Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition

GEORGIA

The Department of Community Health licenses assisted living communities and

personal care homes. Requirements for these two settings differ with regard to

admission thresholds, required services, medication management, and physical plant

requirements. Facilities that provide “memory care” services must meet additional

requirements.

Adult foster care providers that serve two or more adults are licensed as a type of

personal care home.

This profile includes summaries of selected assisted living and personal care home

persons and is licensed to provide “assisted living care,” defined as the provision of

personal services, the administration of medications by a certified medication aide, and

the provision of assisted self-preservation. Assisted self-preservation defines the

capacity of a resident to be evacuated to a designated point of safety within an

established period of time, as determined by the Office of the Fire Safety

Commissioner.

of housing, food service, and one or more personal services for two or more adults who

personal care home that either presents itself as providing memory care services or

provides personal services in secured surroundings to persons with diagnoses of

probable Alzheimer’s disease or other dementia. Memory care services means the

additional watchful oversight systems, program, activities, and devices that are required

for residents who have cognitive deficits that may impact memory, language, thinking,

reasoning, or impulse control, and which place the residents at risk of eloping (i.e.,

engaging in unsafe wandering activities outside the home).

the use of proxy caregivers (i.e., an unlicensed staff person; see Staffing section below).

The agreement must be written to be understandable to the resident and his/her

representative or legal guardian.

In both settings, marketing materials must disclose the facility’s licensure

classification; and the facility must disclose whether or not proxy caregivers are

requirements, post-admission assessments, individual service plans, and therapeutic

prior to move-in to determine if they are capable of transferring with minimal assistance

and able to participate in the facility’s social activities. Individuals may not be admitted if

a physical examination--which must be conducted by a licensed physician, nurse

behavioral condition that requires the use of physical or chemical restraints, isolation, or

confinement. Residents must not be bedridden or require continuous medical or nursing

care and treatment. No home is permitted to admit or retain a resident who needs care

beyond which the home is permitted to provide.

Residents of memory care units in both settings must have a physician’s report of

a physical examination completed within 30 days prior to admission to the assisted

The physical examination must clearly reflect that the resident has a diagnosis of

probable Alzheimer’s disease or other dementia, and has symptoms that demonstrate a

need for placement in the specialized unit. However, the unit may also care for a

resident who does not have a probable diagnosis of Alzheimer’s disease or other

dementia, but desires to live in this unit and waives his or her right to live in a less

restrictive environment. In addition, the physical examination report must establish that

the potential resident of the unit does not require 24-hour skilled nursing care.

the provision of assisted self-preservation.

assist with or supervise self-administration of medications.

needs of the individual residents and adapt the activities, as-necessary, to encourage

resident participation in the following at least weekly, with at least some therapeutic

• Sensory enhancement activities, such as distinguishing pictures and picture

books, reminiscing, and scent and tactile stimulation.

Both settings require an assessment to determine the resident’s functional

capacity with regard to ADLs, physical care needs, medical needs, cognitive and

behavioral impairments, personal preferences relative to care needs, and whether

family supports are available. A written care plan must document the assessment

findings and be updated at least annually and when there is a change in the resident’s

needs.

Memory care units must review care plans quarterly and modify them as changes

in the residents’ needs occur. The residents’ written care plan will be developed or

updated by a staff team that includes at least one member of the specialized memory

Residents of licensed facilities may directly hire a “proxy caregiver” to assist with or

administer medications and provide personal care.

Assisted living community staff may not provide medical and nursing health

services (other than care plans, staff training, and medication administration) that are

capacity to self-administer medications must be allowed to store and self-administer

their own medications. Communities must assist residents with self-administration if

requested. Specific tasks for assisting residents with self-administration include storage

of medications, placing an oral dosage in the resident’s hand, applying topical

medications, and assisting with an Epi pen. Unlicensed staff may provide this

assistance only if unit dose or multi-dose packaged medications are used.

If the facility provides medication administration, certified medication aides must be

• Administer physician-ordered medications.

• Administer insulin, epinephrine, and B-12 according to physicians’ orders and

protocols.

• Administer medications via a metered dose inhaler.

• Conduct finger stick blood glucose testing following an established protocol.

• Administer a commercially prepared disposable enema ordered by a physician.

A licensed pharmacist must conduct quarterly drug regimen reviews, which include

the following duties: (1) report any irregularities to the assisted living community

administration; (2) remove for proper disposal any drugs that are expired, discontinued,

or in a deteriorated condition; (3) establish or review policies and procedures for safe

and effective drug therapy, distribution, use, and control; and (4) monitor compliance

with established policies and procedures for medication handling and storage.

Personal care homes have the same provisions regarding self-administration and

assistance with self-administration of medications described above. However, personal

care homes may not administer medications, nor do they require pharmacist review.

Medications for residents living in a memory care unit must be provided by either

or both of the following: (1) a licensed registered nurse (RN) or a licensed practical

nurse who is working under the supervision of a licensed physician or RN; and (2) a

proxy caregiver employed by the facility in compliance with the rules and regulations for

be provided for each four residents, and at least one bathing/showering room for each

eight residents, based on the facility’s licensed capacity. Communities that serve

persons dependent on a wheelchair or walker must have fully accessible bathrooms for

their use.

Personal Care Homes. Apartment-style units are not required. Living units may

be single-occupancy or have up to four residents. If a resident chooses in writing to

share a private bedroom or living space with another resident of the home, then the

residents must be permitted to share the room, subject to the usable square feet

requirement and the limitation that no more than four residents may share any bedroom

or private living space.

At least one toilet and sink must be provided for each four residents, and at least

one bathing/showering room for each eight residents. At least one toilet and sink must

be provided on each floor having residents' bedrooms.

supervising the unit at all times, and sufficient numbers of trained staff must be on-duty

Dementia Staff Training. In addition to general training requirements, staff in

Memory Care Units must be trained in the philosophy of care for residents with

dementia and facility-specific policies and procedures. Required training topics include:

stimulation, and ADL skills.

• Appropriate floor and wall surfaces with the exception of fire exits, door, and

access ways, which may be designed to minimize contrast to conceal areas

where the residents should not enter.

• Lighting that minimizes glare and shadows.

• The opportunity for the resident’s free movement between the common space

and the resident’s room.

• Individually identified entrances to residents’ rooms to assist them in identifying

Criminal history background checks, including a satisfactory fingerprint records

check, are required for owners, administrators, managers, and all staff. Any owner or

employee who acquires a criminal record must report it to the Department and undergo

another fingerprint records check.

The state has two Elderly and Disabled 1915(c) Medicaid Waiver programs that

pay for services (referred to as alternative living services) in personal care homes with

up to 24 beds: (1) the Community Care Services Program is managed by the

Department of Community Health’s Division of Medical Assistance Plans and partners

with the Division of Aging Services; and (2) the Service Options Using Resources in a

Community Environment (SOURCE) program, an enhanced primary care case

management program that serves frail elderly and disabled beneficiaries. The SOURCE

program works to improve the health outcomes of persons with chronic health

In addition, the Independent Care Waiver Program is a 1915(c) Waiver program

managed by the Department of Community Health that provides alternative living

Income (SSI) benefit for individuals in residential care settings. In 2015, room and board

rates are capped at the federal monthly SSI benefit rate of $733 less a personal needs

allowance of $114. Family supplementation is permitted.

https://dch.georgia.gov/hfr-laws-regulations

Georgia Department of Community Health website: Waivers, with links to the various waiver

programs that provide alternative living services. [January 24, 2014]

https://dch.georgia.gov/waivers