If you have questions concerning the provisions, contact Community Care Licensing or have your attorney review the document for you.