Selecting a Personal Care Home

Introduction
Choosing a personal care home for yourself, a friend or a family member is a very difficult job. This brochure is designed to give guidance in selecting the best personal care home to meet your needs and for seeing that the resident receives proper treatment and care once he or she has moved into a facility.

What is a Personal Care Home?
Although "personal care home" is the official name in Georgia, other names used include "assisted living," residential care facility" and "board and care."
A personal care home provides meals, personal services and companionship for people who are not bedridden, but need some supervision and help with daily personal needs.

A personal care home is not licensed to provide medical or nursing care, so persons requiring continuous medical or nursing services are generally inappropriate to live in a personal care home.

A physician will need to evaluate the potential resident to determine that a personal care home is an appropriate setting to meet the resident's needs before the resident can be admitted.

"Personal services" include assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing and toileting.

Regulations
The Georgia Department of Human Resources (DHR) issues rules and regulations to establish standards for the licensing and operation of personal care homes.
The Office of Regulatory Services (ORS) of the DHR licenses personal care homes. The licensing requirements are minimum standards for items like construction, staffing and diet.

In general, most personal care homes in Georgia are licensed by the state. However, some are not licensed. If you are considering a personal care home for yourself or for someone else, you should make sure that home is licensed so that the ORS will be able to investigate any complaints against the home.

In addition to rules regarding safety and sanitation, there are also specific regulations regarding the rights of residents who live there. The purpose of the rules and regulations are to assure safe, humane and comfortable supportive residential settings for adults who need such services.

However, you should not judge the quality of a personal care home solely by the fact that the home is licensed, as the licensing requirements are only the most basic standards. Those who do not have a permit are operating in violation of Georgia law.

Finding the Right Personal Care Home
Choosing the best personal care home is a difficult and challenging job. The future resident, family members and friends should participate in this process. Those involved in the selection need to consider the medical, practical, physical, emotional and financial needs and circumstances of the future resident.
When possible, locate a personal care home near the family and friends of the future resident, as visits from friends and relatives are very important to the resident's morale and well-being.

Contact the ORS Personal Care Home Program and/or Long-Term Care Ombudsman Program for lists of personal care homes. See "State Resources" at the end of this booklet or visit the ORS Web site at www.state.ga.us/Departments/DHR/ORS/orsmaintarget.htm .
After receiving the list of personal care homes in your area, call or write the home and request information about their basic costs, services and any "extra" charges that may be required.

After obtaining information about the personal care home, it is very important to make an appointment to visit the home and meet the administrator or manager. Later, go unannounced for a second visit and closer inspection.

What to Look For
Licensing. All facilities that provide personal care services are required to have a valid license or permit. The DHR permit and inspection reports are to be displayed in a conspicuous place on the premises. Ask to see the permit and inspection report. Is the license current? What is the home's licensed capacity? How many residents does the home have?

Safety. Make sure that stairways and hallways are well lighted and free of obstacles such as light cords, throw rugs, torn carpets and cracked tiles. Are there grab bars next to bathtubs, showers and toilets? Look for fire hazards, blocked fire doors and smoking restrictions that are ignored. Is there an adequate fire safety system that includes smoke and heat detectors? Is there a plan posted for quick evacuation in case of fire? Are the staff members and residents trained in fire safety?
Cleanliness. Does the home smell of urine or heavy "cover-up" deodorant? Check out window sills, counters and table tops for dust and dirt. Kitchens and residents' bathrooms must be clean.
Meals. Are special diets available? Ask to see a copy of the planned menus.
Medications. Who is responsible for initial acquisition and refilling of prescribed medications? Are medications stored under lock and key? Who supervises the medications?
Pleasant Surroundings. Flowers, pictures, seasonal decorations and general orderliness are all important in providing a happy and comfortable atmosphere for a resident.
Activities Program. Are there organized activities? What are they? Is there a regular schedule? What religious services are available? Regularly scheduled activities with participation encouraged by staff members can boost morale for residents.
Morale. Do staff members have a positive attitude toward the residents? Indifferent or sullen staff members can destroy morale. Do residents appear to be happy, interested and involved in what is going on? Take a good look at how the residents act and how they are dressed.
Privacy and Respect. Are residents afforded privacy and respect? Do staff members knock before entering a resident's room? Do staff members address residents by their names? Watch and talk to the staff members to get an idea of their attitudes towards their jobs and towards the residents. Actions of staff members reflect how the management or administration feels about the residents.

Common Rule Violations
The most common rule violations in personal care homes include: inappropriate residents; inadequate staffing or inadequately trained staff; illegally administered medications; exceeding the facility's licensed capacity; inadequate care and services; use of restraints; inadequate physical plant; residents' rights violations; inaccurate documentation on resident and staff records; and unlicensed facilities. When looking for a suitable personal care home, watch for these common violations.

Admissions Agreement
Before entering a personal care home, a resident must enter into a "written" agreement with the one legally responsible for the operation of the home.
Prior to entering into any written agreement, be sure to obtain the following information:

Fees, Deposits and Other Charges. What services are included in the "basic daily rate" of the personal care home? What services are provided for "extra" charges? If services are not provided, can they be brought in? The agreement should specify all the fees a resident may incur during the course of his or her stay. While the additional services to be purchased cannot always be foreseen, the facility should provide the resident with a cost listing of all services from the time of admission.
In addition, the agreement should specify the frequency or occurrence of fee increases, and allow for 60-day written notification of any fee increases. Is a deposit required in advance? If so, how much and how will the deposit be returned? What is the home's refund policy regarding the deposit, personal needs allowance or room and board in the event a resident is transferred or discharged?

Room. The admission agreement should specify the room or sleeping area in which the resident will reside, and the policies regarding modifying or decorating the room. Flexibility in adapting the room will allow the resident the chance to live in a truly residential setting.

Absentee Policies. 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, and if the resident must continue to pay for basic services during such absences.

House Rules. What are the house rules regarding the use of tobacco and alcohol, use of telephone, television viewing time and visitors?

Transfer and Discharge. In the event of involuntary transfer or discharge, a 30-day written notice must be given prior to termination of the admission agreement. By providing ample notification, arrangements can be made to find an alternate facility or form of care. The home must discharge or transfer the resident to an appropriate facility.

Resident Protection. The Resident Bill of Rights, as well as the admission agreement, should be in the resident's file. Be sure there is a way for a resident to voice concerns. Of utmost importance is the right of a resident to appeal decisions made by the facility on issues regarding services, living arrangements, discharge or any other violation of resident rights.

Carefully review the admission agreement. If there are statements which need clarification, ask the facility administrator to explain what is meant in simple language.

Become familiar with all of the facility rules and any attachments referenced in the agreement before signing. Attachments may be just as binding as the agreement.

Rights of Personal Care Home Residents
It is very important to know that it is illegal for anyone to abuse a personal care home resident or to violate a resident's civil or property rights. There are laws and regulations that specifically forbid this and provide for 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, without discrimination in the quality of service. No resident shall be punished or harassed by the facility, its agents or employees when trying to enforce individual rights.

Personal Care Home Residents Shall Have the Right:

To exercise constitutional rights guaranteed to the citizens of this state and this country including, but not limited to, the right to vote;
To interact with members of the community both inside and outside the facility, and to participate fully in the life of the community;
To associate or communicate privately with persons or groups of his or her choice;
To share a room with a married spouse who is also a resident of the facility, unless separate rooms are requested;
To enjoy privacy in his or her room. Facility staff shall respect this right by knocking before entering a resident's room;
To be treated with respect and be given privacy in the provision of personal care;
To practice religious beliefs as one chooses, and participate in social, religious and community activities that do not interfere with the rights of other residents. No religious belief or practice shall be imposed upon a resident;
To be free from mental, verbal, sexual and physical abuse, neglect and exploitation, humiliation, withholding of money, actual or threatened, physical or chemical restraint, isolation, corporal or unusual punishment, including interference with the daily functions of living, such as eating and sleeping;
To use, keep and control one's own property and possessions in the immediate living quarters, except to the extent that a resident's use of personal property would interfere with the safety or health of other residents;
To receive unopened mail on the day it is delivered to the facility. Outgoing mail shall also remain unopened;
To have access to a telephone and the right to have a private telephone (at the resident's own expense). Telephones shall be placed in areas to insure privacy without denying accessibility;
To have immediate access by visitors who are visiting with the consent of the resident. Residents have the right to have visitors at mutually agreed upon hours. Once the hours are agreed upon, no prior notice is necessary. Each resident shall have the right to terminate any visit by any person who has access to the facility;
To manage one's own financial affairs, including the right to keep and spend money, unless the resident has been adjudicated incompetent by a court of competency jurisdiction;
To have a personal need allowance in the amount of $5 per week. The allowance is not intended for purchase of necessities which the facility ordinarily supplies and does not relieve the facility of its obligation to insure that such necessary goods are available to the resident;
To receive or reject medical care, dental care or other services, except as required by law or regulations;
To choose and retain the services of a personal physician or any health care professional or service. To be free from interference by the facility in the resident's diagnosis, treatment or prognosis. Each resident and/or representative or legal surrogate has the right to be fully informed about care or changes in care and to access all information in medical records;
To participate in the planning of his or her care;
To inspect his or her records on request;
To discharge or transfer upon notification to the facility in conformance with the facility's policies and procedures (unless committed to facility by a court order or by representative with legal, written authority to admit, transfer or discharge);
To contact the State Long-Term Care Ombudsman Program. The facility shall post in a common area of the facility the names, addresses and telephone numbers of the ombudsman and the county inspector assigned to the facility;
To form a Resident Council and have meetings in the facility outside the presence of owners, management or staff members of the facility; and
To receive a copy of the Resident's Bill of Rights at the time of admission to the facility. In the event a resident is unable to read, the manager shall take special steps to assure communication of the contents of the Resident's Bill of Rights to the resident.
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.

Long-Term Care Ombudsman
The Long-Term Care Ombudsman Program provides free services for residents of long-term care facilities and is designed to help protect the rights of the residents. An ombudsman visits personal care homes on a regular basis, without notice, to become familiar with residents and their concerns. Residents often have little or no contact with the outside world and may feel they lack control over their lives. The ombudsman serves as a resident advocate whose primary duty is to protect the rights of individuals by investigating and resolving problems, concerns, and grievances. The goal of the Ombudsman Program is to improve the quality of life for long-term care residents.

Common problems handled by the Ombudsman Program include the care and treatment provided in personal care homes, and help with Medicare, Medicaid and other billing problems. The Ombudsman works with residents and their families to arrive at he best possible solution for any complaint. Confidentiality is maintained for residents and other persons 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:

Utilize grievance procedure of the personal care home;
Make oral or written complaint to the manager of the personal care home. The facility must respond to complaint within five days;
Contact the Long-Term Care Ombudsman Program. The ombudsman will investigate and try to resolve the problem with the resident;
File a complaint with the ORS. The ORS may cite the personal care home for being out of compliance with its licensing requirements. The result may be sanctions against the home;
Request a hearing before an administrative law judge. The resident or representative must file a request for a hearing with the Office of Legal Services of the Georgia Department of Human Resources. The ombudsman can assist with a hearing request;
The resident is entitled to his or her choice of representation. Contact the local Elderly Legal Assistance Program or the State Legal Services Developer for assistance with a hearing;
File a court action to enforce the terms of a resident's contract with the personal care home. The facility may be liable for injuries to a resident intentionally caused by employees of the home; and
In the case of an assault, battery, theft or other criminal violation, seek criminal penalties.

Summary
When selecting a personal care home, there are several things that can be done to assure that one is making the best possible choice. Choose a home close to family and friends. Visit the homes being considered. Inspect them very closely. Ask questions. Get in writing any costs, additional charges, required deposits and rules. The future resident, family and friends should then consider the resident's physical, emotional and financial needs and circumstances before making a final selection.
If you have concerns regarding care and services, notify the appropriate agencies.

State Resources
Office of Regulatory Services
Department of Human Resources
Personal Care Home Program
2 Peachtree Street NW, 31st Floor
Atlanta, GA 30303-3167
(404) 657-4076
(404) 657-5726 (complaints)

Office of the State Long-Term Care Ombudsman
Department of Human Resources
2 Peachtree Street NW, 9th Floor
Atlanta, Ga 30303-3167
(888) 454-5826

Legal Services Developer
Division of Aging Services
Department of Human Resources
2 Peachtree Street NW, 9th Floor
Atlanta, GA 30303-3167
(404) 657-5328

Office of Legal Services
Department of Human Resources
2 Peachtree Street NW, 29th Floor
Atlanta, GA 30303-3167
(404) 656-4421

Senior Legal Hotline
(404) 657-9915
(888) 257-9519

To obtain the booklet "Rules and Regulations for Personal Care Homes," please contact the Office of Regulatory Services. There is a small fee for the booklet.

This information 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.