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AN ACT relating to long-term care facilities. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 194A.700 is amended to read as follows: 3
As used in KRS 194A.700 to 194A.729: 4
(1) "Activities of daily living" means normal daily activities, including but not limited 5
to bathing, dressing, grooming, transferring, toileting, and eating; 6
(2) "Ambulatory" means able to walk, transfer, or move from place to place with or 7
without hands-on assistance of another person, and with or without an assistive 8
device, including but not limited to a walker or a wheelchair; 9
(3) "Assistance with activities of daily living and instrumental activities of daily living" 10
means any assistance provided by the assisted living community staff with the 11
resident having at least minimal ability to verbally direct or physically participate in 12
the activity with which assistance is being provided; 13
(4) "Assistance with self-administration of medication," unless subject to more 14
restrictive provisions in an assisted living community's policies that are 15
communicated in writing to residents and prospective residents, means: 16
(a) Assistance with medication that is prepared or directed by the resident, the 17
resident's designated representative, or a licensed health care professional who 18
is not the owner, manager, or employee of the assisted living community. The 19
medication shall: 20
1. Except for ointments, be preset in a medication organizer or be in a 21
single dose unit; 22
2. Include the resident's name on the medication organizer or container in 23
which the single dose unit is stored; and 24
3. Be stored in a manner requested in writing by the resident or the 25
resident's designated representative and permitted by the assisted living 26
community's policies; 27 UNOFFICIAL COPY 23 RS BR 839
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(b) Assistance by an assisted living community staff person, which includes: 1
1. Reminding a resident when to take medications and observing to ensure 2
that the resident takes the medication as directed; 3
2. Handing the resident's medication to the resident, or if it is difficult for 4
the resident or the resident requests assistance, opening the unit dose or 5
medication organizer, removing the medication from a medication 6
organizer or unit dose container, closing the medication organizer for 7
the resident, placing the dose in a container, and placing the medication 8
or the container in the resident's hand; 9
3. Steadying or guiding a resident's hand while the resident is self-10
administering medications; or 11
4. Applying over-the-counter topical ointments and lotions; 12
(c) Making available the means of communication by telephone, facsimile, 13
computer, or other electronic device with a licensed health care professional 14
and pharmacy regarding a prescription for medication; 15
(d) At the request of the resident or the resident's designated representative, 16
facilitating the filling of a preset medication container by a designated 17
representative or licensed health care professional who is not the owner, 18
manager, or employee of the assisted living community; and 19
(e) None of the following: 20
1. Instilling eye, ear, or nasal drops; 21
2. Mixing compounding, converting, or calculating medication doses; 22
3. Preparing syringes for injection or administering medications by any 23
injection method; 24
4. Administrating medications through intermittent positive pressure 25
breathing machines or a nebulizer; 26
5. Administrating medications by way of a tube inserted in a cavity of the 27 UNOFFICIAL COPY 23 RS BR 839
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body; 1
6. Administrating parenteral preparations; 2
7. Administrating irrigations or debriding agents used in the treatment of a 3
skin condition; or 4
8. Administrating rectal, urethral, or vaginal preparations; 5
(5) "Assisted living community" means a licensed facility that provides sleeping 6
accommodations and assisted living services set forth in the assisted living 7
community's lease and policies for five (5) or more adult persons not related within 8
the third degree of consanguinity to the owner or manager; 9
(6) "Assisted living community with dementia care" means an assisted living 10
community that is advertised, marketed, or otherwise promoted as providing 11
specialized care for individuals with Alzheimer's disease or other dementia illnesses 12
and disorders and has a secured dementia care unit. An assisted living community 13
with a secured dementia care unit shall be licensed as an assisted living community 14
with dementia care; 15
(7) "Assisted living services" means one (1) or more of the following services: 16
(a) Assisting with activities of daily living, including but not limited to bathing, 17
dressing, grooming, transferring, toileting, and eating; 18
(b) Assisting with instrumental activities of daily living that support independent 19
living, including but not limited to housekeeping, shopping, laundry, chores, 20
transportation, and clerical assistance; 21
(c) Providing standby assistance; 22
(d) Providing verbal or visual reminders to the resident to take regularly 23
scheduled medication, including bringing the resident previously set up 24
medication, medication in original containers, or liquid or food to accompany 25
the medication; 26
(e) Providing verbal or visual reminders to the resident to perform regularly 27 UNOFFICIAL COPY 23 RS BR 839
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scheduled treatments and exercises; 1
(f) Preparing and serving three (3) meals per day consisting of regular or 2
modified diets ordered by a licensed health professional; 3
(g) Providing the services of an advanced practice registered nurse, registered 4
nurse, licensed practical nurse, physical therapist, respiratory therapist, 5
occupational therapist, speech pathologist, dietitian or nutritionist, or social 6
worker; 7
(h) Tasks delegated to unlicensed personnel by a [registered ]nurse or assigned by 8
a licensed health professional within the person's scope of practice pursuant 9
to KRS Chapter 314 and 201 KAR Chapter 20; 10
(i) Assistance with self-administration of medication; 11
(j) Medication management; 12
(k) Hands-on assistance with transfers and mobility, including use of gait belts; 13
(l) Treatments and therapies; 14
(m) Assisting residents with eating when the residents have complicated eating 15
problems such as difficulty swallowing or recurrent lung aspirations as 16
identified in the resident record or through an assessment; 17
(n) Scheduled daily social activities that address the general preferences of 18
residents and make reasonable accommodations for specific requests; and 19
(o) Other basic health and health-related services; 20
(8) "Basic health and health-related services" means: 21
(a) Monitoring and providing for the resident's health care needs; 22
(b) Storage and control of medications, other than as requested by a resident or a 23
resident's designated representative; 24
(c) Administration of medications; and 25
(d) Arranging for therapeutic services ordered by the resident's health care 26
practitioner, if the services are not available in the assisted living community; 27 UNOFFICIAL COPY 23 RS BR 839
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(9) "Cabinet" means the Cabinet for Health and Family Services; 1
(10) "Dementia" means the loss of cognitive function, including the ability to think, 2
remember, problem solve, or reason, of sufficient severity to interfere with an 3
individual's daily functioning; 4
(11) "Dementia care services" means ongoing care for behavioral and psychological 5
symptoms of dementia, including but not limited to planned group and individual 6
programming and person-centered care practices to support daily living activities 7
for people living with dementia; 8
(12) "Dementia-trained staff" means any employee who has completed the minimum 9
training required by KRS 194A.7205 and has demonstrated knowledge and the 10
ability to support individuals with dementia; 11
(13) "Hands-on assistance" means physical help by another person without which the 12
resident is not able to perform the activity; 13
(14) "Health services" has the same meaning as in KRS 216B.015; 14
(15) "Instrumental activities of daily living" means activities to support independent 15
living including but not limited to housekeeping, shopping, laundry, chores, 16
transportation, and clerical assistance; 17
(16) "Living unit" means a portion of an assisted living community occupied as the 18
living quarters of a resident under a lease agreement; 19
(17) "Medication administration" means: 20
(a) Checking the resident's medication record; 21
(b) Preparing the medication as necessary; 22
(c) Administering the medication to the resident; 23
(d) Documenting the administration or reason for not administering the 24
medication; and 25
(e) Reporting to a nurse or appropriate licensed health professional any concerns 26
about the medication, the resident, or the resident's refusal to take the 27 UNOFFICIAL COPY 23 RS BR 839
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medication; 1
(18) "Medication management" means the provision of any of the following medication-2
related services to a resident: 3
(a) Performing medication setup; 4
(b) Administering medications; 5
(c) Storing and securing medications; 6
(d) Documenting medication activities; 7
(e) Verifying and monitoring the effectiveness of systems to ensure safe handling 8
and administration; 9
(f) Coordinating refills; 10
(g) Handling and implementing changes to prescriptions; 11
(h) Communicating with the pharmacy about the resident's medications; and 12
(i) Coordinating and communicating with the prescriber; 13
(19) "Medication setup" means arranging medications by a nurse, pharmacy, or 14
authorized prescriber for later administration by the resident or by facility staff; 15
(20) "Nonambulatory" means unable to walk, transfer, or move from place to place with 16
or without hands-on assistance of another person, and with or without an assistive 17
device, including but not limited to a walker or a wheelchair; 18
(21) "Person-centered care" means respecting and valuing the individual, providing 19
individualized care that reflects the individual's changing needs, understanding the 20
perspective of the person, and providing supportive opportunities for social 21
engagement; 22
(22) "Resident" means an adult person who has entered into a lease agreement with an 23
assisted living community; 24
(23) "Secured dementia care unit" means a designated area or setting designed for 25
individuals with dementia that is secured in compliance with the applicable life 26
safety code to prevent or to limit a resident's ability to exit the secured area or 27 UNOFFICIAL COPY 23 RS BR 839
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setting. A secured dementia care unit is not solely an individual resident's living 1
area; 2
(24) "Service plan" means the written plan agreement between the resident and the 3
licensee with the content, form, style, and format solely determined by the 4
licensee, about services that will be provided to the resident; 5
(25) "Standby assistance" means minimizing the risk of injury to a resident who is 6
performing daily activities by a person who is within arm's reach providing physical 7
intervention, cueing, or oversight; 8
(26) "Temporary condition" means a condition that affects a resident as follows: 9
(a) The resident is not ambulatory before or after entering a lease agreement with 10
the assisted living community but is expected to regain ambulatory ability 11
within six (6) months of loss of ambulation, as documented by a licensed 12
health care professional, and the assisted living community has a written plan 13
in place to mitigate risk; or 14
(b) The resident is not ambulatory after entering a lease agreement with the 15
assisted living community but is not expected to regain ambulatory ability, 16
hospice services are provided by a hospice program licensed under KRS 17
Chapter 216B or other end-of-life services are provided by a licensed health 18
care provider in accordance with KRS 194A.705, as documented by a 19
licensed hospice program or other licensed health care professional, and the 20
assisted living community has a written plan in place to mitigate risk; and 21
(27) "Unlicensed personnel" means individuals not otherwise licensed or certified by a 22
governmental health board or agency who provide services to a resident. 23
Section 2. KRS 194A.703 is amended to read as follows: 24
(1) Each living unit in an assisted living community shall: 25
(a) Be at least two hundred (200) square feet for single occupancy, or for double 26
occupancy if the room is shared with a spouse or another individual by mutual 27 UNOFFICIAL COPY 23 RS BR 839
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agreement; 1
(b) Include at least one (1) unfurnished room, a lockable entry door unless in a 2
secured dementia care unit, a private bathroom with a tub or shower, 3
provisions for emergency response, a window to the outdoors, and a telephone 4
jack; 5
(c) Unless living units are in a secured dementia care unit, have an individual 6
thermostat control if the assisted living community has more than twenty (20) 7
units; and 8
(d) Have temperatures that are not under a resident's direct control at a minimum 9
of seventy-one (71) degrees Fahrenheit in winter conditions and a maximum 10
of eighty-one (81) degrees Fahrenheit in summer conditions if the assisted 11
living community has twenty (20) or fewer units, or the living units are in a 12
secured dementia care unit. 13
(2) Each resident shall be provided access to central dining, a laundry facility, and a 14
central living room. 15
(3) Each assisted living community shall comply with applicable building and life 16
safety codes as determined by the building code or life safety code enforcement 17
authority with jurisdiction. 18
(4) Assisted living communities and assisted living communities with dementia care 19
shall be classified and treated as residential buildings and not institutional 20
buildings by the Kentucky Building Code and all other applicable construction, 21
occupancy, and life safety codes. 22
Section 3. KRS 194A.705 is amended to read as follows: 23
(1) The assisted living community shall provide each resident with access to the 24
following services according to the lease agreement: 25
(a) Assistance with activities of daily living and instrumental activities of daily 26
living; 27 UNOFFICIAL COPY 23 RS BR 839
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(b) Three (3) meals and a snack[snacks] made available each day, with food 1
prepared and served in compliance with the Kentucky food code as found in 2
902 KAR 45:005, and not to exceed the applicable requirements set forth in 3
902 KAR 20:036, with flexibility in a secured dementia care unit to meet the 4
needs of residents with cognitive impairments who may eat outside of 5
scheduled dining hours; 6
(c) Scheduled daily social activities that address the general preferences of 7
residents and make reasonable accommodations for specific requests; 8
(d) Assistance with self-administration of medication; and 9
(e) Housing. 10
(2) (a) The assisted living community may provide residents with access to basic 11
health and health-related services. 12
(b) If an assisted living community chooses to provide basic health and health-13
related services, the assisted living community shall supervise the residents to 14
whom basic health and health-related services are provided and the assisted 15
living community shall staff in compliance with KRS Chapter 314 and 201 16
KAR Chapter 20, as applicable, and in accordance with applicable 17
standards established within the exclusive jurisdiction of the Kentucky 18
Board of Nursing. 19
(3) (a) Residents of an assisted living community may arrange for additional services 20
under direct contract or arrangement with an outside agent, professional, 21
provider, or other individual designated by the resident if permitted by the 22
policies of the assisted living community. 23
(b) Permitted services for which a resident may arrange or contract include but 24
are not limited to health services, hospice services provided by a hospice 25
program licensed under KRS Chapter 216B, and other end-of-life services. 26
(4) Upon entering into a lease agreement, an assisted living community shall inform the 27 UNOFFICIAL COPY 23 RS BR 839
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resident in writing about policies relating to the provision of services by the assisted 1
living community and the contracting or arranging for additional services. 2
(5) A resident issued a move-out notice shall receive the notice in writing and the 3
assisted living community shall assist each resident upon a move-out notice to find 4
appropriate living arrangements. Each assisted living community shall share 5
information provided from the cabinet regarding options for alternative living 6
arrangements at the time a move-out notice is given to the resident. 7
(6) An assisted living community shall complete and provide to the resident: 8
(a) Upon move-in, a copy of a functional needs assessment in a form, style, and 9
format to be solely determined by the licensee, with content determined 10
solely by the licensee so long as it pertains[pertaining] to the resident's ability 11
to perform activities of daily living and instrumental activities of daily living 12
and any other topics the assisted living community determines to be helpful 13
or necessary; and 14
(b) After move-in, a copy of an updated functional needs assessment in a form, 15
style, and format to be solely determined by the licensee, with content 16
determined solely by the licensee so long as it pertains[ pertaining] to the 17
resident's ability to perform activities of daily living and instrumental 18
activities of daily living, the service plan designed to meet identified needs, 19
and any other topics the assisted living community determines to be helpful 20
or necessary. 21
Section 4. KRS 194A.707 is amended to read as follows: 22
(1) The Cabinet for Health and Family Services shall establish by the promulgation of 23
administrative regulation under KRS Chapter 13A, an initial and relicensure review 24
process for assisted living communities. This administrative regulation shall 25
establish procedures related to applying for, reviewing, and approving, denying, or 26
revoking licensure, as well as the conduct of hearings upon appeals as governed by 27 UNOFFICIAL COPY 23 RS BR 839
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KRS Chapter 216B. Enforcement of KRS 194A.700 to 194A.729, 216.510 to 1
216.597, 216.765, 216A.030, 216B.015, 216B.160, and 218A.180 and 2
administrative regulations promulgated thereunder shall commence one hundred 3
eighty (180) days following the date when the regulation is approved and final. 4
(2) Notwithstanding the timeframe in KRS 216.530, an on-site visit of an assisted 5
living community shall be conducted by the cabinet: 6
(a) As part of the initial licensure review process; 7
(b) Twenty-four (24) months following the date of the previous licensure review, 8
if during the previous licensure review an assisted living community was not 9
found to have violated an administrative regulation set forth by the cabinet 10
that presented imminent danger to a resident that created substantial risk of 11
death or serious mental or physical harm; and 12
(c) Twelve (12) months following the date of the previous licensure review, if 13
during the previous licensure review an assisted living community was found 14
to have violated an administrative regulation set forth by the cabinet that 15
presented imminent danger to a resident that created substantial risk of death 16
or serious mental or physical harm. 17
(3) No business shall market its service as an assisted living community unless it has: 18
(a) Filed a current application for the business to be licensed by the cabinet as an 19
assisted living community; or 20
(b) Received licensure by the cabinet as an assisted living community. 21
(4) No business that has been denied or had its license revoked shall operate or market 22
its service as an assisted living community unless it has: 23
(a) Filed a current application for the business to be licensed by the cabinet as an 24
assisted living community; and 25
(b) Received licensure as an assisted living community from the cabinet. 26
Revocation of licensure may be grounds for the cabinet to not reissue a 27 UNOFFICIAL COPY 23 RS BR 839
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license for that property for seven (7) years if ownership remains substantially 1
the same. 2
(5) No business shall operate as an assisted living community unless its owner or 3
manager has: 4
(a) Filed a current application for the business to be licensed as an assisted living 5
community by the cabinet; and 6
(b) Received licensure as an assisted living community from the cabinet. 7
(6) [By September 1 of each year, ]Each assisted living community licensed pursuant 8
to this chapter may provide residents with educational information or education 9
opportunities on influenza disease and other diseases or health issues solely 10
determined by the licensee. 11
(7) The cabinet shall determine the feasibility of recognizing accreditation by other 12
organizations in lieu of licensure review by the cabinet. 13
(8) Individuals designated by the cabinet to conduct licensure reviews shall have the 14
skills, training, experience, and ongoing education, including understanding that 15
assisted living is not subject to the rules and regulations of the Centers for Medicare 16
and Medicaid Services, to perform assisted living community and assisted living 17
community with dementia care licensure reviews. 18
(9) The cabinet may promulgate administrative regulations to establish an assisted 19
living community and assisted living community with dementia care licensure fee 20
that shall not exceed costs of the program to the cabinet, to be assessed upon receipt 21
of an application for licensure. The cabinet shall provide a breakdown of fees 22
assessed and costs incurred for conducting licensure reviews upon request of any 23
interested person. 24
(10) The cabinet shall make findings from the most recent licensure review available to 25
the public. 26
(11) Notwithstanding any provision of law to the contrary, the cabinet may request 27 UNOFFICIAL COPY 23 RS BR 839
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additional relevant information from an assisted living community or conduct 1
additional on-site visits to ensure compliance with the provisions of KRS 194A.700 2
to 194A.729 if the cabinet has reasonable cause to believe that the assisted living 3
community is not in compliance. 4
(12) Failure to follow an assisted living community's policies, practices, and procedures 5
shall not result in a finding of noncompliance unless the assisted living community 6
is out of compliance with a related requirement under KRS 194A.700 to 194A.729. 7
(13) Denial or revocation of a license shall be in accordance with and limited to the 8
provisions of 902 KAR 20:008. 9
Section 5. KRS 194A.713 is amended to read as follows: 10
A lease agreement, in no smaller type than twelve (12) point font, shall be executed by 11
the resident and the assisted living community. All documents and information 12
otherwise provided in writing to a resident that are incorporated by reference into a 13
lease signed by the resident or their legal representative shall constitute and satisfy all 14
requirements for proof of disclosure to and review of the information or documents by 15
the resident. A lease agreement[ and] shall include but not be limited to: 16
(1) Resident data, for the purpose of providing service, to include: 17
(a) Emergency contact person's name; 18
(b) Name of responsible party or legal guardian, if applicable; 19
(c) Attending physician's name; 20
(d) Information regarding personal preferences and social factors; and 21
(e) Advance directive under KRS 311.621 to 311.643, if desired by the resident; 22
(2) Assisted living community's policy regarding termination of the lease agreement; 23
(3) Terms of occupancy; 24
(4) General services and fee structure; 25
(5) Information regarding specific services provided, description of the living unit, and 26
associated fees; 27 UNOFFICIAL COPY 23 RS BR 839
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(6) Provisions for modifying resident services and fees; 1
(7) Minimum thirty (30) day notice provision for a change in the community's fee 2
structure; 3
(8) Minimum thirty (30) day move-out notice provision for resident nonpayment, 4
subject to applicable landlord or tenant laws; 5
(9) Provisions for assisting any resident that has received a move-out notice to find 6
appropriate living arrangements prior to the actual move-out date; 7
(10) Refund and cancellation policies; 8
(11) Description of any special programming, staffing, or training if an assisted living 9
community is marketed as providing special programming, staffing, or training on 10
behalf of residents with particular needs or conditions; 11
(12) Other community rights, policies, practices, and procedures; 12
(13) Other resident rights and responsibilities, including compliance with KRS 13
194A.705(3) and (4); and 14
(14) Grievance policies that minimally address issues related to confidentiality of 15
complaints and the process for resolving grievances between the resident and the 16
assisted living community. 17
Section 6. KRS 194A.717 is amended to read as follows: 18
(1) Staffing in an assisted living community shall be sufficient in number and 19
qualification to meet the twenty-four (24) hour specifically known and scheduled 20
needs of each resident pursuant to the lease agreement, functional needs 21
assessment, and service plan. 22
(2) One (1) awake staff member shall be on site at each licensed entity at all times, 23
without regard to other factors so long as staffing is sufficient to comply with 24
subsections (1) and (5) of this section as expressly worded. 25
(3) An assisted living community shall have a designated manager who is at least 26
twenty-one (21) years of age, has at least a high school diploma or a High School 27 UNOFFICIAL COPY 23 RS BR 839
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Equivalency Diploma, and has demonstrated management or administrative ability 1
to maintain the daily operations. 2
(4) No employee who has an active communicable disease reportable to the 3
Department for Public Health shall be permitted to work in an assisted living 4
community if the employee is a danger to the residents or other employees. 5
(5) When a resident requires hands-on assistance of another person to walk, transfer, or 6
move from place to place with or without an assistive device, the assisted living 7
community shall have a policy that describes how priority will be given by staff 8
sufficient to assist that resident during times of emergency when evacuation may be 9
necessary. 10
Section 7. KRS 194A.719 is amended to read as follows: 11
(1) Prior to independently working with residents, assisted living community staff and 12
management shall receive orientation education addressing the following topics, 13
with emphasis on those most applicable to the employee's assigned duties: 14
(a) Resident rights; 15
(b) Community policies; 16
(c) Adult first aid; 17
(d) Cardiopulmonary resuscitation unless the policies of the assisted living 18
community state that this procedure is not initiated by its staff, and that 19
residents and prospective residents are informed of the policies; 20
(e) Adult abuse and neglect; 21
(f) Alzheimer's disease and other types of dementia; 22
(g) Emergency procedures; 23
(h) Aging process; 24
(i) Assistance with activities of daily living and instrumental activities of daily 25
living; 26
(j) Particular needs or conditions if the assisted living community markets itself 27 UNOFFICIAL COPY 23 RS BR 839
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as providing special programming, staffing, or training on behalf of residents 1
with particular needs or conditions; and 2
(k) Assistance with self-administration of medication. 3
(2) Assisted living community staff and management shall receive annual in-service 4
education applicable to their assigned duties that addresses no fewer than four (4) of 5
the topics listed in subsection (1) of this section, one (1) of which shall be 6
Alzheimer's disease and other types of dementia. 7
(3) Compliance with this section shall satisfy the requirements of KRS 216.713 and 8
910 KAR 4:010 as they may pertain to residents of an assisted living community 9
or an assisted living community with dementia care who do not reside in a 10
secured dementia care unit and who exhibit symptoms of Alzheimer's disease or 11
other dementia. 12
Section 8. KRS 194A.7061 is amended to read as follows: 13
(1) An applicant for licensure as an assisted living community with dementia care shall 14
have the ability to provide services in a manner that is consistent with the 15
requirements in this section. The cabinet shall consider the following criteria for 16
licensure, including but not limited to: 17
(a) The education and experience of the applicant or its principals in managing 18
residents with dementia or other dementia illnesses and disorders; and 19
(b) The compliance history of the applicant in the operation of any care facility 20
licensed, certified, or registered under federal or state law. 21
(2) If the applicant or its principals do not have experience in managing residents with 22
dementia, the applicant shall employ or contract with a consultant pursuant to terms 23
determined by the applicant and consultant for at least the first six (6) months of 24
operation. The consultant shall make recommendations on providing dementia care 25
services consistent with the requirements of this chapter. The consultant shall: 26
(a) Possess two (2) years of work experience related to dementia, health care, 27 UNOFFICIAL COPY 23 RS BR 839
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gerontology, or an associated field; and 1
(b) Have completed at least the core training required by KRS 194A.7205. 2
(3) The applicant shall document an acceptable plan to address the consultant's 3
identified concerns and shall either implement the recommendations or document in 4
the plan any consultant recommendations that the applicant chooses not to 5
implement. The cabinet shall review the applicant's plan upon request. 6
(4) Subsections (1), (2), and (3) of this section apply only to the initial licensure of 7
assisted living communities with dementia care and do not apply to existing 8
dementia units in operation as of July 14, 2022. 9
(5) The cabinet shall conduct an on-site inspection prior to the issuance of an assisted 10
living community with dementia care license. An on-site inspection of an existing 11
secured dementia care unit licensed as part of a certified assisted living community 12
or a licensed personal care home that is conducted prior to the initial issuance of an 13
assisted living community with dementia care license shall be for the sole purpose 14
of ensuring compliance with the physical environment requirements. 15
(6) The license shall be inscribed as an "Assisted Living Community with Dementia 16
Care." 17
Section 9. KRS 194A.7203 is amended to read as follows: 18
(1) An assisted living community with dementia care shall assign dementia-trained 19
staff who have been instructed in the person-centered care approach for all residents 20
residing on its secured dementia care unit. All direct care staff assigned to care for 21
residents with dementia residing on its secured dementia care unit shall be trained 22
to work with residents with Alzheimer's disease and other related dementia illnesses 23
and disorders. 24
(2) Only staff trained as required by KRS 194A.7205 shall be assigned to care for 25
dementia residents residing on its secured dementia care unit. 26
(3) Staffing levels shall be sufficient to meet the specifically known and scheduled 27 UNOFFICIAL COPY 23 RS BR 839
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needs of residents. During nighttime hours, staffing levels shall be based on the 1
sleep patterns and specifically known and scheduled needs of residents. 2
(4) In an emergency and when trained staff are not available, the assisted living 3
community may assign staff who have not completed the required training. The 4
emergency situation shall be documented and shall address: 5
(a) The nature of the emergency; 6
(b) The duration of the emergency; and 7
(c) The names and positions of staff who provided coverage and assistance. 8
(5) The licensee shall ensure that staff who provide support for residents with dementia 9
residing on its secured dementia care unit demonstrate a basic understanding and 10
ability to apply dementia training to the residents' emotional and unique health care 11
needs using person-centered planning delivery. 12
(6) Persons in charge of staff training shall have the following experience and 13
credentials: 14
(a) Two (2) years of combined education and work experience related to 15
Alzheimer's disease or other dementia illnesses and disorders, or in health 16
care, gerontology, or another related field; 17
(b) Completion of training equivalent to the requirements in KRS 194A.7205; 18
and 19
(c) A passing score on a skills competency or knowledge test the licensee 20
selected or developed. 21
(7) Orientation and in-service training may include various methods of instruction, 22
including but not limited to classroom style, Web-based training, video, or one-to-23
one training. The licensee shall use a method for determining and documenting 24
each staff person's knowledge and understanding of the training provided. All 25
training shall be documented. 26
Section 10. KRS 194A.7052 is amended to read as follows: 27 UNOFFICIAL COPY 23 RS BR 839
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(1) In addition to the minimum services required in KRS 194A.705, an assisted living 1
community with dementia care shall also provide to residents of its secured 2
dementia care unit: 3
(a) Assistance with activities of daily living that address the needs of each 4
resident with dementia; 5
(b) Nonpharmacological practices that are person-centered and evidence-6
informed; 7
(c) Informational services educating persons living with dementia and their legal 8
and designated representatives about transitions in care and expectations of 9
residents while in care; 10
(d) Social activities offered on or off the premises of the licensed assisted living 11
community with dementia care that provide residents with opportunities to 12
engage with other residents and the broader community; and 13
(e) Basic health and health-related services. 14
(2) Each resident of a secured dementia care unit shall be evaluated for engagement in 15
activities. The evaluation shall address: 16
(a) Past and current interests; 17
(b) Current abilities and skills; 18
(c) Emotional and social needs and patterns; 19
(d) Physical abilities and limitations; 20
(e) Adaptations necessary for residents to participate; and 21
(f) Identification of activities for behavioral interventions. 22
(3) An individualized activity plan shall be developed for each resident of a secured 23
dementia care unit based on his or her activity evaluation. The plan shall reflect the 24
resident's activity preferences and needs. 25
(4) A selection of daily structured and non-structured activities shall be provided to 26
residents of a secured dementia care unit and included on the resident's activity 27 UNOFFICIAL COPY 23 RS BR 839
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service or care plan as appropriate. Daily activity options based on the resident 1
evaluation may include but are not limited to: 2
(a) Occupation or chore related tasks; 3
(b) Scheduled and planned events; 4
(c) Spontaneous activities for enjoyment or to help defuse a behavior; 5
(d) One-to-one activities that promote personal interactions between residents and 6
staff; 7
(e) Spiritual, creative, and intellectual activities; 8
(f) Sensory stimulation activities; 9
(g) Physical activities; and 10
(h) Outdoor activities. 11
(5) Behavioral symptoms that negatively impact the resident and others in the assisted 12
living community with dementia care shall be evaluated and included on the service 13
plan of residents of a secured dementia care unit. The staff shall initiate and 14
coordinate outside consultation or acute care when indicated. 15
(6) Support services shall be offered to family and others with significant relationships 16
with residents of a secured dementia care unit on a regularly scheduled basis but 17
not less than every six (6) months. 18
(7) Subject to appropriate weather, time of day, and other environmental or resident-19
specific considerations as determined by staff, access to secured outdoor space and 20
walkways allowing residents of secured dementia care units to enter the secured 21
outdoor space and return to the building without staff assistance shall be provided. 22
This subsection shall only apply to secured dementia care units constructed after 23
July 14, 2022. 24
Section 11. KRS 194A.7205 is amended to read as follows: 25
In addition to the training required for all assisted living communities, an assisted living 26
community with dementia care shall meet the following training requirements for staff 27 UNOFFICIAL COPY 23 RS BR 839
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who work on its secured dementia care unit: 1
(1) All staff shall receive at least eight (8) hours of dementia-specific orientation within 2
the first thirty (30) days of working in the secured dementia care unit. Until this 3
initial training is complete, an employee shall not provide direct care unless there is 4
another employee on site who has completed the initial eight (8) hours of training 5
on topics related to dementia care and who can act as a resource and assist as 6
needed. The orientation shall include: 7
(a) Information about the nature, progression, and management of Alzheimer's 8
and other dementia illnesses and disorders; 9
(b) Methods for creating an environment that minimizes challenging behavior 10
from residents with Alzheimer's and other dementia illnesses and disorders; 11
(c) Methods for identifying and minimizing safety risks to residents with 12
Alzheimer's and other dementia illnesses and disorders; and 13
(d) Methods for communicating with individuals with Alzheimer's and other 14
dementia illnesses and disorders; 15
(2) All direct care staff members who work on a secured dementia care unit shall also 16
receive orientation training within the first thirty (30) days of caring for residents 17
residing on a secured dementia care unit that includes at a minimum: 18
(a) General training, including: 19
1. Development and implementation of comprehensive and individual 20
service plans; 21
2. Skills for recognizing physical and cognitive changes in residents; 22
3. General infection control principles; and 23
4. Emergency preparedness training; and 24
(b) Specialized training in dementia care, including: 25
1. The nature of Alzheimer's and other dementia illnesses and disorders; 26
2. The unit's philosophy related to the care of residents with Alzheimer's 27 UNOFFICIAL COPY 23 RS BR 839
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and other dementia illnesses and disorders; 1
3. The unit's policies and procedures related to the care of residents with 2
Alzheimer's and other dementia illnesses and disorders; 3
4. Behavioral problems commonly found in residents with Alzheimer's and 4
other dementia illnesses and disorders; 5
5. Positive therapeutic interventions and activities; 6
6. Skills for maintaining the safety of the residents; and 7
7. The role of family in caring for residents with Alzheimer's and other 8
dementia illnesses and disorders; 9
(3) Direct care staff who work on a secured dementia care unit shall complete a 10
minimum of sixteen (16) hours of specialized training in dementia care within the 11
first thirty (30) days of working independently with residents with Alzheimer's or 12
other dementia illnesses and disorders, and a minimum of eight (8) hours of 13
specialized training in dementia care annually thereafter; 14
(4) The secured dementia care unit shall maintain documentation reflecting course 15
content, instructor qualifications, agenda, and attendance rosters for all training 16
sessions provided; and 17
(5) Completion of orientation and training required pursuant to this section and KRS 18
194A.719 shall be deemed to satisfy the requirements of KRS 216B.072 and 19
216.713 and administrative regulations promulgated thereunder. 20
Section 12. KRS 194A.710 is amended to read as follows: 21
(1) An assisted living community shall not operate unless it is licensed under this 22
chapter. A licensee shall be legally responsible for the management, control, and 23
operations of the facility. 24
(2) (a) Only the following categories as expressly described are established and 25
permitted for assisted living community licensure: 26
1.[(a)] An assisted living community license for any assisted living 27 UNOFFICIAL COPY 23 RS BR 839
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community without a secured dementia care unit; and 1
2.[(b)] An assisted living community with dementia care license for an 2
assisted living community that provides assisted living services and 3
dementia care services in a secured dementia care unit. 4
(b) These shall be the only two (2) assisted living licensure categories that shall 5
be utilized by the cabinet that permit and promote resident aging in place, 6
with care provided in a resident living unit pursuant to the policies of the 7
licensee and as permitted by these license categories acting as a continuum 8
and being allowed to change as needed and appropriate to meet the varying 9
needs of each resident in his or her living unit over time. 10
(c) Notwithstanding paragraph (b) of this subsection, a licensee shall not be 11
required to provide basic health and health-related services to any resident 12
who does not reside in a secured dementia care unit. A licensee as disclosed 13
through its policies and resident lease may choose to provide or not provide 14
basic health or health-related services to residents of a licensed assisted 15
living community, and to residents of an assisted living community with 16
dementia care who do not reside in its secured dementia care unit. 17
(3) On or after July 14, 2022, no assisted living community shall operate a secured 18
dementia care unit without first obtaining an assisted living community with 19
dementia care license from the cabinet. A license issued pursuant to this section 20
shall not be assignable or transferable. 21
(4) An assisted living community that has one (1) or more buildings on the same 22
campus operated by the same licensee shall be licensed as one (1) entity and shall 23
receive one (1) license. If any of the buildings within the assisted living 24
community have a secured dementia care unit, the single license shall be for an 25
assisted living community with dementia care. If no secured dementia care unit 26
exists within the assisted living community, the single license shall be for an 27 UNOFFICIAL COPY 23 RS BR 839
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assisted living community. 1
Section 13. KRS 216.597 is amended to read as follows: 2
(1) As used in this section: 3
(a) "Cabinet" means the Cabinet for Health and Family Services; 4
(b) "Personal care home" or "PCH" means an establishment located in a 5
permanent building that does not comply with the physical plant requirements 6
of KRS 194A.703, has resident beds, and provides: 7
1. Supervision of residents; 8
2. Basic health and health-related services; 9
3. Personal care services; 10
4. Residential care services; and 11
5. Social and recreational activities; and 12
(c) "Specialized personal care home" or "SPCH" means a personal care home 13
that: 14
1. Participates in the mental illness or intellectual disability supplement 15
program pursuant to administrative regulations promulgated by the 16
cabinet; or 17
2. Serves residents with thirty-five percent (35%) or more having a serious 18
mental illness as defined by administrative regulations promulgated by 19
the cabinet. 20
(2) A resident in a PCH or SPCH shall: 21
(a) Be admitted in accordance with KRS 216.765; 22
(b) Be ambulatory as defined by KRS 194A.700; 23
(c) Be able to manage most of the activities of daily living; and 24
(d) Have care needs that do not exceed the capability of the PCH or SPCH. 25
(3) An individual who is nonambulatory as defined in KRS 194A.700 shall not be 26
eligible for residence in a PCH or SPCH. 27 UNOFFICIAL COPY 23 RS BR 839
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(4) A PCH or SPCH may provide services to a resident who is deemed to have a 1
temporary condition as defined in KRS 194A.700. 2
(5) (a) Residents of a PCH or SPCH may arrange for additional services under direct 3
contract or arrangement with an outside agent, professional, provider, or other 4
individual designated by the resident if permitted by the policies of the PCH 5
or SPCH. 6
(b) Permitted services for which a resident may arrange or contract include but 7
are not limited to health services, hospice services provided by a hospice 8
program licensed under KRS Chapter 216B, and other end-of-life services. 9
(6) (a) Staffing in a PCH or SPCH shall be sufficient in number and qualification to 10
meet the twenty-four (24) hour specifically known and scheduled needs of 11
each resident. 12
(b) One (1) awake staff member shall be on site at each licensed entity at all 13
times, without regard to other factors so long as staffing is sufficient to 14
comply with paragraphs (a) and (c) of this subsection. 15
(c) When a resident requires hands-on assistance of another person to walk, 16
transfer, or move from place to place with or without an assistive device, the 17
PCH or SPCH shall have a policy that describes how priority will be given by 18
staff sufficient to assist that resident during times of emergency when 19
evacuation may be necessary. 20
(7) (a) The cabinet shall promulgate administrative regulations in accordance with 21
KRS Chapter 13A to establish an initial and relicensure review process for 22
personal care homes or specialized personal care homes. Administrative 23
regulations shall establish procedures related to applying for, reviewing, and 24
approving, denying, or revoking licensure, as well as the conduct of hearings 25
upon appeals as governed by KRS Chapter 216B. 26
(b) Notwithstanding any provision of law to the contrary, the cabinet may request 27 UNOFFICIAL COPY 23 RS BR 839
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additional relevant information from a personal care home or specialized 1
personal care home or conduct additional on-site visits to ensure compliance 2
with the provisions of this chapter and other applicable statutes and 3
administrative regulations if the cabinet has reasonable cause to believe that 4
the personal care home or specialized personal care home is not in 5
compliance. 6
(c) Notwithstanding KRS 216.530, the cabinet shall conduct an on-site visit of a 7
personal care home or specialized personal care home: 8
1. As part of the initial licensure review process; 9
2. Twenty-four (24) months following the date of the previous licensure 10
review, if during the previous licensure review a personal care home or 11
specialized personal care home was not found to have violated an 12
administrative regulation set forth by the cabinet that presented 13
imminent danger to a resident that created substantial risk of death or 14
serious mental or physical harm; and 15
3. Twelve (12) months following the date of the previous licensure review, 16
if during the previous licensure review a personal care home or 17
specialized personal care home was found to have violated an 18
administrative regulation set forth by the cabinet that presented 19
imminent danger to a resident that created substantial risk of death or 20
serious mental or physical harm. 21