June 2005

Information Bulletin 05-3
SLF-16

Persons Requiring Nursing Care in a Supervised Living Facility (SLF) Waiver Provision for Minnesota Rule 4665.0900

Purpose and Background:

Supervised Living Facilities are currently precluded from accepting individuals who require nursing care according to Minnesota Rule 4665.0900B, unless a rule waiver is obtained from the Minnesota Department of Health (MDH).

This bulletin establishes a standard waiver process for Minnesota Rule 4665.0900 B., related to residents requiring nursing care who are accepted in a Supervised Living Facility (SLF) without the SLF having to submit an individual waiver request to the Minnesota Department of Health.

This means that if a SLF follows the provisions of the waiver set forth in this Information Bulletin, an individual waiver request would no longer be required to be submitted to the Minnesota Department of Health for Minnesota Rule 4665.0090 B., related to accepting persons requiring nursing care.

Waivers of all other Minnesota Rule requirements for a SLF would need to be submitted in writing to the Minnesota Department of Health.

Minnesota Rule 4665.0900 B States: Supervised living facilities may accept as residents such persons as are described in part 4665.0100 , subpart 10, but may not accept as residents, nor provide lodging to any of the following persons:

B. persons who require nursing care as defined in Minnesota Statutes, section 144A.01 , subdivision 6, except for brief episodic periods.

Examples of nursing care: bedside care, including administration of medications, irrigations and catheterizations, applications of dressings or bandages; rehabilitative nursing techniques; and other medical treatments prescribed by a physician.

CONDITIONS OF WAIVER TO RETAIN RESIDENTS IN A SLF WHO REQUIRE NURSING CARE:

The nursing care is provided by a registered nurse, licensed practical nurse or unlicensed assistive nursing personnel.

Written protocols/procedures are established in accordance with current professional standards for care to be provided.

An up to date individualized nursing assessment and individualized care plan are maintained in writing for the individual and are implemented by a registered nurse.

A registered nurse monitors the resident's functional, nursing, and medical status.

A registered nurse does periodic reassessment of the resident to evaluate the appropriate and effectiveness of the care to include evaluating the appropriateness of the continuation of the waiver.

There are physician's orders for medical treatment.

A registered nurse does periodic monitoring of the nursing staff to assure the procedures for the individualized care are implemented.

Adequate licensed nursing staff coverage is provided to meet the resident's needs.

A unlicensed assistive person who satisfies the following may perform delegated nursing procedures if:

1. A registered nurse delegates nursing care to persons who possess the knowledge and skill consistent with the complexity of the nursing task being delegated, in accordance with Minnesota Nurse Practice Act, Minnesota Statutes, sections 148.171 to 148.285.

    

2. Before performing the procedures, the person is instructed by a registered nurse in the proper methods to perform the procedures with respect to each client.

    

3. A registered nurse specifies in writing, specific instructions for performing the procedures for each resident.

    

4. Before performing the procedures, the person demonstrates to the registered nurse the person's ability to competently follow the procedures, and training must include education of staff pertaining to infection control.

    

5. The SLF retains documentation by the registered nurse regarding the person's demonstrated competency.

    

6. The SLF must establish and implement policies to communicate up to date information to the registered nurse regarding the current available unlicensed personnel and their training and qualifications, so the registered nurse has sufficient information to determine the appropriateness of delegating tasks in individual's situations.

    

7. The direct care staff is appropriately trained in the specific protocols/procedures to care for the resident.

Other Waiver Provisions

This waiver will remain in effect indefinitely for the resident; however, all waivers are subject to review as deemed necessary by the Department. Please remember that all alternative measures or conditions attached to a variance or waiver shall have the force and effect of the licensure rule(s) and shall be subject to the issuance of correction orders and penalty assessments in accordance with the provisions of Minn. Stat., section 144.653 and 144A.10. The period of time for correction and the amount of fines specified for the particular rules for which the variance or waiver was requested, shall apply.

If you have any questions related to this Information Bulletin, please contact:

Minnesota Department of Health
Division of Health Regulation
Licensing and Certification Program
85 East Seventh Place, Suite 300
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4101