Choosing a personal care home for yourself or a loved one can be challenging--both practically and emotionally. This pamphlet is designed to give guidance for selecting the personal care home that best meets the needs of the resident and for making sure that the resident receives good care once they have moved into the facility.
What is a personal care home?
In Georgia, personal care home is a term applicable to many different facilities. Several types of facilities can fall under this umbrella, such as assisted living facilities, residential care facilities and board and care.
A personal care home provides meals, personal services and companionship for people who wish to maintain active lifestyles but need some level of supervision and help with daily personal needs. Some of the personal services provided in this type of facility include assistance with or supervision of self-administered medication and essential daily living activities, such as eating, bathing, grooming, dressing and using the restroom.
These facilities are not licensed to provide medical or nursing care, so people in need of continuous medical services are generally not appropriate residents for these homes.
Before a person can be admitted to a personal care home, the potential resident will need a physician's evaluation to determine if this type of facility will meet the potential resident's needs.
Regulation of Personal Care Home
The Georgia Department of Human Resources (DHR) issues rules and regulations to establish standards for the licensing and operation of personal care homes.
Within the DHR, the Office of Regulatory Services (ORS) licenses personal care homes. To obtain a license, the home must meet minimum standards for things such as construction, staffing and diet.
While most personal care homes in Georgia are licensed by the state, all are not. Therefore, in your pursuit to find the right personal care home for yourself or a loved one, you should make sure that the home is licensed so that the ORS will be able to investigate if and when complaints are made against the facility. All facilities providing personal care services are required to have valid licenses and permits. But, licensing should not be the only thing you consider when choosing a facility, since a license only ensures that the most basic standards are met.
Choosing the Right Facility
To find the best personal care home, the future resident and his or her family and friends should all participate. Everyone involved should consider the medical, practical, physical, emotional and financial needs of the future resident.
As you begin the selection process, contact the ORS Personal Care Home Program and the Long-Term Care Ombudsman Program. These entities can provide you with lists of local facilities. Once you obtain a list of facilities, call or write to the home to request information about basic costs, services and any additional charges that may be required. Also, you may wish to focus your search on facilities that are close to the resident's family and friends. Frequent visits from loved ones are very important to the resident's well-being and morale.
Once you have narrowed down the list of homes in which you are interested, make appointments to visit the facilities and meet with the administrators or managers. Then, make unannounced return visits at a later time for closer inspection of the facilities and their operation.
What to Look For
As was emphasized above, all facilities providing personal care services must have valid licenses and permits. The DHR permit and inspection report must be displayed in a conspicuous place on the premises. A review of the permit and report will show you how many residents the home has, what the licensed capacity is and whether the license is up to date.
When visiting a facility, check the stairwells and hallways. It is important that they are well-lit and free of obstacles, such as electrical cords, throw rugs, torn carpeting or cracked tiles.
When touring rooms, check the bathrooms to ensure that there are grab bars next to bathtubs, showers and toilets.
Also, be on the lookout for fire hazards, such as blocked doors and smoking restrictions that are ignored. You will want to know about the adequacy of the facility's fire safety system, whether there are smoke and heat detectors in place and whether there is a posted plan for emergency evacuation in the event of a fire. Further, you will want to inquire about whether the staff and residents are trained in fire safety.
Upon entering a facility, you should take note of the smells and sights you encounter, especially if the facility smells of urine or heavy room deodorant. Also, inspect window sills, counters, table tops and floors for dust and dirt. Kitchens and residents' bathrooms must be kept clean.
During your tour of a home, ask to see a copy of the planned menus. You will also want to ask whether there are menus to accommodate special diets.
While meeting with the facility's administrator or manager, be sure to ask who bears the responsibility for the initial acquisition and refilling of prescription medication. Also, you will want to know who supervises the medication and whether medicines are kept in a secured place.
Residents will want to feel at home in a personal care facility, and pleasant surroundings help to achieve that. Flowers, pictures, seasonal decorations and general orderliness are all vital in providing a happy and comfortable environment for residents.
Regularly scheduled activities with participation encouraged by staff members helps to boost morale and a sense of community within a personal care home. Be sure to find out whether a particular facility sponsors organized activities and events, what the events are and whether these events are regularly scheduled and posted. Also, you may wish to inquire about the availability of religious services.
The attitudes of both staff members and residents are extremely important when choosing a personal care home. Happiness is contagious, but sullenness can spread just as easily. When visiting a home, pay close attention to the interactions between the staff and the current residents. Look to see if the staff members display care, concern and positive attitudes toward the residents. Also, note whether the residents seem happy, engaged, interested and involved. Observe how the residents behave and how they are dressed as well, as this will give you an indication of how closely the staff pays attention to the residents.
Privacy and respect
During your visits to facilities, watch the staff members closely. By observing them, you will be able to get an idea of their attitudes towards their jobs and towards their residents. The actions of the staff reflect how the management or the administration feels about the resident. Therefore, it is important to note whether the staff members afford residents consideration. Displays of courtesy are evident in the smallest of instances. For example, look to see whether staff members knock before entering a resident's room and whether they address residents by their names.
Common Rule Violations
When visiting a facility, be sure to watch for these common infractions:
The Admissions Agreement
Before entering a personal care home, a resident must enter into a written agreement with the person who is legally responsible for operating the facility. Before signing this contract, review it carefully, address any concerns and ask any questions you may have. If any of the terms are confusing, ask the administrator to explain them. Also, be familiar with the facility's rules and with any attachments referenced in the contract, as these attachments may be as binding as the admissions agreement itself. Finally, before signing the agreement, make sure to obtain the following information.
Fees, deposits and other charges
The admissions agreement should specify all the fees a resident may incur during the course of his or her stay. Though the need for unforeseen services and accompanying expenses arise, the facility should provide the resident with a bottom-line cost that details all the services from the time of admission.
To ensure that you are not surprised by hidden costs, ask what services are included in the basic daily rate of the personal care home. Also, inquire about the types of services provided for extra charges. Further, if there are certain, unprovided services that you wish to receive, ask whether these services can be acquired and for what cost.
Additionally, the admissions agreement should clearly state the frequency or the occurrences of fee increases. It should also allow for 60-day written notification of any fee increases. You will also want to ask whether a deposit is required in advance, how much that deposit is and whether it will be returned at the end of the resident's stay. You will also want to know what the refund policy is regarding the deposit, the personal needs allowance and room and board costs in the event of transfer or discharge.
The admissions agreement should state specifically the room or sleeping area in which the resident will reside, and the policies regarding the modification and decoration of that room. Allowing a resident to make changes to a room enables the resident to live in a more comfortable and more residential setting.
Medical or family emergencies may require the resident to be absent from the facility for a period of time. The admission agreement should stipulate how long the facility will hold the resident's room. It should also state if a resident will be billed for basic services during such absences.
The admissions contract should state clearly the facility's rules regarding telephone use, television viewing times, visitors, alcohol and tobacco use.
Transfer and discharge
In the event of an involuntary transfer or discharge, a 30-day written notice must be given prior to the termination of the admissions agreement. By providing ample notification to the resident, the resident can make arrangements to find an alternate facility or form of care. All residents must be discharged or transferred to an appropriate facility.
The Resident Bill of Rights, as well as the admissions agreement, should be included in the resident's file. Be sure there is a way for the resident to voice concerns. Of utmost importance is the right of a resident to appeal decisions made by the facility involving services, living arrangements, discharge or any of violation of the resident's rights.
Rights of Personal Care Home Residents
It is illegal for anyone to abuse a personal care home resident or violate a resident's civil or property rights. There are laws and regulations specifically prohibiting this and providing for the enforcement of residents' rights.
Each resident shall receive adequate and appropriate care and services in compliance with all applicable federal and state laws and regulations. There shall be no discrimination in the quality of service, and no resident shall be punished or harassed by a facility, its agents or its employees when trying to enforce his or her individual rights.
Personal care home residents shall have the right:
The rights of residents in personal care homes and the responsibilities of persons licensed to provide personal care are not limited to those set forth in this pamphlet.
The Long-Term Care Ombudsman Program
The goal of the Ombudsman Program is to improve the quality of life for residents of long-term care facilities. It provides free services for residents of long-term care facilities and is designed to help protect the residents' rights. Though an ombudsman has no regulatory authority, an ombudsman serves as an effective and helpful advocate whose primary duty is to protect the rights of individuals by investigating and resolving problems, concerns and grievances. Often, residents have little or no contact with the outside world and may feel they lack control over their lives. Therefore, ombudsmen visit personal care homes regularly and without notice to become familiar with residents and with their concerns.
Common issues handled by the Ombudsman Program include the care and treatment provided in personal care homes, as well as help with Medicare, Medicaid and other billing problems. The ombudsman works with residents and their families to arrive at the best possible solution for any complaint. Confidentiality is maintained for residents and others making complaints or providing information to the ombudsmen.
Enforcing the Rights of Personal Care Home Residents
The following options may be available for enforcing the rights of a personal care home resident:
To assist you with any questions or concerns you may have regarding personal care home residency, please contact the resources listed below for assistance and information.
Office of Regulatory Services
Long-Term Care Section
2 Peachtree St. NW, 31st Floor
Atlanta, GA 30303-3142
Georgia Long-Term Care Ombudsman Program
Georgia Senior Legal Hotline
404-657-9915 or 1-888-257-9519
Division of Aging Services
2 Peachtree St. NW, Suite 9385
Atlanta, GA 30303-3142
Elder Rights and Advocacy
This pamphlet was prepared by the Elder Law Committee of the Young Lawyers Division of the State Bar of Georgia as a public service. It is not intended to be a comprehensive statement of law. Its purpose is to inform, not to advise on any specific legal problem. If you have specific questions regarding any matter contained in this pamphlet, you are encouraged to consult an attorney.