.05 Levels of Care.

A. An assisted living program may provide:

(1) The level of care for which the assisted living program has been approved; and

(2) Any lower level of care.

B. At the time of initial licensure, an applicant shall:

(1) Request approval to provide services at one of the three levels of care set forth in §G of this regulation; and

(2) Demonstrate that the assisted living program has the capacity to provide the level of care requested either directly or through the coordination of community services.

C. If, at any time, an assisted living program wants to provide a higher level of care than that for which it is licensed, the assisted living program shall request authority from the Department to change its licensed level of care.

D. The Department shall determine if an applicant or the assisted living program has the capacity to provide and ensure the requested level of care.

E. The Department may approve or deny the request.

F. If an applicant or an assisted living program is aggrieved by the Department’s decision, the applicant or the assisted living program may appeal by filing a request for a hearing consistent with Regulation .65 of this chapter.

G. Levels of Care.

(1) The applicant or assisted living program shall:

(a) Request one of the levels of care listed below; and

(b) Have sufficient staff and the abilities necessary to provide the level of care selected.

(2) Level 1: Low Level of Care.

(a) Health and Wellness. Staff shall have the ability to:

(i) Recognize the causes and risks associated with a resident’s current health condition once these factors are identified by a health care practitioner; and

(ii) Provide occasional assistance in accessing and coordinating health services and interventions.

(b) Functional Condition. Staff shall have the ability to provide occasional supervision, assistance, support, setup, or reminders with two or more activities of daily living.

(c) Medication and Treatment. Staff shall have the ability to assist a resident with taking medication or to coordinate access to necessary medication and treatment.

(d) Behavioral Condition. Staff shall have the ability to monitor and provide uncomplicated intervention to manage occasional behaviors that are likely to disrupt or harm the resident or others.

(e) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage occasional psychological or psychiatric episodes or fluctuations that require uncomplicated intervention or support.

(f) Social and Recreational Interests. Staff shall have the ability to provide occasional assistance in accessing social and recreational services.

(3) Level 2: Moderate Level of Care.

(a) Health and Wellness. Staff shall have the ability to:

(i) Recognize and accurately describe and define a resident’s health condition and identify likely causes and risks associated with the resident’s condition; and

(ii) Provide or ensure access to necessary health services and interventions.

(b) Functional Condition. Staff shall have the ability to provide or ensure:

(i) Substantial support with two or more activities of daily living; or

(ii) Minimal support with any number of activities of daily living.

(c) Medication and Treatment. Staff shall have the ability to:

(i) Provide or ensure assistance with taking medication; or

(ii) Administer necessary medication and treatment, including monitoring the effects of the medication and treatment.

(d) Behavioral Condition. Staff shall have the ability to monitor and provide or ensure intervention to manage frequent behaviors which are likely to disrupt or harm the resident or others.

(e) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage frequent psychological or psychiatric episodes that may require limited skilled interpretation, or prompt intervention or support.

(f) Social and Recreational Interests. Staff shall have the ability to provide or ensure ongoing assistance in accessing social and recreational services.

(4) Level 3: High Level of Care.

(a) Health and Wellness. Staff shall have the ability to:

(i) Recognize and accurately describe and define a resident’s health condition and identify likely causes and risks associated with the residents’ condition; and

(ii) Provide or ensure ongoing access to and coordination of comprehensive health services and interventions, including nursing overview.

(b) Functional Condition. Staff shall have the ability to provide or ensure comprehensive support as frequently as needed to compensate for any number of activities of daily living deficits.

(c) Medication and Treatment. Staff shall have the ability to:

(i) Provide or ensure assistance with taking medication; and

(ii) Administer necessary medication and treatment, including monitoring or arranging for monitoring of the effects of complex medication and treatment regimens.

(d) Behavioral Condition. Staff shall have the ability to monitor and provide or ensure ongoing therapeutic intervention or intensive supervision to manage chronic behaviors which are likely to disrupt or harm the resident or others.

(e) Psychological or Psychiatric Condition. Staff shall have the ability to monitor and manage a variety of psychological or psychiatric episodes involving active symptoms, condition changes, or significant risks that may require skilled interpretation or immediate interventions.

(f) Social and Recreational Interests. Staff shall have the ability to provide or ensure ongoing access to comprehensive social and recreational services.