Charleston Senior AdvisorWhich conditions keep someone out of South Carolina assisted living?
Regulation 60-84 bars a CRCF from admitting anyone whose needs exceed what it may provide, and it names the common ones, from intravenous therapy and sliding-scale insulin to stage 2 or worse pressure ulcers and tube feeding the person cannot manage alone (Section 801.C).
The list in the regulation covers anyone who:
- A person likely to endanger themselves or others, as determined by a physician or other authorized healthcare provider
- A person needing hospitalization or nursing home care
- A person needing daily skilled monitoring for an unstable or complex medical condition (for example brittle diabetes)
- A person needing medications that require frequent dosage adjustment, such as sliding-scale insulin
- A person needing intravenous medications or fluids, or regular intramuscular or subcutaneous injections by staff (routine daily insulin is permitted)
- A person needing urinary catheter care they cannot manage independently
- A person needing treatment of stage 2, 3 or 4 pressure ulcers or widespread skin disorders
- A person needing nasogastric tube feeding, or gastrostomy feedings they cannot manage independently
- A person needing suctioning, or tracheostomy care they cannot manage independently
- A person receiving oxygen for the first time that requires adjustment and evaluation
Several items turn on independence. A resident who manages their own catheter, gastrostomy feeding or tracheostomy may be admitted; one who needs staff to do it may not. Routine daily insulin injections given by trained staff are allowed, sliding-scale dosing is not.
When must a CRCF stop caring for a resident?
A CRCF may not keep a resident with serious aggressive or socially inappropriate behavior it cannot control, a resident totally dependent in all activities of daily living for more than 14 consecutive days, or a resident who needs a licensed nurse's continuous daily attention (Regulation 60-84, Section 801.D).
The 14-day clock matters after a hospital stay. A resident who comes back from Roper, MUSC or Trident unable to do anything for themselves can stay while recovering, but if there is no improvement by the 15th day the facility must draw up a transfer plan. Short-term nursing for up to 14 consecutive days during convalescence is allowed, provided by a licensed home health agency or the facility's own licensed nurse.
How much notice does a family get before a required move?
When a CRCF's care, even with outside services such as home health or hospice added, can no longer meet a resident's needs, the regulation requires a transfer within 30 days to a setting that can, coordinated by the administrator with the resident, family and sponsor (Regulation 60-84, Section 801.F).
Thirty days is tight in a market where some memory care and nursing beds have waiting lists. Families who start looking at the next level of care early, ideally when the facility first raises concerns, usually get to choose rather than take whatever bed is open. A dispute over a discharge is something the regional long-term care ombudsman at the Trident Area Agency on Aging can help with.
Can hospice care happen in a Charleston assisted living facility?
Yes. A licensed hospice can serve a resident inside a CRCF, and with hospice's nurses, aides and medications added many residents remain in their apartment through the end of life instead of moving to a nursing home.
Hospice does not change the retention limits: the facility must still be able to meet the resident's needs with hospice's help. Ask any building how many residents currently receive hospice there and whether it has a policy on end-of-life care. The Lowcountry's licensed inpatient hospice house is in Summerville, for symptoms that cannot be managed at home.
What assessments happen when someone moves in?
A physical examination within 30 days before admission, a written assessment within 72 hours after move-in, and an individual care plan within seven days, reviewed at least every six months with the resident and responsible party (Regulation 60-84, Sections 702, 703 and 1101).
The examination must also be repeated at least once a year. The care plan is the document that says who helps with what and how often, so ask to attend the care plan meeting. If needs grow, the plan should change before the fees do.
Side by side
| A South Carolina CRCF may | A South Carolina CRCF may not | |
|---|---|---|
| Insulin | Have trained staff give routine daily insulin | Have staff give sliding-scale insulin |
| Nursing | Bring in short-term nursing for up to 14 days | Keep a resident needing continuous licensed nursing |
| Hospice | Keep a resident on hospice | Ignore the 30-day transfer rule when care no longer fits |
| Behavior | Care for residents with dementia | Keep a resident whose dangerous behavior it cannot control |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
