Michigan Regulatory Compliance Resources for Residential Care Facilities

Based on the sources, there are certain conditions or practices that are prohibited for licensed homes for the aged.

Regarding resident admission and retention:

• A home shall not accept an individual seeking admission unless the individual’s needs can be adequately and appropriately met within the scope of the home’s program statement.
• A home shall not retain a resident if the resident has harmed himself or herself or others, or has demonstrated behaviors that pose a risk of serious harm to himself or herself or others, unless the home has the capacity to manage the resident’s behavior.
• A home shall not admit a resident who requires continuous nursing care services of the kind normally provided in a nursing home.
• A home shall not retain a resident who requires continuous nursing care services of any kind normally provided in a nursing home unless the home meets specific provisions or the individual is enrolled in and receiving services from a licensed hospice program or a home health agency.
• A home cannot improperly discharge a resident in violation of the rules or the home’s discharge policy. If found to be improperly discharged, the resident may return to the first available bed that can meet their needs. A resident who poses a substantial risk may be discharged before the standard 30-day notice, but specific steps involving notification must be taken, and the resident shall not be discharged until a subsequent setting is located.

Regarding terminology:

• The home shall not use the term “state approved” or words with a similar meaning unless it is operating under a current license.
• The home shall not use the term “hospital” or words with a similar meaning.
• The home shall not use the term “nursing home” or words with a similar meaning.

The sources outline various types of documentation that licensed homes for the aged are required to maintain or provide:

• General Records: Resident register, resident records, accident records and incident reports, and employee records and work schedules must be kept in the home and be available to the director or their authorized representative.
• Resident-Specific Documentation:
  • A written resident admission contract between the home and the resident and/or authorized representative. This contract must specify services provided, fees, notice of fee changes, transportation services (if any), admission and discharge policy, refund policy, and resident rights and responsibilities. Changes to the contract must be reviewed with the resident and authorized representative.
  • A program statement describing the home’s philosophy, mission, resident needs reflected, and services provided. Homes representing care for persons with Alzheimer’s or related conditions must include specific information in their program statement.
  • A written admission and discharge policy. The admission policy must detail documenting individual needs, not accepting individuals whose needs cannot be met, resident/representative participation in service plan development, and the policy on annual tuberculosis screening for residents. The discharge policy must specify reasons for transfer/discharge and the procedures for notice.
  • A resident’s service plan for each resident. This is a written statement developed with the resident and/or representative that identifies care, maintenance, services, and activities appropriate for the resident’s needs, taking into account their preferences and competency. The service plan must be updated at least annually or with significant changes in care needs.
  • Documentation of individual needs at the time of admission, used to develop the service plan.
  • For residents under care of a licensed health care professional for ongoing treatments or prescription medications requiring home intervention, a written statement from the professional completed within 90 days before admission (or within 30 days for emergency admissions) listing treatments or medications.
  • Evidence of tuberculosis screening on record for each admitted individual, performed within 12 months before admission.
  • Documentation of the reason for transfer or discharge in the resident record.
  • A 30-day written notice before discharge to the resident and their authorized representative (if any) and the placement agency (if any), including reasons for discharge, effective date, and notice of the right to file a complaint.
  • For immediate discharge due to substantial risk, a written notice to the resident, representative, and placement agency (if any) not less than 24 hours before discharge, including the reason, attempted alternatives, location of discharge, and right to complain.
  • Notification to the department and adult protective services not less than 24 hours before discharge in certain circumstances (no representative/placement agency or no subsequent placement), including reason, attempted alternatives, and known discharge location.
  • An individual medication log for each resident if staff supervise medication taking, containing medication name, dosage, instructions, time, administrator initials, and refusal notation.
  • Records of reasons for administering as-needed medication.
  • Written records of any instructions regarding prescription medication from a licensed health care professional.
  • Resident records containing identifying information, next of kin/representative contact, person/agency responsible for care contact, dates of admission/discharge, reason for discharge, health information, and contact information for the resident’s licensed health care professional. These records must be maintained for at least 2 years after discharge.
  • A current resident register including name, date of birth, gender, room, contact information for next of kin/representative, contact for person/agency responsible for care, dates of admission/discharge, reason for discharge, and licensed health care professional contact. The register must be maintained for the previous 2 years.
• Employee-Specific Documentation:
  • Files containing evidence of adequate health, such as qualified health care professional examination results and tuberculosis screening results.
  • Records of accidents or illnesses occurring while on duty that place others at risk.
  • Annual tuberculosis screening results for employees.
  • Records for each employee including name, contact information, social security number, license/registration number (if applicable), date of birth, summary of experience/education/training, beginning employment date and position, references (if provided), annual TB screening results, date and reason for leaving (if known), and criminal background information.
  • A work schedule showing planned and actual staff on duty daily. These schedules must be retained for the preceding 3 months.
• Home Operations and Infrastructure Documentation:
  • A floor plan of the home with room details.
  • Complete plans, specifications, and an operational narrative for new buildings, additions, major changes, and conversions, submitted to the department for review and approval before construction begins.
  • Incident/accident reports containing person(s) involved, date/time/location/description/cause of incident, effect on person involved, extent of injuries, medical treatment sought, individuals notified (with time/date), and corrective measures taken. The original report must be maintained for not less than 2 years. Incident/accident reports must be reported to the department within 48 hours and verbally or in writing to the resident’s representative and physician immediately.
  • Menus for regular and therapeutic/special diets, prepared and posted for the current week, with changes noted to show what was actually served. Copies of menus as actually served for the preceding 3 months must be maintained.
  • A record of the meal census (residents, personnel, visitors) and a record of the kind and amount of food used for the preceding 3-month period.
  • A written disaster plan and procedure for emergencies like fire, explosion, loss of utilities, etc.

The sources provide requirements related to the staffing and personnel in licensed homes for the aged:

• The owner, operator, and governing body must appoint a competent administrator who is responsible for operating the home according to policies.
• An administrator must be at least 18 years old, have relevant education/training/experience for the population served, and be capable of assuring program planning, development, and implementation consistent with the program statement and resident service plans. A licensee who qualifies may serve as the administrator.
• The home must have adequate and sufficient staff on duty at all times who are awake, fully dressed, and capable of providing for resident needs consistent with their service plans.
• The home shall designate 1 person on each shift to be supervisor of resident care. This supervisor must be fully dressed, awake, and on the premises when on duty. The supervisor is responsible for assuring residents are treated with kindness and respect, protecting residents from accidents and injuries, and ensuring resident safety in case of emergency.
• For homes with a “distinct part” (a clearly identifiable area for residents 60+), appropriate personnel must be regularly assigned and work in that part under qualified direction.
• Staff who supervise medication taking must be trained in proper handling and administration of medication.
• The home must establish and implement a staff training program based on the home’s program statement, resident service plans, and employee needs. This training may include reporting, first aid/medication, personal care, resident rights, safety/fire prevention, infectious disease containment, and medication administration.
• The administrator or designees are responsible for evaluating employee competencies.
• Personnel shall be trained to perform assigned tasks in accordance with the disaster plan.