CHAPTER 69
ASSISTED LIVING PROGRAMS
481—69.1(231C) Definitions. In addition to the definitions in 481—Chapter 67 and Iowa Code chapter 231C, the following definitions apply.
“Accredited” means that the program has received accreditation from an accreditation entity recognized in subrule 69.14(1).
“Applicable requirements” means Iowa Code chapter 231C, this chapter, and 481—Chapter 67 and includes any other applicable administrative rules and provisions of the Iowa Code.
“Assisted living” or “program” means provision of housing with services, which may include but are not limited to health-related care, personal care, and assistance with instrumental activities of daily living, to three or more tenants in a physical structure which provides a homelike environment. “Assisted living” also includes encouragement of family involvement, tenant self-direction, and tenant participation in decisions that emphasize choice, dignity, privacy, individuality, shared risk, and independence. “Assisted living” includes the provision of housing and assistance with instrumental activities of daily living only if personal care or health-related care is also included. “Assisted living” includes 24 hours per day response staff to meet scheduled and unscheduled or unpredictable needs in a manner that promotes maximum dignity and independence and provides supervision, safety, and security.
“CARF” means the Commission on Accreditation of Rehabilitation Facilities.
“Change of ownership” means the purchase, transfer, assignment or lease of a certified assisted living program and includes a change in the management company responsible for the day-to-day operation of the program, if the management company is ultimately responsible for any enforcement action taken by the department.
“Cognitive disorder” means a disorder characterized by cognitive dysfunction presumed to be the result of illness that does not meet the criteria for dementia, delirium, or amnestic disorder.
“Dementia-specific assisted living program” means an assisted living program certified under this chapter that:
	1.	Serves fewer than 55 tenants and has 5 or more tenants who have dementia between Stages 4 and 7 on the Global Deterioration Scale, or
	2.	Serves 55 or more tenants and 10 percent or more of the tenants have dementia between Stages 4 and 7 on the Global Deterioration Scale, or
	3.	Holds itself out as providing specialized care for persons with dementia, such as Alzheimer’s disease, in a dedicated setting.
“Dwelling unit” means a single unit which provides complete, independent living facilities for one or more persons, including permanent provisions for living, sleeping and sanitation, and which may include permanent provisions for eating and cooking. “Sanitation” for purposes of this definition means bathroom fixtures as required by this chapter.
“In the proximate area” means located within a five minutes or less response time.
“Maximal assistance with activities of daily living ” means routine total dependence on staff for the performance of a minimum of four activities of daily living for a period that exceeds 21 days.
“Medically unstable” means that a tenant has a condition or conditions:
	1.	Indicating physiological frailty as determined by the program’s staff in consultation with a physician or physician extender;
	2.	Resulting in three or more significant hospitalizations within a consecutive three-month period for more than observation; and
	3.	Requiring frequent supervision of the tenant for more than 21 days by a registered nurse.
For example, a tenant who has a condition such as congestive heart failure which results in three or more significant hospitalizations during a quarter and which requires that the tenant receive frequent supervision may be considered medically unstable.
“Nonaccredited” means that the program has been certified under the provisions of this chapter but has not received accreditation from an accreditation entity recognized in subrule 69.14(1).
“Unmanageable incontinence” means a condition that requires staff provision of total care for an incontinent tenant who lacks the ability to assist in bladder or bowel continence care.
“Unmanageable verbal abuse” means repeated verbalizations against tenants or staff that persist despite all interventions and that negatively affect the program. “Unmanageable verbal abuse” includes but is not limited to threats, frequent use of profane language, or unwelcome sexually oriented remarks.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 1927C, IAB 4/1/15, effective 5/6/15; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.2(231C) Program certification. A program may obtain certification by meeting all applicable requirements. In addition, a program may be voluntarily accredited by a recognized accreditation entity. For the purpose of these rules, certification is equivalent to licensure.
	69.2(1) Posting requirements. A program’s current certificate shall be visibly displayed within the designated operation area of the program. In addition, the latest monitoring report, state fire marshal report, and food establishment inspections report issued pursuant to Iowa Code chapter 137F shall be made available to the public by the program upon request.
	69.2(2) Dementia-specific programs and door alarms. If a program meets the definition of a dementia-specific assisted living program during two sequential certification monitorings, the program shall meet all requirements for a dementia-specific program, including the requirements set forth in rule 481—69.30(231C), subrules 69.29(2) and 69.29(4), paragraph 69.35(1)“d,” and subrules 69.32(2) and 69.32(3), which include the requirements relating to door alarms and specialized locking systems.
	69.2(3) Dementia-specific program by definition. If a program meets the definition of a dementia-specific assisted living program during two sequential certification monitorings based on the number of tenants served who have dementia between Stages 4 and 7 on the Global Deterioration Scale, the program shall be deemed a dementia-specific program by definition. If the number of tenants served who have dementia between Stages 4 and 7 on the Global Deterioration Scale goes below that which is required by the definition of dementia-specific program at any time after the program has been deemed dementia-specific by definition and the program is not holding itself out as providing dementia care in a specialized setting, the program will no longer be considered dementia-specific.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.3(231C) Certification of a nonaccredited program—application process.
	69.3(1) The applicant shall complete an application packet obtained from the department. Application materials may be obtained from the health facilities division Web site at https://dia-hfd.iowa.gov/DIA_HFD/Home.do; by mail from the Department of Inspections and Appeals, Adult Services Bureau, Lucas State Office Building, Third Floor, 321 E. 12th Street, Des Moines, Iowa 50319-0083; or by telephone at (515)281-6325.
	69.3(2) The applicant shall submit one copy of the completed application and all supporting documentation to the department at the above address at least 90 calendar days prior to the expected date of beginning operation.
	69.3(3) The appropriate fee as stated in Iowa Code section 231C.18 shall accompany each application and be payable by check or money order to the Department of Inspections and Appeals. Fees are nonrefundable.
	69.3(4) The department shall consider the application when all supporting documents and fees are received.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.4(231C) Nonaccredited program—application content. An application for certification or recertification of a nonaccredited program shall include the following:
	69.4(1) A list that includes the names, addresses, and percentage of stock, shares, partnership or other equity interest of all officers, members of the board of directors and trustees, as well as stockholders, partners or any individuals who have greater than a 10 percent equity interest in each of the following, as applicable:
	a. 	The real estate owner or lessor;
	b. 	The lessee; and
	c. 	The management company responsible for the day-to-day operation of the program.
The program shall notify the department of any changes in the list no later than ten working days after the effective date of the change.
	69.4(2) A statement disclosing whether the individuals listed in subrule 69.4(1) have been convicted of a felony or an aggravated or serious misdemeanor or found to be in violation of the child abuse or dependent adult abuse laws of any state.
	69.4(3) A statement disclosing whether any of the individuals listed in subrule 69.4(1) have or have had an ownership interest in an assisted living program, adult day services program, elder group home, home health agency, licensed health care facility as defined in Iowa Code section 135C.1, or licensed hospital as defined in Iowa Code section 135B.1, which has been closed in any state due to removal of program, agency, or facility licensure, certification, or registration or due to involuntary termination from participation in either the Medicaid or Medicare program; or have been found to have failed to provide adequate protection or services to prevent abuse or neglect of residents, patients, tenants or participants.
	69.4(4) The policy and procedure for evaluation of each tenant. A copy of the evaluation tool or tools to be used to identify the functional, cognitive and health status of each tenant shall be included.
	69.4(5) The policy and procedure for service plans.
	69.4(6) The policy and procedure for addressing medication needs of tenants.
	69.4(7) The policy and procedure for accidents and emergency response, including provisions related to head injuries.
	69.4(8) The policies and procedures for food service, including those relating to staffing, nutrition, menu planning, therapeutic diets, and food preparation, service and storage.
	69.4(9) The policy and procedure for activities.
	69.4(10) The policy and procedure for transportation.
	69.4(11) The policy and procedure for staffing and training.
	69.4(12) The policy and procedure for emergencies, including natural disasters. The policy and procedure shall include an evacuation plan and procedures for notifying legal representatives in emergency situations as applicable.
	69.4(13) The policy and procedure for managing risk and upholding tenant autonomy when tenant decision making results in poor outcomes for the tenant or others.
	69.4(14) The policy and procedure for reporting incidents including dependent adult abuse as required in rule 481—67.2(231B,231C,231D).
	69.4(15) The policy and procedure related to life safety requirements for a dementia-specific program as required by subrule 69.32(2).
	69.4(16) The tenant occupancy agreement and all attachments.
	69.4(17) If the program contracts for personal care or health-related care services from a certified home health agency, a mental health center or a licensed health care facility, a copy of that entity’s current license or certification.
	69.4(18) A copy of the state license for the entity that provides food service, whether the entity is the program or an outside entity or a combination of both.
	69.4(19) The fee set forth in Iowa Code section 231C.18.
	69.4(20) The policy and procedure for addressing sexual relationships between tenants and staff or between tenants with dementia greater than Stage 5 on the Global Deterioration Scale.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 1927C, IAB 4/1/15, effective 5/6/15; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.5(231C) Initial certification process for a nonaccredited program.
	69.5(1) Upon receipt of all completed documentation, including state fire marshal approval and structural and evacuation review approval, the department shall determine whether or not the proposed program meets applicable requirements.
	69.5(2) If, based upon the review of the complete application including all required supporting documents, the department determines the proposed program meets the requirements for certification, a provisional certification shall be issued to the program to begin operation and accept tenants.
	69.5(3) Within 180 calendar days following issuance of provisional certification, the department shall conduct a monitoring to determine the program’s compliance with applicable requirements.
	69.5(4) If a regulatory insufficiency is identified as a result of the monitoring, the process in rule 481—67.10(17A,231B,231C,231D) shall be followed.
	69.5(5) The department shall make a final certification decision based on the results of the monitoring and review of an acceptable plan of correction.
	69.5(6) The department shall notify the program of a final certification decision within 10 working days following the finalization of the monitoring report or receipt of an acceptable plan of correction, whichever is applicable.
	69.5(7) If the decision is to continue certification, the department shall issue a full two-year certification effective from the date of the original provisional certification.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.6(231C) Expiration of the certification of a nonaccredited program.
	69.6(1) Unless conditionally issued, suspended or revoked, certification of a program shall expire at the end of the time period specified on the certificate.
	69.6(2) The department shall send recertification application materials to each program at least 120 calendar days prior to expiration of the program’s certification.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.7(231C) Recertification process for a nonaccredited program. To obtain recertification, a program shall:
	69.7(1) Submit one copy of the completed application, including the information required in rule 481—69.4(231C), associated documentation, and the recertification fee as listed in Iowa Code section 231C.18 to the department at the address stated in subrule 69.3(1) at least 90 calendar days prior to the expiration of the program’s certification. The program need not submit policies and procedures that have been previously submitted to the department and remain unchanged. The program shall provide a list of the policies and procedures that have been previously submitted and are not being resubmitted.
	69.7(2) Submit additional documentation that each of the following has been inspected by a qualified professional and found to be maintained in conformance with the manufacturer’s recommendations and nationally recognized standards: heating system, cooling system, water heater, electrical system, plumbing, sewage system, artificial lighting, and ventilation system; and, if located on site, garbage disposal, kitchen appliances, washing machines and dryers, and elevators.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.8(231C) Notification of recertification for a nonaccredited program.
	69.8(1) The department shall review the application and associated documentation and fees. If the application is incomplete, the department shall contact the program to request the additional information. After all finalized documentation is received, including state fire marshal approval, the department shall determine the program’s compliance with applicable requirements.
	69.8(2) The department shall conduct a monitoring of the program between 60 and 90 days prior to expiration of the program’s certification.
	69.8(3) If a regulatory insufficiency is identified as a result of the monitoring, the process in rule 481—67.10(17A,231B,231C,231D) shall be followed.
	69.8(4) If no regulatory insufficiency is identified as a result of the monitoring, the department shall issue a report of the findings with the final recertification decision.
	69.8(5) If the decision is to recertify, the department shall issue the program a two-year certification effective from the date of the expiration of the previous certification.
	69.8(6) If the decision is to deny recertification, the department shall issue a notice of denial and provide the program the opportunity for a hearing pursuant to rule 481—67.13(17A,231B,231C,231D).
	69.8(7) If the department is unable to recertify a program through no fault of the program, the department shall issue to the program a time-limited extension of certification of no longer than one year.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.9(231C) Certification or recertification of an accredited program—application process.
	69.9(1) An applicant for certification or recertification of a program accredited by a recognized accrediting entity shall:
	a. 	Submit a completed application packet obtained from the department. Application materials may be obtained from the health facilities division Web site at https://dia-hfd.iowa.gov/DIA_HFD/ Home.do; by mail from the Department of Inspections and Appeals, Adult Services Bureau, Lucas State Office Building, Third Floor, 321 E. 12th Street, Des Moines, Iowa 50319-0083; or by telephone at (515)281-6325.
	b. 	Submit a copy of the current accreditation outcome from the recognized accrediting entity.
	c. 	Apply for certification or recertification within 90 calendar days following verification of compliance with life safety requirements pursuant to this chapter.
	d. 	Maintain compliance with the state fire marshal division’s requirements.
	e. 	Submit the appropriate fees as set forth in Iowa Code section 231C.18.
	69.9(2) The department shall not consider an application until it is complete and includes all supporting documentation and the appropriate fees.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.10(231C) Certification or recertification of an accredited program—application content. An application for certification or recertification of an accredited program shall include the following:
	69.10(1) A list that includes the names, addresses and percentage of stock, shares, partnership or other equity interest of all officers, members of the board of directors, and trustees, as well as stockholders, partners or any individuals who have greater than a 10 percent equity interest in each of the following, as applicable:
	a. 	The real estate owner or lessor;
	b. 	The lessee; and
	c. 	The management company responsible for the day-to-day operation of the program.
The program shall notify the department of any changes in the list no later than ten working days after the effective date of the change.
	69.10(2) A statement disclosing whether the individuals listed in subrule 69.10(1) have been convicted of a felony or an aggravated or serious misdemeanor or found to be in violation of the child abuse or dependent adult abuse laws of any state.
	69.10(3) A statement disclosing whether any of the individuals listed in subrule 69.10(1) have or have had an ownership interest in a program, adult day services program, elder group home, home health agency, licensed health care facility as defined under Iowa Code section 135C.1, or licensed hospital as defined under Iowa Code section 135B.1, which has been closed in any state due to removal of program, agency, or facility licensure or certification or due to involuntary termination from participation in either the Medicaid or Medicare program; or have been found to have failed to provide adequate protection or services to prevent abuse or neglect of residents, patients, tenants or participants.
	69.10(4) A copy of the current accreditation outcome from the recognized accrediting entity.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 1927C, IAB 4/1/15, effective 5/6/15]
481—69.11(231C) Initial certification process for an accredited program.
	69.11(1) Within 20 working days of receiving all finalized documentation, including state fire marshal approval, the department shall determine and notify the accredited program whether or not the accredited program meets applicable requirements and whether or not certification will be issued.
	69.11(2) If the decision is to certify, a certification shall be issued for the term of the accreditation not to exceed three years, unless the certification is conditionally issued, suspended or revoked by either the department or the recognized accrediting entity.
	69.11(3) If the decision is to deny certification, the department shall provide the applicant an opportunity for hearing in accordance with rule 481—67.13(17A,231B,231C,231D).
	69.11(4) Unless conditionally issued, suspended or revoked, certification for a program shall expire at the end of the time period specified on the certificate.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.12(231C) Recertification process for an accredited program.
	69.12(1) The department shall send recertification application materials to each program at least 120 calendar days prior to expiration of the program’s certification.
	69.12(2) To obtain recertification, an accredited program shall submit one copy of the completed application, associated documentation, and the administrative fee as stated in Iowa Code section 231C.18 to the department at the address stated in subrule 69.9(1) at least 90 calendar days prior to the expiration of the program’s certification.
	69.12(3) Within 20 working days of receiving all finalized documentation, including state fire marshal approval, the department shall determine the program’s compliance with applicable requirements and make a recertification decision.
	69.12(4) The department shall notify the accredited program within 10 working days of the final recertification decision.
	a. 	If the decision is to recertify, a full certification shall be issued for the term of the accreditation not to exceed three years, unless the certification is conditionally issued, suspended or revoked by either the department or the recognized accrediting entity.
	b. 	If the decision is to deny recertification, the department shall provide the applicant an opportunity for hearing in accordance with rule 481—67.13(17A,231B,231C,231D).
	69.12(5) If the department is unable to recertify a program through no fault of the program, the department shall issue to the program a time-limited extension of certification of no longer than one year.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.13(231C) Listing of all certified programs. The department shall maintain a list of all certified programs, which is available online at https://dia-hfd.iowa.gov/DIA_HFD/Home.do under the “Entities Book” tab.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.14(231C) Recognized accrediting entity.
	69.14(1) The department designates CARF as a recognized accrediting entity for programs.
	69.14(2) To apply for designation by the department as a recognized accrediting entity for programs, an accrediting entity shall submit a letter of request, and its standards shall, at minimum, meet the applicable requirements for programs.
	69.14(3) The designation shall remain in effect for as long as the accreditation standards continue to meet, at minimum, the applicable requirements for programs.
	69.14(4) An accrediting entity shall provide annually to the department, at no cost, a current edition of the applicable standards manual and survey preparation guide, and training thereon, within 120 working days after the publications are released.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.15(231C) Requirements for an accredited program. Each accredited program that is certified by the department shall:
	69.15(1) Provide the department a copy of all survey reports including outcomes, quality improvement plans and annual conformance to quality reports generated or received, as applicable, within ten working days of receipt of the reports.
	69.15(2) Notify the department by the most expeditious means possible of all credible reports of alleged improper or inappropriate conduct or conditions within the program and any actions taken by the accrediting entity with respect thereto.
	69.15(3) Notify the department immediately of the expiration, suspension, revocation or other loss of the program’s accreditation.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.16(231C) Maintenance of program accreditation.
	69.16(1) An accredited program shall continue to be recognized for certification by the department if both of the following requirements are met:
	a. 	The program complies with the requirements outlined in rule 481—69.15(231C).
	b. 	The program maintains its voluntary accreditation status for the duration of the time-limited certification period.
	69.16(2) A program that does not maintain its voluntary accreditation status must become certified by the department prior to any lapse in accreditation.
	69.16(3) A program that does not maintain its voluntary accreditation status and is not certified by the department prior to any lapse in voluntary accreditation shall cease operation as a program.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.17(231C) Change of ownership—notification to the department.
	69.17(1) Certification, unless conditionally issued, suspended or revoked, may be transferable. If the program’s certification has been conditionally issued, the department must approve a change of ownership prior to the transfer of the certification.
	69.17(2) In order to transfer certification, the applicant must:
	a. 	Meet the requirements of the rules, regulations and standards contained in Iowa Code chapter 231C and 481—Chapter 67 and this chapter; and
	b. 	At least 30 days prior to the change of ownership of the program, make application on forms provided by the department.
	69.17(3) The department may conduct a monitoring within 90 days following a change in the program’s ownership to ensure that the program complies with applicable requirements. If a regulatory insufficiency is found, the department shall take any necessary enforcement action authorized by applicable requirements.
[ARC 1927C, IAB 4/1/15, effective 5/6/15]
481—69.18(231C) Plan reviews of a building for a new program.
	69.18(1) Before a building is constructed or remodeled for use in a new program, the state fire marshal division of the department of public safety shall review the blueprints for compliance with requirements pursuant to this chapter. Construction or remodeling includes new construction, remodeling of any part of an existing building, addition of a new wing or floor to an existing building, or conversion of an existing building.
	69.18(2) A program applicant shall submit blueprints wet-sealed by an Iowa-licensed architect or Iowa-licensed engineer and the blueprint plan review fee as stated in Iowa Code section 231C.18 to the Department of Public Safety, State Fire Marshal Division, 215 E. 7th Street, Third Floor, Des Moines, Iowa 50319.
	69.18(3) Failure to submit the blueprint plan review fee with the blueprints shall result in delay of the blueprint plan review until the fee is received.
	69.18(4) The state fire marshal division of the department of public safety shall review the blueprints and notify the Iowa-licensed architect or Iowa-licensed engineer in writing regarding the status of compliance with requirements.
	69.18(5) The Iowa-licensed architect or Iowa-licensed engineer shall respond to the state fire marshal division of the department of public safety to state how any noncompliance will be resolved.
	69.18(6) Upon final notification by the state fire marshal division of the department of public safety that the blueprints meet the state fire marshal division’s requirements, construction or remodeling of the building may commence.
	69.18(7) The state fire marshal division of the department of public safety shall schedule an on-site visit of the building site with the contractor, or Iowa-licensed architect or Iowa-licensed engineer, during the construction or remodeling process to ensure compliance with the approved blueprints. Any noncompliance must be resolved prior to approval for certification.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.19(231C) Plan review prior to the remodeling of a building for a certified program.
	69.19(1) Before a building for a certified program is remodeled, the state fire marshal division of the department of public safety shall review the blueprints for compliance with requirements set forth in rule 481—69.35(231C). Remodeling includes modification of any part of an existing building, addition of a new wing or floor to an existing building, or conversion of an existing building.
	69.19(2) A certified program shall submit blueprints wet-sealed by an Iowa-licensed architect or Iowa-licensed engineer and the blueprint plan review fee as stated in Iowa Code section 231C.18 to the Department of Public Safety, State Fire Marshal Division, 215 E. 7th Street, Third Floor, Des Moines, Iowa 50319.
	69.19(3) Failure to submit the blueprint plan review fee with the blueprints shall result in delay of the blueprint plan review until the fee is received.
	69.19(4) Upon final notification by the state fire marshal division of the department of public safety that the blueprints meet structural and life safety requirements, remodeling of the building may commence.
	69.19(5) The state fire marshal division of the department of public safety shall schedule an on-site visit of the building with the contractor, or Iowa-licensed architect or Iowa-licensed engineer, during the remodeling process to ensure compliance with the approved blueprints. Any noncompliance must be resolved prior to approval for continued certification or recertification of the program.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.20(231C) Cessation of program operation.
	69.20(1) If a certified program ceases operation, which includes seeking decertification, at any time prior to expiration of the program’s certification, the program shall submit the certificate to the department. At least 90 days in advance of cessation or decertification, the program shall provide to the department and the office of long-term care ombudsman written notification of the date on which the program will cease operation or decertify.
	69.20(2) If a certified program plans to cease operation, which includes seeking decertification, at the time the program’s certification expires, the program shall provide written notice of this fact to the department and the office of long-term care ombudsman at least 90 days prior to expiration of the certification.
	69.20(3) At the time a program decides to cease operation, which includes seeking decertification, the program shall submit a plan to the department and make arrangements for the safe and orderly transfer or transition of all tenants within the 90-day period specified by subrule 69.20(2).
	69.20(4) The department may conduct a monitoring during the 90-day period to ensure the safety of tenants during the transfer process or transition process.
	69.20(5) The department may conduct an on-site visit to verify that the program has ceased operation as a certified program in accordance with the notice provided by the program.
	69.20(6) When a program ceases operation, which includes seeking decertification, representatives from the office of long-term care ombudsman shall be allowed by the program to privately meet with tenants to provide education and service options.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.21(231C) Occupancy agreement.
	69.21(1) The occupancy agreement shall be in 12-point type or larger, shall be written in plain language using commonly understood terms and shall be easy for the tenant or the tenant’s legal representative to understand.
	69.21(2) In addition to the requirements of Iowa Code section 231C.5, the written occupancy agreement shall include, but not be limited to, the following information in the body of the agreement or in the supporting documents and attachments:
	a. 	The telephone number for filing a complaint with the department.
	b. 	The telephone number for the office of long-term care ombudsman.
	c. 	The telephone number for reporting dependent adult abuse.
	d. 	A copy of the program’s statement on tenants’ rights.
	e. 	A statement that the tenant landlord law applies to assisted living programs.
	f. 	A statement that the program will notify the tenant at least 90 days in advance of any planned program cessation, which includes voluntary decertification, except in cases of emergency.
	69.21(3) The occupancy agreement shall be reviewed and updated as necessary to reflect any change in services or financial arrangements.
	69.21(4) A copy of the occupancy agreement shall be provided to the tenant or the tenant’s legal representative, if any, and a copy shall be kept by the program.
	69.21(5) A copy of the most current occupancy agreement shall be made available to the general public upon request. The basic marketing material shall include a statement that a copy of the occupancy agreement is available to all persons upon request.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.22(231C) Evaluation of tenant.
	69.22(1) Evaluation prior to occupancy. A program shall evaluate each prospective tenant’s functional, cognitive and health status prior to the tenant’s signing the occupancy agreement and taking occupancy of a dwelling unit in order to determine the tenant’s eligibility for the program, including whether the services needed are available. The cognitive evaluation shall utilize a scored, objective tool. When the score from the cognitive evaluation indicates moderate cognitive decline and risk, the Global Deterioration Scale shall be used at all subsequent intervals, if applicable. If the tenant subsequently returns to the tenant’s mildly cognitively impaired state, the program may discontinue the GDS and revert to a scored cognitive screening tool. The evaluation shall be conducted by a health care professional or human service professional.
	69.22(2) Evaluation within 30 days of occupancy and with significant change. A program shall evaluate each tenant’s functional, cognitive and health status within 30 days of occupancy. A program shall also evaluate each tenant’s functional, cognitive and health status as needed with significant change, but not less than annually, to determine the tenant’s continued eligibility for the program and to determine any changes to services needed. The evaluation shall be conducted by a health care professional or human service professional. A licensed practical nurse may complete the evaluation via nurse delegation when the tenant has not exhibited a significant change.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.23(231C) Criteria for admission and retention of tenants.
	69.23(1) Persons who may not be admitted or retained. A program shall not knowingly admit or retain a tenant who:
	a. 	Is bed-bound; or
	b. 	Requires routine, two-person assistance with standing, transfer or evacuation; or
	c. 	Is dangerous to self or other tenants or staff, including but not limited to a tenant who:
	(1)	Despite intervention chronically elopes, is sexually or physically aggressive or abusive, or displays unmanageable verbal abuse or aggression; or
	(2)	Displays behavior that places another tenant at risk; or
	d. 	Is in an acute stage of alcoholism, drug addiction, or uncontrolled mental illness; or
	e. 	Is under the age of 18; or
	f. 	Requires more than part-time or intermittent health-related care; or
	g. 	Has unmanageable incontinence on a routine basis despite an individualized toileting program; or
	h. 	Is medically unstable; or
	i. 	Requires maximal assistance with activities of daily living; or
	j. 	Despite intervention, chronically urinates or defecates in places that are not considered acceptable according to societal norms, such as on the floor or in a potted plant.
	69.23(2) Disclosure of additional occupancy and transfer criteria. A program may have additional occupancy or transfer criteria if the criteria are disclosed in the written occupancy agreement prior to the tenant’s occupancy.
	69.23(3) Assistance with transfer from the program. A program shall provide assistance to a tenant and the tenant’s legal representative, if applicable, to ensure a safe and orderly transfer from the program when the tenant exceeds the program’s criteria for admission and retention.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.24(231C) Involuntary transfer from the program.
	69.24(1) Program initiation of transfer. If a program initiates the involuntary transfer of a tenant and the action is not the result of a monitoring, including a complaint investigation or program-reported incident investigation, by the department and if the tenant or tenant’s legal representative contests the transfer, the following procedures shall apply:
	a. 	The program shall notify the tenant or tenant’s legal representative, in accordance with the occupancy agreement, of the need to transfer the tenant and of the reason for the transfer and shall include the contact information for the office of long-term care ombudsman.
	b. 	The program shall immediately provide to the office of long-term care ombudsman, by certified mail, a copy of the notification and notify the tenant’s treating physician, if any.
	c. 	Pursuant to statute, the office of long-term care ombudsman shall offer the notified tenant or tenant’s legal representative assistance with the program’s internal appeal process. The tenant or tenant’s legal representative is not required to accept the assistance of the office of long-term care ombudsman.
	d. 	If, following the internal appeal process, the program upholds the transfer decision, the tenant or tenant’s legal representative may utilize other remedies authorized by law to contest the transfer.
	69.24(2) Transfer pursuant to results of monitoring or complaint or program-reported incident investigation by the department. If one or more tenants are identified as exceeding the admission and retention criteria for tenants and need to be transferred as a result of a monitoring or a complaint or program-reported incident investigation conducted by the department, the following procedures shall apply:
	a. 	Program agreement with the department’s finding. If the program agrees with the department’s finding and the program begins involuntary transfer proceedings, the program’s internal appeal process in subrule 69.24(1) shall be utilized for appeals.
	b. 	Program disagreement with the department’s finding. If the program does not agree with the department’s finding that the tenant exceeds admission and retention criteria, the program may appeal the department’s final report as provided in rule 481—67.14(17A,231B,231C,231D,85GA,HF2365). If an appeal is filed, the tenant who exceeds admission and retention criteria shall be allowed to continue living at the program until all administrative appeals have been exhausted. Appeals filed that relate to the tenant’s exceeding admission and retention criteria shall be heard within 30 days of receipt, and appropriate services to meet the tenant’s needs shall be provided during that period of time.
	c. 	Request for waiver of criteria for retention of a tenant in a program. To allow a tenant to remain in the program, the program may request a waiver of criteria for retention of a tenant pursuant to rule 481—67.7(231B,231C,231D) from the department within 10 working days of the receipt of the report.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.25(231C) Tenant documents.
	69.25(1) Documentation for each tenant shall be maintained by the program and shall include:
	a. 	An occupancy record including the tenant’s name, birth date, and home address; identification numbers; date of occupancy; name, address and telephone number of health professional(s); diagnosis; and names, addresses and telephone numbers of family members, friends or other designated people to contact in the event of illness or an emergency;
	b. 	Application forms;
	c. 	The initial evaluations and updates;
	d. 	A nutritional assessment as necessary;
	e. 	The initial individual service plan and updates;
	f. 	Signed authorizations for permission to release medical information, photographs, or other media information as necessary;
	g. 	A signed authorization for the tenant to receive emergency medical care as necessary;
	h. 	A signed managed risk policy and signed managed risk consensus agreements, if any;
	i. 	When any personal or health-related care is delegated to the program, the medical information sheet; documentation of health professionals’ orders, such as those for treatment, therapy, and medication; and nurses’ notes written by exception;
	j. 	Medication lists, which shall be maintained in conformance with 481—subrule 67.5(4);
	k. 	Advance health care directives as applicable;
	l. 	A complete copy of the tenant’s occupancy agreement, including any updates;
	m. 	A written acknowledgment that the tenant or the tenant’s legal representative, if applicable, has been fully informed of the tenant’s rights;
	n. 	A copy of guardianship, durable power of attorney for health care, power of attorney, or conservatorship or other documentation of a legal representative;
	o. 	Incident reports involving the tenant, including but not limited to those related to medication errors, accidents, falls, and elopements (such reports shall be maintained by the program but need not be included in the tenant’s medical record);
	p. 	A copy of waivers of admission or retention criteria, if any;
	q. 	When the tenant is unable to advocate on the tenant’s own behalf or the tenant has multiple service providers, including hospice care providers, accurate documentation of the completion of routine personal or health-related care is required on task sheets. If tasks are doctor-ordered, the tasks shall be part of the medication administration records (MARs); and
	r. 	Authorizations for the release of information, if any.
	69.25(2) The program records relating to a tenant shall be retained for a minimum of three years after the transfer or death of the tenant.
	69.25(3) All records shall be protected from loss, damage and unauthorized use.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.26(231C) Service plans.
	69.26(1) A service plan shall be developed for each tenant based on the evaluations conducted in accordance with subrules 69.22(1) and 69.22(2) and shall be designed to meet the specific service needs of the individual tenant. The service plan shall subsequently be updated at least annually and whenever changes are needed.
	69.26(2) Prior to the tenant’s signing the occupancy agreement and taking occupancy of a dwelling unit, a preliminary service plan shall be developed by a health care professional or human service professional in consultation with the tenant and, at the tenant’s request, with other individuals identified by the tenant, and, if applicable, with the tenant’s legal representative. All persons who develop the plan and the tenant or the tenant’s legal representative shall sign the plan.
	69.26(3) When a tenant needs personal care or health-related care, the service plan shall be updated within 30 days of the tenant’s occupancy and as needed with significant change, but not less than annually.
	a. 	If a significant change triggers the review and update of the service plan, the updated service plan shall be signed and dated by all parties.
	b. 	If a significant change does not exist, the program may, after nurse review, add minor discretionary changes to the service plan without a comprehensive evaluation and without obtaining signatures on the service plan.
	c. 	If a significant change relates to a recurring or chronic condition, a previous evaluation and service plan of the recurring condition may be utilized without new signatures being obtained. For example, with chronic exacerbation of a urinary tract infection, nurse review is adequate to institute the previously written evaluation and service plan.
	d. 	The service plan updated within 30 days of the tenant’s occupancy shall be signed and dated by all parties.
	69.26(4) The service plan shall be individualized and shall indicate, at a minimum:
	a. 	The tenant’s identified needs and preferences for assistance;
	b. 	Any services and care to be provided pursuant to the occupancy agreement;
	c. 	The service provider(s), if other than the program, including but not limited to providers of hospice care, home health care, occupational therapy, and physical therapy;
	d. 	For tenants who are unable to plan their own activities, including tenants with dementia, a list of person-centered planned and spontaneous activities based on the tenant’s abilities and personal interests; and
	e. 	Preferences, if any, of the tenant or the tenant’s legal representative for nursing facility care, if the need for nursing facility care presents itself during the assisted living program occupancy.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.27(231C) Nurse review.
	69.27(1) If a tenant does not receive personal or health-related care, but an observed significant change in the tenant’s condition occurs, a nurse review shall be conducted. If a tenant receives personal or health-related care, the program shall provide for a registered nurse:
	a. 	To monitor, at least every 90 days, or after a significant change in the tenant’s condition, any tenant who receives program-administered prescription medications for adverse reactions to the medications and to make appropriate interventions or referrals, and to ensure that the prescription medication orders are current and that the prescription medications are administered consistent with such orders; and
	b. 	To ensure that health care professionals’ orders are current for tenants who receive health care professional-directed care from the program; and
	c. 	To assess and document the health status of each tenant, to make recommendations and referrals as appropriate, and to monitor progress relating to previous recommendations at least every 90 days and whenever there are changes in the tenant’s health status; and
	d. 	To provide the program with written documentation of the nurse review, showing the time, date and signature.
	69.27(2) A licensed practical nurse via nurse delegation may complete the tasks required by this rule, except when a tenant experiences a significant change in condition.
Note: Refer to Table A at the end of this chapter. If the program does not provide personal or health-related care to a tenant, nurse review is not required.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.28(231C) Food service.
	69.28(1) The program shall provide or coordinate with other community providers to provide a hot or other appropriate meal(s) at least once a day or shall make arrangements for the availability of meals.
	69.28(2) Meals and snacks provided by the program but not prepared on site shall be obtained from or provided by an entity that meets the standards of state and local health laws and ordinances concerning the preparation and serving of food.
	69.28(3) Menus shall be planned to provide the following percentage of the daily recommended dietary allowances as established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences based on the number of meals provided by the program:
	a. 	A minimum of 33⅓ percent if the program provides one meal per day;
	b. 	A minimum of 66⅔ percent if the program provides two meals per day; and
	c. 	One hundred percent if the program provides three meals per day.
	69.28(4) Therapeutic diets may be provided by a program. If therapeutic diets are provided, they shall be prescribed by a physician, physician assistant, or advanced registered nurse practitioner. A current copy of the Iowa Simplified Diet Manual published by the Iowa Dietetic Association shall be available and used in the planning and serving of therapeutic diets. A licensed dietitian shall be responsible for writing and approving the therapeutic menu and for reviewing procedures for food preparation and service for therapeutic diets.
	69.28(5) Personnel who are employed by or contract with the program and who are responsible for food preparation or service, or both food preparation and service, shall have an orientation on sanitation and safe food handling prior to handling food and shall have annual in-service training on food protection.
	a. 	In addition to the requirements above, a minimum of one person directly responsible for food preparation shall have successfully completed a state-approved food protection program by:
	(1)	Obtaining certification as a dietary manager; or
	(2)	Obtaining certification as a food protection professional; or
	(3)	Successfully completing an ANSI-accredited certified food protection manager program meeting the requirements for a food protection program included in the Food Code adopted pursuant to Iowa Code chapter 137F. Another program may be substituted if the program’s curriculum includes substantially similar competencies to a program that meets the requirements of the Food Code and the provider of the program files with the department a statement indicating that the program provides substantially similar instruction as it relates to sanitation and safe food handling.
	b. 	If the person is in the process of completing a course or certification listed in paragraph “a,” the requirement relating to completion of a state-approved food protection program shall be considered to have been met.
	69.28(6) Programs engaged in the preparation and service of meals and snacks shall meet the standards of state and local health laws and ordinances pertaining to the preparation and service of food and shall be licensed pursuant to Iowa Code chapter 137F. The department will not require the program to be licensed as a food establishment if the program limits food activities to the following:
	a. 	All main meals and planned menu items must be prepared offsite and transferred to the program kitchen for service to tenants.
	b. 	Baked goods that do not require temperature control for safety and single-service juice or milk may be stored in the program’s kitchen and provided as part of a continental breakfast.
	c. 	Ingredients used for food-related activities with tenants may be stored in the program’s kitchen. Tenant activities may include the preparation and cooking of food items in the program’s kitchen if the activity occurs on an irregular or sporadic basis and the items prepared are not part of the program’s menu.
	d. 	Appropriately trained staff may prepare in the program’s kitchen individual quantities of tenant-requested menu-substitution food items that require limited or no preparation, such as peanut butter or cheese sandwiches or a single-service can of soup. The food items necessary to prepare the menu substitution may be stored in the program’s kitchen. These food items may not be cooked in the program’s kitchen but may be reheated in a microwave. A two- or four-slice toaster may be used for tenant-requested menu-substitution items, but no bare-hand contact is permitted.
	e. 	Tenants may take food items left over from a meal back to their apartments. The program may not store leftovers in the program’s kitchen.
	f. 	Warewashing may be done in the program’s kitchen as long as the program utilizes a commercial dishwasher and documents daily testing of sanitizer chemical ppm and proper water temperatures. Verification by the department of these practices may be conducted during on-site visits.
	69.28(7) Programs may have an on-site dietitian. Programs may secure menus and a dietitian through other methods.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 1376C, IAB 3/19/14, effective 4/23/14; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.29(231C) Staffing. In addition to the general staffing requirements in rule 481—67.9(231B,231C,231D), the following requirements apply to staffing in programs.
	69.29(1) Each tenant shall have access to a 24-hour personal emergency response system that automatically identifies the tenant in distress and can be activated with one touch.
	69.29(2) In lieu of providing access to a personal emergency response system, a program serving one or more tenants with cognitive disorder or dementia shall follow a system, program, or written staff procedures that address how the program will respond to the emergency needs of the tenant(s).
	69.29(3) The owner or management corporation of the program is responsible for ensuring that all personnel employed by or contracting with the program receive training appropriate to assigned tasks and target population.
	69.29(4) A dementia-specific assisted living program shall have one or more staff persons who monitor tenants as indicated in each tenant’s service plan. The staff shall be awake and on duty 24 hours a day on site and in the proximate area. The staff shall check on tenants as indicated in the tenants’ service plans.
A non-dementia-specific assisted living program shall have one or more staff persons who monitor tenants as indicated in each tenant’s service plan. The staff shall be able to respond to a call light or other emergent tenant needs and be in the proximate area 24 hours a day on site. The staff shall check on tenants as indicated in the tenants’ service plans.
	69.29(5) All programs employing a new program manager after January 1, 2010, shall require the manager within six months of hire to complete an assisted living management class whose curriculum includes at least six hours of training specifically related to Iowa rules and laws on assisted living programs. Managers who have completed a similar training prior to January 1, 2010, shall not be required to complete additional training to meet this requirement.
	69.29(6) All programs employing a new delegating nurse after January 1, 2010, shall require the delegating nurse within six months of hire to complete an assisted living manager class or assisted living nursing class whose curriculum includes at least six hours of training specifically related to Iowa rules and laws on assisted living. A minimum of one delegating nurse from each program must complete the training. If there are multiple delegating nurses and only one delegating nurse completes the training, the delegating nurse who completes the training shall train the other delegating nurses in the Iowa rules and laws on assisted living. As of January 1, 2011, all programs shall have a minimum of one delegating nurse who has completed the training described in this subrule.
	69.29(7) The program shall notify the department in writing within ten business days of a change in the program’s manager.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 1927C, IAB 4/1/15, effective 5/6/15; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.30(231C) Dementia-specific education for program personnel.
	69.30(1) All personnel employed by or contracting with a dementia-specific program shall receive a minimum of eight hours of dementia-specific education and training within 30 days of either employment or the beginning date of the contract, as applicable.
	69.30(2) The dementia-specific education or training shall include, at a minimum, the following:
	a. 	An explanation of Alzheimer’s disease and related disorders;
	b. 	The program’s specialized dementia care philosophy and program;
	c. 	Skills for communicating with persons with dementia;
	d. 	Skills for communicating with family and friends of persons with dementia;
	e. 	An explanation of family issues such as role reversal, grief and loss, guilt, relinquishing the care-giving role, and family dynamics;
	f. 	The importance of planned and spontaneous activities;
	g. 	Skills in providing assistance with instrumental activities of daily living;
	h. 	The importance of the service plan and social history information;
	i. 	Skills in working with challenging tenants;
	j. 	Techniques for simplifying, cueing, and redirecting;
	k. 	Staff support and stress reduction; and
	l. 	Medication management and nonpharmacological interventions.
	69.30(3) Dementia-specific continuing education.
	a. 	Except as otherwise provided in this subrule, all personnel employed by or contracting with a dementia-specific program shall receive a minimum of two hours of dementia-specific continuing education annually.
	b. 	Direct-contact personnel employed by or contracting with a dementia-specific program or employed by a contracting agency providing staff to a dementia-specific program shall receive a minimum of eight hours of dementia-specific continuing education annually.
	c. 	Contracted personnel who have no contact with tenants (e.g., persons providing lawn maintenance or snow removal) are not required to receive the two hours of training required in paragraph “a.”
	d. 	The contracting agency may provide the program with documentation of dementia-specific continuing education that meets the requirements of this subrule.
	69.30(4) An employee or contractor who provides documentation of completion of a dementia- specific education or training program within the past 12 months shall be exempt from the education and training requirement of subrule 69.30(1).
	69.30(5) Dementia-specific training shall include hands-on training and may include any of the following: classroom instruction, Web-based training, and case studies of tenants in the program.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.31(231C) Managed risk policy and managed risk consensus agreements. The program shall have a managed risk policy. The managed risk policy shall be provided to the tenant along with the occupancy agreement. The managed risk policy shall include the following:
	69.31(1) An acknowledgment of the shared responsibility for identifying and meeting the needs of the tenant and the process for managing risk and for upholding tenant autonomy when tenant decision making results in poor outcomes for the tenant or others; and
	69.31(2) A consensus-based process to address specific risk situations. Program staff and the tenant shall participate in the process. The result of the consensus-based process may be a managed risk consensus agreement. The managed risk consensus agreement shall include the signature of the tenant and the signatures of all others who participated in the process. The managed risk consensus agreement shall be included in the tenant’s file.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.32(231C) Life safety—emergency policies and procedures and structural safety requirements.
	69.32(1) The program shall submit to the department and follow written emergency policies and procedures, which shall include the following:
	a. 	An emergency plan, which shall include procedures for natural disasters (identify where the plan is located for easy reference);
	b. 	Fire safety procedures;
	c. 	Other general or personal emergency procedures;
	d. 	Provisions for amending or revising the emergency plan;
	e. 	Provisions for periodic training of all employees;
	f. 	Procedures for fire drills;
	g. 	Regulations regarding smoking;
	h. 	Monitoring and testing of smoke-control systems;
	i. 	Tenant evacuation procedures; and
	j. 	Procedures for reporting and documentation.
	69.32(2) An operating alarm system shall be connected to each exit door in a dementia-specific program.
	69.32(3) The program shall obtain approval from the state fire marshal division of the department of public safety before the installation of any delayed-egress specialized locking systems.
	69.32(4) A program serving a person(s) with cognitive disorder or dementia shall have:
	a. 	Written procedures regarding alarm systems, if an alarm system is in place.
	b. 	Written procedures regarding appropriate staff response when a tenant’s service plan indicates a risk of elopement or when a tenant exhibits wandering behavior.
	c. 	Written procedures regarding appropriate staff response if a tenant with cognitive disorder or dementia is missing.
	69.32(5) The program’s structure and procedures and the facility in which a program is located shall meet the requirements adopted for assisted living programs in administrative rules promulgated by the state fire marshal. Approval of the state fire marshal indicating that the building is in compliance with these requirements is necessary for certification of a program.
	69.32(6) The program shall have the means to control the maximum temperature of water at sources accessible by a tenant to prevent scalding and shall control the maximum water temperature for tenants with cognitive impairment or dementia or at a tenant’s request.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.33(231C) Transportation. When transportation services are provided directly or under contract with the program:
	69.33(1) The vehicle shall be accessible and appropriate to the tenants who use it, with consideration for any physical disabilities and impairments.
	69.33(2) Every tenant transported shall have a seat in the vehicle, except for a tenant who remains in a wheelchair during transport.
	69.33(3) Vehicles shall have adequate seat belts and securing devices for ambulatory and wheelchair-using passengers.
	69.33(4) Wheelchairs shall be secured when the vehicle is in motion.
	69.33(5) During loading and unloading of a tenant, the driver shall be in the proximate area of the tenants in a vehicle.
	69.33(6) The driver shall have a valid and appropriate Iowa driver’s license or commercial driver’s license as required by law for the vehicle being utilized for transport. If the driver is licensed in another state, the license shall be valid and appropriate for the vehicle being utilized for transport. The driver shall meet any state or federal requirements for licensure or certification for the vehicle operated.
	69.33(7) Each vehicle shall have a first-aid kit, fire extinguisher, safety triangles and a device for two-way communication.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.34(231C) Activities.
	69.34(1) The program shall provide appropriate activities for each tenant. Activities shall reflect individual differences in age, health status, sensory deficits, lifestyle, ethnic and cultural beliefs, religious beliefs, values, experiences, needs, interests, abilities and skills by providing opportunities for a variety of types and levels of involvement.
	69.34(2) Activities shall be planned to support the tenant’s service plan and shall be consistent with the program statement and occupancy policies.
	69.34(3) A written schedule of activities shall be developed at least monthly and made available to tenants and their legal representatives.
	69.34(4) Tenants shall be given the opportunity to choose their levels of participation in all activities offered in the program.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.35(231C) Structural requirements.
	69.35(1) General requirements.
	a. 	The structure of the program shall be designed and operated to meet the needs of the tenants.
	b. 	The buildings and grounds shall be well-maintained, clean, safe and sanitary.
	c. 	Programs shall have private dwelling units with a single-action, lockable entrance door.
	d. 	A program serving persons with cognitive impairment or dementia, whether in a general or dementia-specific setting, shall have the means to disable or remove the lock on an entrance door and shall disable or remove the lock if its presence presents a danger to the health and safety of the tenant.
	e. 	The structure in which a program is housed shall comply with the administrative rules promulgated by the state fire marshal.
	f. 	Programs may have individual cooking facilities within the private dwelling units. Any program serving persons with cognitive impairment or dementia, whether in a general or dementia-specific setting, shall have the means to disable or easily remove appliances and shall disable or remove them if their presence presents a danger to the health and safety of the tenant or others.
	69.35(2) Programs certified prior to July 4, 2001. Facilities for programs certified prior to July 4, 2001, shall meet the following requirements:
	a. 	Each dwelling unit shall have at least one room that shall have not less than 120 square feet of floor area. Other habitable rooms shall have an area of not less than 70 square feet.
	b. 	Each dwelling unit shall have not less than 190 square feet of floor area, excluding bathrooms.
	c. 	A dwelling unit used for double occupancy shall have not less than 290 square feet of floor area, excluding bathrooms.
	d. 	The program shall have a minimum of 15 square feet of common area per tenant.
	69.35(3) New construction built on or after July 4, 2001. Programs operated in new construction built on or after July 4, 2001, shall meet the following requirements:
	a. 	Each dwelling unit shall have at least one room that shall have not less than 120 square feet of floor area. Other habitable rooms shall have an area of not less than 70 square feet.
	b. 	Each dwelling unit used for single occupancy shall have a total square footage of not less than 240 square feet of floor area, excluding bathrooms and door swing.
	c. 	A dwelling unit used for double occupancy shall have a total square footage of not less than 340 square feet of floor area, excluding bathrooms and door swing.
	d. 	Each dwelling unit shall contain a bathroom, including but not limited to a toilet, sink and bathing facilities. A program serving persons with cognitive impairment or dementia, whether in a general or dementia-specific setting, shall have the means to disable or remove the sink or bathing facility water control and shall disable or remove the water control if its presence presents a danger to the health and safety of the tenant.
	e. 	Self-closing doors are not required for individual dwelling units, whether in a general or dementia-specific setting, unless the authority with jurisdiction determines that the level of hazard has increased to require the installation of closure hardware (for example, presence of a stove, range or oven).
	69.35(4) Structure being converted to or remodeled for use by a program on or after July 4, 2001. A program operating in a structure that was converted or remodeled for use for a program on or after July 4, 2001, shall meet the following requirements:
	a. 	Each dwelling unit shall have at least one room that has not less than 120 square feet of floor area. Other habitable rooms shall have an area of not less than 70 square feet.
	b. 	Each dwelling unit used for single occupancy shall have a total square footage of not less than 190 square feet of floor area, excluding bathrooms and door swing.
	c. 	A dwelling unit used for double occupancy shall have a total square footage of not less than 290 square feet of floor area, excluding bathrooms and door swing.
	d. 	Each dwelling unit shall have a bathroom, including but not limited to a toilet, sink and bathing facility.
[ARC 8176B, IAB 9/23/09, effective 1/1/10; ARC 2463C, IAB 3/16/16, effective 4/20/16]
481—69.36(231C) Dwelling units in dementia-specific programs. Dementia-specific programs are exempt from the requirements in subrules 69.35(2) to 69.35(4) as follows:
	69.36(1) For a program built in a family or neighborhood design:
	a. 	Each dwelling unit used for single occupancy shall have a total square footage of not less than 150 square feet of floor area, excluding a bathroom; and
	b. 	Each dwelling unit used for double occupancy shall have a total square footage of not less than 250 square feet of floor area, excluding a bathroom.
	69.36(2) Dementia-specific programs may choose not to provide bathing facilities in the dwelling units.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.37(231C) Landlord and tenant Act. Iowa Code chapter 562A, the uniform residential landlord and tenant Act, shall apply to programs under this chapter.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.38(83GA,SF203) Identification of veteran’s benefit eligibility.
	69.38(1) Within 30 days of a tenant’s admission to an assisted living program that receives reimbursement through the medical assistance program under Iowa Code chapter 249A, the program shall ask the tenant or the tenant’s personal representative whether the tenant is a veteran or whether the tenant is the spouse, widow, or dependent of a veteran and shall document the response.
	69.38(2) If the program determines that the tenant may be a veteran or the spouse, widow, or dependent of a veteran, the program shall report the tenant’s name along with the name of the veteran, if applicable, as well as the name of the contact person for this information, to the Iowa department of veterans affairs. When appropriate, the program may also report such information to the Iowa department of human services.
	69.38(3) If a tenant is eligible for benefits through the U.S. Department of Veterans Affairs or other third-party payor, the program first shall seek reimbursement from the identified payor source before seeking reimbursement from the medical assistance program established under Iowa Code chapter 249A.
[ARC 8176B, IAB 9/23/09, effective 1/1/10]
481—69.39(231C) Respite care services. “Respite care services” means an organized program of temporary supportive care provided for 24 hours or more to a person in order to relieve the usual caregiver of the person from providing continual care to the person. “Respite care individual” means an individual receiving respite care services. An assisted living program which chooses to provide respite care services must meet the following requirements related to respite care services and must be certified as an assisted living program.
	69.39(1) Length of stay. Respite care services shall be provided for no more than 30 consecutive days and for a total of no more than 60 days in a consecutive 12-month period. The 12-month period begins on the first day of the respite care individual’s stay in the program.
	69.39(2) No separate certificate. An assisted living program that chooses to provide respite care services is not required to obtain a separate certificate or pay a certification fee.
	69.39(3) Assessment. The program nurse shall conduct an assessment of the respite care individual prior to the respite care individual’s stay. The assessment shall be documented and shall include, at a minimum:
	a. 	Safety and supervision needs;
	b. 	Medical needs;
	c. 	Dietary needs; and
	d. 	Bowel and bladder function.
	69.39(4) Written direction to staff. The program nurse shall document the care needs of the respite care individual based on the assessment conducted pursuant to subrule 69.39(3) and provide the documentation to staff.
	69.39(5) Involuntary termination of respite care services. The program may terminate the respite care services for a respite care individual. Rule 481—69.24(231C) shall not apply. The program shall make proper arrangements for the welfare of the respite care individual prior to involuntary termination of respite care services, including notification of the respite care individual’s family or legal representative.
	69.39(6) Contract. The program shall have a contract with each respite care individual. The contract shall, at a minimum, include the following:
	a. 	The time period during which the individual will be considered to be receiving respite care services, not to exceed 30 consecutive days.
	b. 	A description of all fees, charges, and rates for respite care services, and any additional and optional services and their related costs.
	c. 	A statement that respite care services may be involuntarily terminated. Rule 481—69.24(231C) shall not apply.
	d. 	Identification of the party responsible for payment of fees and identification of the respite care individual’s legal representative, if any.
	e. 	Identification of emergency contacts, including but not limited to the respite care individual’s family member(s) and physician.
	f. 	A statement that all respite care individual information shall be maintained in a confidential manner to the extent required under state and federal law.
	g. 	The refund policy, if applicable.
	h. 	A statement regarding billing and payment procedures.
	69.39(7) Admission to program.
	a. 	A respite care individual shall not be considered an admission to the program.
	b. 	A respite care individual shall be included in the program’s census.
	c. 	The program shall not enter into multiple 30-day contracts with a respite care individual in order to lengthen the respite care individual’s stay in the program.
	d. 	If a respite care individual remains in the program beyond 30 consecutive days and is eligible for admission, the department shall consider the individual a tenant in the program. The program shall follow all requirements for admission to the program.
	69.39(8) Level of care criteria. Respite care individuals must meet the criteria found in subrule 69.23(1) for admission and retention of tenants. Respite care services shall not be provided by an assisted living program to persons requiring a level of care which is higher than the level of care the program is certified to provide.
	69.39(9) Accessibility by the department. The department shall have the same access to respite care services records as provided in 481—subrule 67.10(2).
[ARC 1667C, IAB 10/15/14, effective 11/19/14]
These rules are intended to implement Iowa Code chapter 231C.
Table A

[Filed ARC 8176B (Notice ARC 7878B, IAB 6/17/09), IAB 9/23/09, effective 1/1/10]
[Filed ARC 1376C (Notice ARC 1291C, IAB 1/22/14), IAB 3/19/14, effective 4/23/14]
[Filed ARC 1667C (Notice ARC 1511C, IAB 6/25/14), IAB 10/15/14, effective 11/19/14]
[Filed ARC 1927C (Notice ARC 1860C, IAB 2/4/15), IAB 4/1/15, effective 5/6/15]
[Filed ARC 2463C (Notice ARC 2200C, IAB 10/14/15), IAB 3/16/16, effective 4/20/16]