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LB 439: New Requirements under Nebraska’s Assisted-Living Facility Act

on Thursday, 3 May 2018 in Health Law Alert: Erin E. Busch, Editor

LB 439, which makes a number of changes to Nebraska’s Assisted-Living Facility Act (the “Act”), was recently passed by the Nebraska Legislature and signed by Governor Ricketts. The bill goes into effect on July 19, 2018, so it would be prudent for an assisted-living facility to review the bill now to ensure that any necessary changes are made by the effective date. This article highlights the major changes made by LB 439. A link to LB 439 is provided at the end of this article.

A purpose for the Act has been added. Promoting the goals of individualized decision making and personal autonomy has been added to the Act’s purposes.

The definition of “assisted-living facility” in the Act was changed by adding language that it means a residential setting that provides “assisted-living services” and that it can with some exceptions include a home, apartment, or facility. A definition of “assisted-living services” was added to the Act to mean services that promote the health and safety of persons in a residential setting, including housing, three meals each day, access to staff for twenty-four hours each day, noncomplex nursing interventions, and support with activities of daily living, and includes resident assessment for admission and continued stay. The Legislature’s Health and Human Services Committee (the legislative committee to which LB 439 was assigned) stated that the bill provides clarification to better distinguish between assisted-living facilities and nursing facilities.

LB 439 made other changes to the Act’s definitions. “Activities of daily living” will mean activities such as bathing, continence, dressing, grooming, eating, mobility, toileting, transferring, self-administration of medication and similar activities. “Administrator” will mean the person responsible for day-to-day operations of an assisted-living facility and includes a person with a title such as administrator, chief executive officer, manager, superintendent, director, or other similar designation. “Authorized representative” will mean a person authorized by a resident of an assisted-living facility, such as a person holding a power of attorney or a resident designee, or authorized by a court, such as a guardian, to manage the affairs of the resident.

Admission and retention requirements have also been changed. Prior to the enactment of LB 439, the Act stated that to be eligible for admission to an assisted-living facility, a person must be in need of or wish to have available room, board, assistance with or provision of personal care, activities of daily living, or health maintenance activities or supervision due to age, illness, or physical disability. That language has now been deleted, and the Act will state that the administrator will have the discretion regarding admission or retention of residents of the assisted-living facility subject to the Act and rules and regulations adopted and promulgated under the Act.

LB 439 revises the Act to state that an assisted-living facility will determine whether or not an applicant for admission will be admitted or, in the case of current residents, whether or not he or she will be retained based on the care needs of the applicant or resident, the ability to meet those care needs within the facility, and the degree to which the admission or retention of the applicant or resident poses a danger to the applicant or resident or others. LB 439 eliminates language under the Act that stated if an applicant for admission or resident for retention required complex nursing interventions or whose condition was not stable or predictable, certain admission/retention conditions had to then be met.

LB 439 will permit assisted-living facilities to provide complex nursing interventions on a part-time or intermittent basis. A definition of “part-time or intermittent basis” has been added to mean not to exceed ten hours each week for each resident for a period of time with a predictable end within twenty-one days. “Complex nursing interventions” will be defined under the Act as interventions that require: (i) nursing judgment to safely alter standard procedures in accordance with the needs of the resident; (ii) nursing judgment to determine how to proceed from one step to the next; or (iii) a multidimensional application of the nursing process. The following language will be deleted from the definition of “complex nursing interventions”: “Complex nursing interventions does not include a nursing assessment.” A definition of “noncomplex interventions” was substituted under the Act for “health maintenance activities” and will mean interventions which can safely be performed according to exact directions, which do not require alteration of the standard procedure, and for which the results and resident responses are predictable. The Act was also revised so that any complex nursing intervention or noncomplex intervention provided by an employee of the assisted-living facility will have to be performed in accordance with applicable state law.

The revised Act requires each assisted-living facility to provide each applicant for admission (or his or her authorized representative) written information about the practices of the facility. The written information will have to include the criteria for admission and continued residence in the facility and the process for addressing issues that may prevent admission to or continued residence in the facility (as opposed to just providing information as to the circumstance under which a resident would be required to leave as was the was the case under the Act prior to LB 439) and a statement of whether or not the facility provides part-time or intermittent complex nursing interventions.

LB 439 also requires each assisted-living facility to enter into a resident services agreement in consultation with each resident. A “resident services agreement” will mean an agreement entered into by the resident or the resident’s authorized representative and the assisted-living facility that sets out the responsibilities of the facility and the resident, identifies service needs of the resident, outlines the services that will be provided to the resident by the facility and from other sources, and specifies the cost of services provided by the facility.

Click here to view the deletions and new language to be added to the Act by LB439.

If you have any questions about LB 439 and its implications or if you need any assistance with a Resident Services Agreement, please do not hesitate to call us.

Joseph P. Loudon

1700 Farnam Street | Suite 1500 | Omaha, NE 68102 | 402.344.0500