senate Bill S1417A

2013-2014 Legislative Session

Relates to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
May 30, 2014 print number 1417a
amend and recommit to aging
Jan 08, 2014 referred to aging
Jan 09, 2013 referred to aging

Bill Amendments

Original
A (Active)
Original
A (Active)

Co-Sponsors

view additional co-sponsors

S1417 - Bill Details

See Assembly Version of this Bill:
A5168A
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd ยง4655, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
S6274, A8870

S1417 - Bill Texts

view summary

Relates to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living.

view sponsor memo
BILL NUMBER:S1417

TITLE OF BILL:
An act
to amend the public health law, in relation to requiring a registered
nurse on staff at facilities certified for enhanced assisted living or
special needs assisted living

PURPOSE OR GENERAL IDEA OF BILL:
To require that a registered nurse be
on staff five days a week to assure adequate assessment and
monitoring of resident care in certain adult care facilities.

SUMMARY OF SPECIFIC PROVISIONS:
Amends Public Health Law section 4655
to require that adult care facilities pursuing new or renewing
enhanced assisted living certificates include a registered nurse (RN)
on staff a minimum of one shift per day, five days a week.

Facilities with resident populations that do not require full time
oversight by the RN may employ the individual for administrative or
other purposes, as well.

Determination of a resident's need for 24 hour skilled nursing care
must be made by both the resident's physician and the facility's RN.

Existing facilities are given an additional 18 months to comply with
the RN staffing requirement.

JUSTIFICATION:
"Enhanced assisted living residences" (EALR) and
"special needs assisted living residences" (SNALR) are categories of
assisted living residences that are authorized to house residents who
need a higher level of care, such as those who are chronically
chairfast and unable to transfer, or suffering from significant
dementia.

These individuals are inherently more fragile and more likely to be or
become unstable and need full-time assistance than the general
population of assisted living residents. Although under current
regulatory requirements registered nurses are available on call,
there is no system in place for residents to receive ongoing,
in-person, professional monitoring or assessment. This type of
ongoing evaluation is essential to helping residents age in place
safely. This requirement had been adopted by DOH, but a court
decision held that it required statutory authority, which this bill
would provide.

The bill would update the requirements for obtaining or renewing
certification as an EALR or SNALR to include having a full-time
registered nurse on-site at the facility, employed primarily to
coordinate and monitor resident care. To minimize the burden on
smaller facilities, with the department's permission, the staff
registered nurse may also be employed in an administrative or other
capacity.


PRIOR LEGISLATIVE HISTORY:
2011-2012: S.6274 - Died in Committee

FISCAL IMPLICATIONS:
None to the state.

EFFECTIVE DATE:
Ninety days after becoming law.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1417

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens.  MONTGOMERY,  KRUEGER,  PARKER  --  read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Aging

AN ACT to amend the public health law, in relation to requiring a regis-
  tered  nurse  on  staff  at facilities certified for enhanced assisted
  living or special needs assisted living

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Section 4655 of the public health law, as added by chapter
2 of the laws of 2004, is amended to read as follows:
  S 4655. Certification procedures and requirements. 1.  Notwithstanding
any other provision of law, an assisted living operator may apply to the
department to obtain an enhanced assisted living certificate pursuant to
this section.
  (a) Such application shall be on a form approved by the department.
  (b)  An  assisted living operator may apply for such a certificate for
the entire facility or any number of beds at the facility.
  (c) To obtain an enhanced assisted living certificate,  the  applicant
must  submit  a  plan to the department setting forth how the additional
needs of residents will be safely and appropriately met  at  such  resi-
dence.  Such  plan  shall include, but need not be limited to, a written
description of services, staffing levels, staff education and  training,
work experience, and any environmental modifications that have been made
or  will  be  made  to  protect  the  health, safety and welfare of such
persons in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY  WILL
MEET THE REGISTERED NURSE STAFFING REQUIREMENT.
  (d) In addition to any other requirements of assisted living, an oper-
ator  of  enhanced assisted living may hire care staff directly pursuant
to standards developed by the department or contract with  a  home  care

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01611-01-3

S. 1417                             2

services  agency  which has been approved to operate pursuant to article
thirty-six of this chapter.
  (e)  No  assisted  living  residence  shall  be  certified as enhanced
assisted living unless and  until  the  applicant  obtains  the  written
approval of the department.
  (F)  (I)  TO  OBTAIN OR RENEW AN ENHANCED ASSISTED LIVING CERTIFICATE,
THE APPLICANT SHALL BE REQUIRED TO HAVE A STAFF MEMBER ONSITE TO  ASSESS
AND  MONITOR  THE  CONDITION OF RESIDENTS. AT A MINIMUM, THIS INDIVIDUAL
SHALL BE A REGISTERED NURSE.
  (II) THE REGISTERED NURSE SHALL BE AT THE FACILITY A  MINIMUM  OF  ONE
SHIFT  PER  DAY,  FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES OF THE REGIS-
TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI-
DENT ASSESSMENT AND MONITORING, AND  ENSURING  THAT  ALL  RESIDENTS  ARE
RECEIVING APPROPRIATE CARE.
  (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE
MONITORING  OR  OVERSIGHT  SERVICES OF A REGISTERED NURSE ON A FULL TIME
BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER
CAPACITY, AS APPROPRIATE FOR  THE  FACILITY.  FACILITIES  CHOOSING  THIS
OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT
AND MONITORING.
  (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO
FURNISH  PROOF  OF COMPLIANCE WITH THIS PARAGRAPH NO LATER THAN EIGHTEEN
MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW.
  2. No resident shall be permitted to continue to age  in  place  under
the  terms  of an enhanced assisted living certificate unless the opera-
tor, the resident's physician, THE FACILITY'S  STAFF  REGISTERED  NURSE,
and, if applicable, the resident's licensed or certified home care agen-
cy,  agree  that  the additional needs of the resident can be safely and
appropriately met at the residence. A  resident  eligible  for  enhanced
assisted  living  or his or her representative shall submit to the resi-
dence a written report from a physician, which report shall state that:
  (a) the physician has physically examined the resident within the last
month; and
  (b) the resident is not in need of twenty-four  hour  skilled  nursing
care  or  medical  care  which  would require placement in a hospital or
residential health care facility.
  3. The residence must notify a resident that, while the residence will
make reasonable efforts to facilitate the resident's ability to  age  in
place  pursuant  to an individualized service plan, there may be a point
reached where the needs of the resident cannot be safely or appropriate-
ly met at the residence, requiring the transfer of  the  resident  to  a
more  appropriate  facility  in  accordance  with the provisions of this
article.
  4. If a resident reaches the point where he or she is in need of twen-
ty-four hour skilled  nursing  care  or  medical  care  required  to  be
provided by facilities licensed pursuant to article twenty-eight of this
chapter  or  article  nineteen,  thirty-one  or thirty-two of the mental
hygiene law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE  FACILITY'S
STAFF  RESIDENT  NURSE,  then  the  resident must be discharged from the
residence and the operator shall initiate  proceedings  for  the  termi-
nation  of  the  residency agreement of such resident in accordance with
the provisions  of  section  four  hundred  sixty-one-h  of  the  social
services law.  Provided, however, a resident may remain at the residence
if each of the following conditions are met:

S. 1417                             3

  (a)  a  resident  in  need of twenty-four hour skilled nursing care or
medical care hires appropriate nursing, medical or hospice staff to care
for his or her increased needs;
  (b)  the  resident's physician [and], home care services agency [both]
AND THE FACILITY'S STAFF REGISTERED NURSE  ALL  determine  and  document
that,  with the provision of such additional nursing, medical or hospice
care, the resident can be safely cared for in the residence,  and  would
not  require  placement  in  a  hospital, nursing home or other facility
licensed under article twenty-eight of this chapter or article nineteen,
thirty-one or thirty-two of the mental hygiene law;
  (c) the operator agrees to retain the resident and to  coordinate  the
care  provided  by  the  operator and the additional nursing, medical or
hospice staff; and
  (d) the resident is otherwise eligible to reside at the residence.
  5. In addition to the requirements otherwise required for licensure as
assisted living, any residence that  advertises  or  markets  itself  as
serving  individuals  with special needs, including, but not limited to,
individuals with  dementia  or  cognitive  impairments,  must  submit  a
special needs plan to the department setting forth how the special needs
of  such  residents  will  be safely and appropriately met at such resi-
dence. Such plan shall include, but need not be limited  to,  a  written
description  of  specialized  services, staffing levels, staff education
and training, work  experience,  professional  affiliations  or  special
characteristics  relevant to serving persons with special needs, and any
environmental modifications that have been  made  or  will  be  made  to
protect the health, safety and welfare of such persons in the residence.
In approving an application for special needs certification, the depart-
ment shall develop standards to ensure adequate staffing and training in
order  to  safely meet the needs of the resident. The standards shall be
based upon recommendations of the task force established by section five
of the chapter of the  laws  of  two  thousand  four  which  added  this
section.  IN  ADDITION  TO  ANY OTHER STANDARDS WHICH THE DEPARTMENT MAY
DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL
BE SUBJECT TO THE SAME REGISTERED NURSE STAFFING  REQUIREMENTS  DETAILED
IN  PARAGRAPHS  (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION. No resi-
dence shall market [themselves] ITSELF as providing specialized services
unless and until the  department  has  approved  such  applicant  for  a
special  needs  assisted  living  certificate.  EXISTING  SPECIAL  NEEDS
ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI-
ANCE WITH THE NEW STAFFING REQUIREMENTS NO LATER  THAN  EIGHTEEN  MONTHS
AFTER THIS SENTENCE SHALL HAVE BECOME A LAW.
  6. An enhanced assisted living certificate shall not be required of an
adult care facility, or part thereof, which has obtained approval by the
department  to  operate  an  assisted living program pursuant to section
four hundred sixty-one-l of the social services law. Provided,  however,
such  exemption shall only apply to those beds at the facility which are
subject to the assisted living program.
  S 2. This act shall take effect on the ninetieth day  after  it  shall
have  become  a  law;  provided  that any rules and regulations, and any
other actions necessary to implement the provisions of this act  on  its
effective  date are authorized and directed to be completed on or before
such date.

Co-Sponsors

view additional co-sponsors

S1417A (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A5168A
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd ยง4655, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
S6274, A8870

S1417A (ACTIVE) - Bill Texts

view summary

Relates to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living.

view sponsor memo
BILL NUMBER:S1417A

TITLE OF BILL: An act to amend the public health law, in relation to
requiring a registered nurse on staff at facilities certified for
enhanced assisted living or special needs assisted living

PURPOSE OR GENERAL IDEA OF BILL: To require that a registered nurse
be on staff five days a week to assure adequate assessment and
monitoring of resident care in certain adult care facilities.

SUMMARY OF SPECIFIC PROVISIONS: Amends Public Health Law section 4655
to require that adult care facilities pursuing new or renewing
enhanced assisted living certificates include a registered nurse (RN)
on staff a minimum of one shift per day, five days a week.

Facilities with resident populations that do not require full time
oversight by the RN may employ the individual for administrative or
other purposes, as well.

Determination of a resident's need for 24 hour skilled nursing care
must be made by both the resident's physician and the facility's RN.

Existing facilities are given an additional 18 months to comply with
the RN staffing requirement.

JUSTIFICATION: "Enhanced assisted living residences" (EALR) and
"special needs assisted living residences" (SNALR) are categories of
assisted living residences that are authorized to house residents who
need a higher level of care, such as those who are chronically
chairfast and unable to transfer, or suffering from significant
dementia.

These individuals are inherently more fragile and more likely to be or
become unstable and need full-time assistance than the general
population of assisted living residents. Although under current
regulatory requirements registered nurses are available on call, there
is no system in place for residents to receive ongoing, in-person,
professional monitoring or assessment. This type of ongoing evaluation
is essential to helping residents age in place safely. This
requirement had been adopted by DOH, but a court decision held that it
required statutory authority, which this bill would provide.

The bill would update the requirements for obtaining or renewing
certification as an EALR or SNALR to include having a full-time
registered nurse on-site at the facility, employed primarily to
coordinate and monitor resident care. To minimize the burden on
smaller. facilities, with the department's permission, the staff
registered nurse may also be employed in an administrative or other
capacity.

PRIOR LEGISLATIVE HISTORY: 2011-2012: S.6274 - Died in Committee

FISCAL IMPLICATIONS: None to the state.

EFFECTIVE DATE: Ninety days after becoming law.


view full text
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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 1417--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens.  MONTGOMERY,  ADDABBO, GRISANTI, HOYLMAN, KRUEGER,
  PARKER -- read twice and ordered  printed,  and  when  printed  to  be
  committed to the Committee on Aging -- recommitted to the Committee on
  Aging   in  accordance  with  Senate  Rule  6,  sec.  8  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the public health law, in relation to requiring a regis-
  tered nurse on staff at facilities  certified  for  enhanced  assisted
  living or special needs assisted living

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 4655 of the public health law, as added by  chapter
2 of the laws of 2004, is amended to read as follows:
  S  4655. Certification procedures and requirements. 1. Notwithstanding
any other provision of law, an assisted living operator may apply to the
department to obtain an enhanced assisted living certificate pursuant to
this section.
  (a) Such application shall be on a form approved by the department.
  (b) An assisted living operator may apply for such a  certificate  for
the entire facility or any number of beds at the facility.
  (c)  To  obtain an enhanced assisted living certificate, the applicant
must submit a plan to the department setting forth  how  the  additional
needs  of  residents  will be safely and appropriately met at such resi-
dence. Such plan shall include, but need not be limited  to,  a  written
description  of services, staffing levels, staff education and training,
work experience, and any environmental modifications that have been made
or will be made to protect  the  health,  safety  and  welfare  of  such
persons  in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY WILL
MEET THE REGISTERED NURSE STAFFING REQUIREMENT.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01611-03-4

S. 1417--A                          2

  (d) In addition to any other requirements of assisted living, an oper-
ator of enhanced assisted living may hire care staff  directly  pursuant
to  standards  developed  by the department or contract with a home care
services agency which has been approved to operate pursuant  to  article
thirty-six of this chapter.
  (e)  No  assisted  living  residence  shall  be  certified as enhanced
assisted living unless and  until  the  applicant  obtains  the  written
approval of the department.
  (F)  (I)  TO  OBTAIN OR RENEW AN ENHANCED ASSISTED LIVING CERTIFICATE,
THE APPLICANT SHALL BE REQUIRED TO HAVE A  REGISTERED  NURSE  ONSITE  TO
ASSESS AND MONITOR THE CONDITION OF RESIDENTS.
  (II)  THE  REGISTERED  NURSE SHALL BE AT THE FACILITY A MINIMUM OF ONE
SHIFT PER DAY, FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES  OF  THE  REGIS-
TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI-
DENT  ASSESSMENT  AND  MONITORING,  AND  ENSURING THAT ALL RESIDENTS ARE
RECEIVING APPROPRIATE CARE.
  (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE
MONITORING OR OVERSIGHT SERVICES OF A REGISTERED NURSE ON  A  FULL  TIME
BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER
CAPACITY,  AS  APPROPRIATE  FOR  THE  FACILITY. FACILITIES CHOOSING THIS
OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT
AND MONITORING.
  (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO
FURNISH PROOF OF COMPLIANCE WITH THIS PARAGRAPH NO LATER  THAN  EIGHTEEN
MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW.
  2.  No  resident  shall be permitted to continue to age in place under
the terms of an enhanced assisted living certificate unless  the  opera-
tor,  the  resident's  physician, THE FACILITY'S STAFF REGISTERED NURSE,
and, if applicable, the resident's licensed or certified home care agen-
cy, agree that the additional needs of the resident can  be  safely  and
appropriately  met  at  the  residence. A resident eligible for enhanced
assisted living or his or her representative shall submit to  the  resi-
dence a written report from a physician, which report shall state that:
  (a) the physician has physically examined the resident within the last
month; and
  (b)  the  resident  is not in need of twenty-four hour skilled nursing
care or medical care which would require  placement  in  a  hospital  or
residential health care facility.
  3. The residence must notify a resident that, while the residence will
make  reasonable  efforts to facilitate the resident's ability to age in
place pursuant to an individualized service plan, there may be  a  point
reached where the needs of the resident cannot be safely or appropriate-
ly  met  at  the  residence, requiring the transfer of the resident to a
more appropriate facility in accordance  with  the  provisions  of  this
article.
  4. If a resident reaches the point where he or she is in need of twen-
ty-four  hour  skilled  nursing  care  or  medical  care  required to be
provided by facilities licensed pursuant to article twenty-eight of this
chapter or article nineteen, thirty-one  or  thirty-two  of  the  mental
hygiene  law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE FACILITY'S
STAFF RESIDENT NURSE, then the resident  must  be  discharged  from  the
residence  and  the  operator  shall initiate proceedings for the termi-
nation of the residency agreement of such resident  in  accordance  with
the  provisions  of  section  four  hundred  sixty-one-h  of  the social
services law.  Provided, however, a resident may remain at the residence
if each of the following conditions are met:

S. 1417--A                          3

  (a) a resident in need of twenty-four hour  skilled  nursing  care  or
medical care hires appropriate nursing, medical or hospice staff to care
for his or her increased needs;
  (b)  the  resident's physician [and], home care services agency [both]
AND THE FACILITY'S STAFF REGISTERED NURSE  ALL  determine  and  document
that,  with the provision of such additional nursing, medical or hospice
care, the resident can be safely cared for in the residence,  and  would
not  require  placement  in  a  hospital, nursing home or other facility
licensed under article twenty-eight of this chapter or article nineteen,
thirty-one or thirty-two of the mental hygiene law;
  (c) the operator agrees to retain the resident and to  coordinate  the
care  provided  by  the  operator and the additional nursing, medical or
hospice staff; and
  (d) the resident is otherwise eligible to reside at the residence.
  5. In addition to the requirements otherwise required for licensure as
assisted living, any residence that  advertises  or  markets  itself  as
serving  individuals  with special needs, including, but not limited to,
individuals with  dementia  or  cognitive  impairments,  must  submit  a
special needs plan to the department setting forth how the special needs
of  such  residents  will  be safely and appropriately met at such resi-
dence. Such plan shall include, but need not be limited  to,  a  written
description  of  specialized  services, staffing levels, staff education
and training, work  experience,  professional  affiliations  or  special
characteristics  relevant to serving persons with special needs, and any
environmental modifications that have been  made  or  will  be  made  to
protect the health, safety and welfare of such persons in the residence.
In approving an application for special needs certification, the depart-
ment shall develop standards to ensure adequate staffing and training in
order  to  safely meet the needs of the resident. The standards shall be
based upon recommendations of the task force established by section five
of [the] chapter TWO of the laws of two thousand four [which added  this
section].  IN  ADDITION  TO ANY OTHER STANDARDS WHICH THE DEPARTMENT MAY
DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL
BE SUBJECT TO THE SAME REGISTERED NURSE STAFFING  REQUIREMENTS  DETAILED
IN  PARAGRAPHS  (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION. No resi-
dence shall market [themselves] ITSELF as providing specialized services
unless and until the  department  has  approved  such  applicant  for  a
special  needs  assisted  living  certificate.  EXISTING  SPECIAL  NEEDS
ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI-
ANCE WITH THE NEW STAFFING REQUIREMENTS NO LATER  THAN  EIGHTEEN  MONTHS
AFTER THIS SENTENCE SHALL HAVE BECOME A LAW.
  6. An enhanced assisted living certificate shall not be required of an
adult care facility, or part thereof, which has obtained approval by the
department  to  operate  an  assisted living program pursuant to section
four hundred sixty-one-l of the social services law. Provided,  however,
such  exemption shall only apply to those beds at the facility which are
subject to the assisted living program.
  S 2. This act shall take effect on the ninetieth day  after  it  shall
have  become  a  law;  provided  that any rules and regulations, and any
other actions necessary to implement the provisions of this act  on  its
effective  date are authorized and directed to be completed on or before
such date.

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