The Oregon Caregiver SPRING/SUMMER 2023 www.ohca.com 12 LEGAL & REGULATORY A Quick Overview of the Regulations, Laws, and Rules Facilities Must Follow and Balance Every Day By Eugenia Liu, J.D., Oregon Health Care Association Nursing facilities and communitybased care communities, such as assisted living and residential care facilities, operate under an extremely complex regulatory framework, which is sometimes even at odds with itself. Regulations govern every aspect of operations, from resident care to employee relations, to workplace safety. Facilities must comply with these various regulations every day and, more importantly, all at once. Below, we take a glance into the extensive rules, laws, and regulations that a facility must carefully balance every single day to provide quality care to residents and to support workers. Resident-Focused Regulations The resident is at the heart of everything that a facility does every day, so it makes sense that the majority of the regulations focus on resident care and services. The rules come into play even before a potential resident steps into a facility. There are extensive requirements governing who can be admitted and the processes for doing so. For example, nursing facilities cannot admit individuals with a mental disorder or intellectual disability absent of state approval. Furthermore, both nursing facilities and community-based care communities must complete pre-admission assessments and accept only residents whose care needs they can meet. To promote transparency, the rules require certain pre-admission disclosures. Depending on the type of setting, the required disclosures are outlined in the residency agreement and/or Consumer Statements and Consumer Disclosures, and include details of services offered as well as service limits of the facility, the costs associated with basic services and charges for additional items or services, and the resident’s rights and responsibilities. Once a resident is admitted, detailed rules dictate the comprehensive assessment that must be completed to create a person-centered service plan and the frequency of re-assessments. Under the rules, facilities carefully consider— among other things—the resident’s medical conditions and history, functional status and activities of daily living, cognition, physical impairments, nutritional requirements, preferences, and care goals. Residents also enjoy a broad range of rights and protections so long as the exercise of these rights does not infringe upon the rights or safety or others. These rights include, being treated with dignity and respect, being free from abuse or neglect, participating in the development of their service plans and being able to choose or refuse services, associating and communicating in private with persons of their choice, and being assured privacy during care or having records kept confidential. Facilities also must comply with rules that govern how services are delivered. For nursing facilities, the rules outline requirements for nursing services, physician services, dental services, rehabilitative services, activity services, social services, dietary services, and pharmaceutical services. For community- based care facilities, which is a non- medical social model, the rules focus on the minimum scope of services that a facility must provide, such as assistance with activities of daily living, transportation for medical and social purposes, and medication administration. There are even rules that govern the end of a resident’s stay with a facility. In both settings, residents can only be transferred or discharged for nonpayment and selected medical, welfare, or safety reasons. Then, there are the rules that regulate the building and physical environment. Aside from compliance with general building codes, facilities must meet specific requirements for almost every space in the facility, from resident units to medication to common areas. Additionally, heating systems must be able to maintain certain temperatures and lighting must have certain intensities— measured in minimum footcandles— based on certain areas such as resident The resident is at the heart of everything that a facility does every day, so it makes sense that the majority of the regulations focus on resident care and services.
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