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PURPOSE OF THE TUTORIAL
The purpose of this tutorial is to answer questions and provide information to assist you in making an informed decision about applying for a home for the aged license.
This tutorial will not:
- Determine your appropriateness to be a licensee.
- Provide you with training or competency to be a licensee or administrator.
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BUSINESS CONSIDERATIONS
The purpose of this section is to discuss the business aspect of becoming a licensee.
The licensee is the owner (person, persons in a partnership, the corporation or the limited liability company (LLC)) who the home for the aged license is issued to. It is best to check with your business consultant first before submitting an application.
- The Effect of Licensing on You:
- Developing and operating a business today requires a level of sophistication
- Perhaps consult with someone already licensed
- Determine type of ownership
- Proprietorship/partnership/corporation/limited liability company
- Determine level of insurance (auto/home and liability) to buy
- Determine how to market and finance
- Determine food service supplier - vendor/local grocery
- Determine if you want employees bonded
- Determine if you are ready to face many conflicting demands and pressures:
- you must satisfy your customers
- you must comply with the regulation of at least two government agencies, maybe more
- you must meet the expectations of employees
- you must make a good impression on the public
Although not a licensing requirement, it is recommended that you develop a business plan to include:
- Marketing strategies
- Financial plan
- Determine/get acquainted with potential placement sources: Local Department of Human Services/Adult Services, local Office on Aging, hospital medical social workers/discharge planners, veteran's hospital, community mental health system, etc.
The following website may be helpful: http://www.michiganbusiness.org/start-up/business-assistance/
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PURPOSE AND DEFINITION OF HOME FOR THE AGED
The purpose of this section is to provide the purpose and definition of a home for the aged and describe how homes for the aged differ from other types of residential programs.
Definition of Home for the Aged
- A home for the aged is a specific type of assisted living, as outlined in PA 368 and the administrative rules.
- Home for the aged means a supervised personal care facility that provides room, board, and supervised personal care to 21 or more unrelated, non-transient individuals 55 years of age or older. Home for the aged includes a supervised personal care facility for 20 or fewer individuals 55 years of age or older if the facility is operated in conjunction with and as a distinct part of a licensed nursing home.
- Room and board means the provision of housing and meals. A "room" could be a bedroom, an apartment, a suite, etc. Board generally means the provision of one or more meals/food as part of a "package" that includes room or lodging.
- Supervised personal care means guidance (cuing, prompting , reminding) or assistance (help provided by a home or employee or agent of a home) with eating, toileting, bathing, grooming, dressing, transferring, mobility, medication management , reminding resident of important activities to be carried out, assisting a resident to keep appointments , supporting a resident ' s personal and social needs, and being aware of a resident ' s general whereabouts even if the resident is capable of independent travel about the community.
Purpose of Home for the Aged
To provide needed care for vulnerable, aged adults.
To assure resident protection from physical harm, humiliation, intimidation, and social, moral, financial and personal exploitation.
To treat residents with dignity while meeting their personal care needs and ensuring their health, safety and well-being.
What a Home for the Aged is Not
- It is not a nursing home as the residents do not require continuous nursing care, unless a hospice patient.
- It is not a room and board situation.
- It is not specialized care provided in an individual's home as the individual receiving care typically does not own or control the real estate.
- It excludes facilities licensed under other laws such as:
§ Adult foster care
§ Hospitals
§ Facilities operated by the Department of Health and Human Services
§ Children's facilities.
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POPULATIONS SERVED IN HOMES FOR THE AGED
This section will provide an overview of aged populations served and their referral and funding sources.
An administrator is required to have education and/or experience working with each population identified by the home on the application, program statement and admission policy. It is recommended that you research how you will receive placement referrals as well as the sources and amount of funding provided for each population served. This will assist in determining administrative costs and budget planning for the monthly operation of the home.
Populations Served in Homes for the Aged
- Aged residents may need home for the aged care because of the physical frailties of age. Common referral sources include local Offices on Aging and the Department of Human Services' Office of Adult Services.
- Aged residents may need specialized care in a home for the aged as a result of Alzheimer's Disease or other causes of dementia. There are additional statutory requirements for a written description of services, staff training and environmental design features of homes for the aged that represent to the public that they provide services to persons with Alzheimer's Disease or related conditions.
- Aged developmentally disabled residents may exhibit extremely challenging behaviors, may be medically fragile, and require highly skilled staff. Common referral sources include local mental health agencies and the ARC of Michigan. Residential services are often funded by the resident's Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Consumers of the public mental health system who require a specialized residential program and those receiving SSI may receive additional public funding and support.
- Aged mentally ill residents may exhibit extremely challenging behaviors and require highly skilled staff. Common referral sources include local mental health agencies and the Alliance for the Mentally Ill.
- Aged residents who have sustained closed head injuries need special rehabilitation program services to be eligible for receipt of funding by most auto or workers compensation insurers.
- Aged physically handicapped residents include those with cerebral palsy and spinal cord injuries. Sources of referrals for placement include the Easter Seals Society and the United Cerebral Palsy Association as well as private insurers.
The Bureau of Community and Health Systems maintains a "searchable" database of all currently licensed homes for the aged on its website that is available to the public for use in identifying and exploring placement possibilities. The homes' approved program(s), aged and/or Alzheimer's/Dementia, are included.
The Bureau of Community and Health Systems DOES NOT make referrals or recommendations for placement or have any involvement in payment for home for the aged care.
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QUALIFICATIONS FOR LICENSEES AND ADMINISTRATORS
There are no specific qualifications for the licensee (owner, operator and governing body of a home). However, the licensee must be able to:
- assure that the home has an organized program to provide room, board, protection, supervision, assistance and supervised personal care for the residents
- assure the availability of emergency medical care required by a resident
- appoint a competent administrator responsible for operating the home
As the licensee, you must have sufficient knowledge of the home for the aged requirements and profession to be able to evaluate, select and monitor an administrator to know that your established policies and program are being successfully implemented. As the licensee, you have the full legal responsibility for the overall conduct and operation of the home.
The administrator is required to have specific qualifications.
Administrator is Required to:
- be at least 18 years
- have education, training, and/experience working with the resident population
- be capable of assuring program planning, development, and implementation of services to residents consistent with the home's program statement and in accordance with the residents' service plans and agreements
- be responsible for employee competency in the following areas:
§ Reporting requirements
§ First aid and/or medication, if any
§ Personal care
§ Resident rights and responsibilities
§ Safety and fire prevention
§ Containment of communicable diseases and standard precautions
§ Administration of medication, if applicable
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QUALIFICATIONS FOR STAFF
This section will provide an overview of the qualifications for all direct care staff and contract employees who provide direct services to residents.
The Licensee is Required to:
- Conduct a background check of employees via the Michigan Workforce Background Check website.
- Maintain evidence of the adequacy of employee health and annual tuberculosis screening.
- Maintain adequate and sufficient staff on duty at all times who are awake and dressed.
- Assure direct care staff are capable of providing for resident needs as indicated in their resident service plans.
- Assure competency in the following areas:
§ Reporting requirements
§ Personal care
§ Resident rights
§ Safety and fire prevention
§ Containment of communicable disease and standard precautions
§ Administration of medication
§ Food preparation
§ First aid
§ Services consistent with the home's program statement
§ Services identified in resident services plans
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PURCHASING AN EXISTING FOR HOME FOR THE AGED FACILITY
This section will inform inquirers about the provisions of Act 368 and administrative rules related to the procedures for purchasing an existing home for the aged
PUBLIC HEALTH CODE
PA 368 OF 1978, AS AMENDED
Section 20141 (1) A person shall not establish or maintain and operate a health facility or agency without holding a license from the department. (3) A change in ownership shall be reported to the director not less than 15 days before the change occurs… A person who violates this subsection is guilty of a misdemeanor, punishable by a fine of not more than $1,000.00 for each violation.
Rule 325.1913 (1) A license, provisional license, or temporary nonrenewable permit is not transferable between owners, or from one location to another, or from one part of an institution to another. (2) The applicant or the authorized representative shall give written notice to the department within 5 business days of any changes in information as submitted in the application pursuant to which a license, provisional license, or temporary nonrenewable permit has been issued.
To Assist You in Exploring this Option, You Should Know that:
- A license is issued to a specific person or corporation or legal business entity at a specific location and the licensee remains responsible for the home for the aged until the license is closed by the Department.
- Although a licensee has a property right to a license that has been issued, the license is the property of the Department.
- Licensing regulations do not permit the "transfer" of a license to a new licensee nor can it be purchased or inherited.
- Before finalizing the purchase of a licensed home for the aged, the most recent annual inspection reports by BCAL and the Bureau of Fire Services should be reviewed for noncompliance with physical plant requirements.
- The current licensee (owner) may appoint a prospective new owner as the authorized representative and/or as administrator while the new owner's application is pending - current licensee still responsible for all that occurs.
- When considering the purchase of an existing facility, be aware that it may have been licensed using previous administrative rules or statute. The Facility may have been grandfathered but now would require the new owner to comply with current administrative rules and statute. For example, the new owner will be required to install a generator that meets MCL 333.21335 (1) if the facility currently does not have a compliant generator.
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MICHIGAN BUILDING CODE CONSTRUCTION
Michigan's Building Code is used by local building authorities to review building plans, issue building permits, inspect building sites and progress, and issue their final occupancy approval. When the applicant's architect or building contractor applies for a construction permit via submission of a request for plan review, it must indicate the type of building it will be. The recommended classification of a proposed home for the aged is I-2 which includes facilities used to provide custodial care on a 24 hour basis to occupants who are not capable of self-preservation. The rationale is that HFAs are defined in the Public Health Code as health care facilities; medical care and nursing care may be, and often are, provided to residents in HFA facilities; and the Bureau of Fire Services' administrative rules are categorized as health care occupancies under the Life Safety Code. If the I-1 classification is used, which includes "assisted living" but states that the occupants are capable of responding to emergency situations without physical assistance from staff, automatic self-closers are required on resident room doors. These pose a danger to some frail residents and those who use mobility devices, may cause the rooms to be not meet accessibility requirements, and unnecessarily impede residents' independent functioning.
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APPROVAL OF FACILITY BUILDING PLANS
- The Department of Licensing and Regulatory Affairs' Health Facility Engineering Section (HFES) and the Department of Licensing and Regulatory Affairs' Bureau of Fire Services (BFS) must approve the building plans and then inspect and approve the physical plant for a home for the aged licensed for the first time. Note: These plan reviews are not required for a license application for a change in ownership of an existing licensed home for the aged if no changes to the physical plant will be made as part of the application for a new license.
- Plan review and approvals of sealed architectural plans and shop drawings are required for new construction, conversions, remodeling and major building modifications. Conversion means an existing building not currently licensed as a home for the aged is being converted to use as a home for the aged. See link to Fire Safety Inspections.
- Construction or remodeling should not begin until plan review approval is received.
Information about the HFES plan review process is available at www.michigan.gov/lara
Information about the BFS plan review process is available at www.michigan.gov/lara
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APPLICATION PROCESS
This section will provide an overview of the application process.
- If the proposed home for the aged has not yet been constructed, an address will need to be obtained. A license is issued for a home at a specific address. A change of address requires a new license.
- The applicant submits completed application (BCAL-1600) and a Certificate of Appointment for Authorized Representative (BCAL-1603 or equivalent).
- When complete application and certificate are received in Lansing, we request HFES and BFS plan reviews if needed. The applicant is responsible for submitting the plans to these agencies for review following their procedures.
- The application is assigned to a licensing staff who will contact you upon receipt to discuss the application process and documents that will be required to be reviewed and approved. Licensing staff will first request to review your proposed floor plan of the home with a description of rooms, their sizes, use, door locations, window areas and number of beds. This floor plan is not the detailed architectural building plans submitted to HFES and BFS.
- When BFS and HFES have approved building plans, HFES will issue a Construction Permit.
Determining Compliance
- When construction is complete, BFS and HFES will inspect the facility.
- When both have approved the completed construction, HFES will issue an Occupancy Permit. Note: The Occupancy Permit is not a license. You must be licensed to admit residents.
- Full compliance with licensing requirements is required before an original license can be issued.
- Residents may not be admitted to a home/facility prior to the license being issued.
- An initial onsite inspection will be completed by the licensing staff after the Occupancy Permit and related documents have been received by us from HFES.
- Additional onsite inspections may be necessary if the facility is not in full compliance with all requirements at the time of the initial inspection.
- We will provide you with written documentation of our findings from all inspections we conduct.
Prior to a recommendation for licensure:
- Required policies, procedures and forms must be reviewed and approved
- Administrator qualifications must be reviewed and approved
- All noncompliance with physical plant requirements must be resolved
- The home must be fully equipped and ready to accept residents.
General Information
- Application packet contains instructions on how to complete and where to forward applications.
- License issuance:
No license can be issued until full compliance is achieved.
- At the time of original license issuance, you will receive an Original Licensing Study Report and a letter informing you that a license has been issued. A license to "post" will be mailed to you shortly thereafter.
- A license is issued to a particular person/entity at a specific location for a certain number of residents (capacity).
- A temporary license is issued for the first 6 months. It provides the opportunity to demonstrate compliance with quality of care requirements.
- A regular license is renewed annually when a facility is in substantial compliance with regulatory requirements.
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ONGOING LICENSE PROCEDURES
The purpose of this section is to provide a brief overview of expectations and events after issuance of an original license.
Compliance
- Full compliance with licensing rules is required before an original license will be issued.
- Residents may not be admitted to a home/facility prior to the license being issued.
Maintaining a License
- Ongoing compliance is expected.
- Interim inspections may be conducted between renewal inspections. These may focus on selected areas based on the previous renewal inspection or a special investigation.
- Inspections are unannounced: Cooperation with inspections is required.
- Renewal inspections will be conducted annually.
- An exit conference is conducted with the authorized representative and/or administrator at the conclusion of the renewal inspection.
- Written confirmation of the findings of an on-site inspection is provided to the authorized representative.
- Fire safety inspections are conducted by BFS annually.
Complaints
- Complaint investigations are conducted by licensing staff when an allegation of a violation of the Act or a rule is made against a home/facility.
- Investigations may be conducted jointly with Department of Human Services' Adult Protective Services, Department of Community Health's Office of Recipient Rights, and/or law enforcement officials.
- Licensing staff conducts the investigation. This includes an exit interview during which the authorized representative and/or administrator are given an opportunity to demonstrate compliance prior to the conclusion of the investigation.
- Licensing staff prepares a written Special Investigation Report that is sent to the authorized representative.
Special Investigation Report can conclude that:
- No Act or rule violations occurred.
- Violations occurred that were isolated incidents of noncompliance that did not result in or have the potential for more than minimal harm to residents that were corrected or can be easily and quickly corrected without a corrective action plan from the licensee/licensee designee.
- Violations occurred and a corrective action plan from the licensee/licensee designee is required.
- Violations occurred that result in a recommendation for disciplinary action against the license.
- Examples of disciplinary action include a correction order, revocation of a license, refusal to renew a license, and summary suspension of a license.
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HELPFUL SOURCES OF INFORMATION
The purpose of this section is to identify other sources of information that may be of assistance to you in exploring your interest in applying for an adult foster care license.
Professional Organizations
Michigan Assisted Living Association
15441 Middlebelt Road
Livonia, MI 48154
800-487-0118
LeadingAge Michigan
201 North Washington Square, Suite 920
Lansing, MI 48933
517-323-3687
Health Care Association of Michigan (HCAM)
7413 Westshire Drive
Lansing, MI 48917
517-627-1561
Consumer Organizations/Resources
Michigan Alliance for the Mentally Ill
921 N. Washington
Lansing, MI 48906
800-331-4264, 517-485-4049
The Arc Michigan
1325 South Washington Ave.
Lansing, MI 48910
800-292-7851, 517-487-5426
Alzheimer's Disease and Related Disorders Association
Greater Michigan Chapter
800-337-3827
Michigan Office of Services to the Aging and Area Offices on Aging
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