1. (a) Where this part refers to an enactment of the General Assembly, such reference shall include subsequent enactment or amendments by the General Assembly on the same subject matter.

2. (b) As used in this part, the following definitions shall apply unless the context clearly states otherwise:

   1. (1)

      1. (A) “Abuse” shall have the same meaning as prescribed by Arkansas Code § 5-28-101 and 42 C.F.R. § 488.301.
      2. (B) “Abuse” also includes sexual abuse as defined in Arkansas Code § 5-28-101(16);

   2. (2)

      1. (A) “Activities of daily living” means the activities of daily living that are performed either:

3. (i) Independently;

   1. (ii) With supervision;

      1. (iii) With assistance; or

         1. (iv) By others.

      2. (B) “Activities of daily living” include, but are not limited to:

         1. (i) Ambulating;
         2. (ii) Transferring;
         3. (iii) Grooming;
         4. (iv) Bathing;
         5. (v) Dressing;
         6. (vi) Eating; and
         7. (vii) Toileting;
   2. (3) “ADA” means the Americans with Disabilities Act;

   3. (4)

      1. (A) “Administrator” means the person who has successfully completed a course of training or instruction certified by the Department of Human Services as an assisted living facility administrator who is in charge of the daily operation of the facility.
      2. (B) Until programs have been certified by the Department of Human Services, residential care facility administrators or nursing home administrators may be used;

   4. (5)

      1. (A) “Advertise” means to make publicly and generally known.

      2. (B) “Advertise” includes, but is not limited to:

         1. (i) Signs, billboards, or lettering;
         2. (ii) Electronic publishing or broadcasting, including the use of the internet or email; and
         3. (iii) Printed material;

   5. (6) “Alzheimer’s special care unit (ASCU)” means a separate and distinct unit within an assisted living or other home and community-based services (HCBS) facility that:

      1. (A) Segregates and provides a special program for residents with a diagnosis of probable Alzheimer’s disease or related dementia; and
      2. (B) Advertises, markets, or otherwise promotes the facility as providing specialized Alzheimer’s disease or related dementia care services;

   6. (7)

      1. (A) “Assisted living facility” means any building or buildings, section, or distinct part of a building, boarding home, home for the aged, or other residential facility whether operated for profit or not, that undertakes through its ownership or management to provide assisted living services for a period exceeding twenty-four (24) hours to more than three (3) adult residents of the facility who are not relatives of the owner or administrator.
      2. (B) “Assisted living facility” means facilities in which assisted living services are provided either directly or through contractual arrangements or in which contracting in the name of residents is facilitated;

   7. (8)

      1. (A) “Assisted Living I License” means a time-limited, nontransferable permit required by Arkansas Code § 20-10-224 and issued for a maximum period of twelve (12) months to a licensee who complies with the Department of Human Services rules.
      2. (B) This document must list the maximum number of beds for the facility;
   8. (9) “Assisted living program” means a program of assisted living services;

   9. (10)

      1. (A) “Assisted living services” means:

         1. (i) Housing;
         2. (ii) Meals;
         3. (iii) Laundry;
         4. (iv) Social activities;
         5. (v) Assistance with transportation;
         6. (vi) Direct care services;
         7. (vii) Healthcare services;
         8. (viii) Twenty-four-hour supervision and care; and
         9. (ix) Limited nursing services.
      2. (B) For purposes of this part, “assistance with transportation” means making arrangements for transportation;
   10. (11) “Caregiver” shall have the same meaning prescribed by Arkansas Code § 5-28-101;

   11. (12)

       1. (A) “Choice” means viable options available to a resident that enables the resident to exercise greater control over his or her life.
       2. (B) “Choice” is supported by a resident’s self-directed care, including methods and scheduling, established through the care planning process, and the provision of sufficient private and common space within the facility to provide opportunities for residents to select when and how to spend time, and when and how to receive personal or assisted living services;

   12. (13)

       1. (A) “Common areas (for Alzheimer’s special care units)” means portions of the Alzheimer’s special care units, exclusive of residents’ rooms and bathrooms.
       2. (B) “Common areas” include any facility grounds accessible to residents of the ASCU;
   13. (14) “Compliance agreement”, if needed, means the written formal plan developed in consideration of shared responsibility, choice, and assisted living values and negotiated between the resident or his or her representative and the assisted living facility to avoid or reduce the risk of adverse outcomes that may occur in an assisted living environment;
   14. (15) “Continuous” means available at all times without cessation, break, or interruption;

   15. (16)

       1. (A) “Covered direct service staff member”. This definition is pertinent to dementia training requirements listed in 20 CAR §§ 410-309(c) and 410-310.
       2. (B) “Covered direct service staff member” means a staff member whose work involves extensive contact with residents or program participants.
       3. (C) “Covered direct service staff members” include certified nursing assistants, nurse aides, personal care assistants, personal care aides, licensed practical nurses, licensed vocational nurses, registered nurses, activity directors, and staff members who provide direct patient care to residents;
   16. (17) “Deficiency” means a facility’s failure to meet program participation requirements as defined in this part and other applicable rules and laws;

   17. (18)

       1. (A) “Dementia” means a loss or decrease in intellectual ability that is of sufficient severity to interfere with social or occupational functioning.

       2. (B) It describes a set of symptoms such as:

          1. (i) Memory loss;
          2. (ii) Personality change;
          3. (iii) Poor reasoning or judgment; and
          4. (iv) Language difficulties;
   18. (19) “Department” means the Department of Human Services and its divisions and offices;
   19. (20) “Direct care service plan” means a written plan for direct care services that is developed to meet the needs and preferences of the resident or his or her representative through a negotiated process that becomes a part of the resident’s occupancy admission agreement;
   20. (21) “Direct care services” means services that directly help a resident with certain activities of daily living such as assistance with mobility and transfers, assistance provided to a resident to consume a meal, grooming, shaving, trimming or shaping fingernails and toenails, bathing, dressing, personal hygiene, bladder and bowel requirements, including incontinence, or assistance with medication, only to the extent permitted by the state Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing;
   21. (22) “Direct care staff” means any licensed or certified staff acting on behalf of, employed by, or contracted by the facility, to provide services and who provides direct care services or assistance to residents, including activities of daily living and tasks related to medication administration or assistance;
   22. (23) “Direct care staff (Alzheimer’s special care unit)” means an individual who is an employee of the facility, or an individual who is an employee of a temporary or employment agency assigned to work in the facility, who has received or will receive, in accordance with this part, specialized training regarding Alzheimer’s disease or related dementia, and who is responsible for providing direct, hands-on care or cuing services to residents of the ASCU;
   23. (24) “Direct contact” means the ability or opportunity of employees of the facility, or individuals with whom the facility contracts, to physically interact with or be in the presence of residents;

   24. (25)

       1. (A) “Direct threat” means a significant risk to the health or safety of self or others that cannot be eliminated by reasonable accommodation.
       2. (B) This term as used in this part is designed to ensure conformity with the Americans with Disabilities Act in determining whether a person with a disability poses a “direct health or safety threat”;
   25. (26) “Directed plan of correction” means a plan developed by the Department of Human Services that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected;

   26. (27)

       1. (A) “Discharge” means when a resident leaves the facility and it is not anticipated that the resident will return.
       2. (B) A discharge occurs when a return to the facility by the resident requires that admission procedures set forth in this part be followed;
   27. (28) “Disclosure statement (Alzheimer’s special care unit)” means a written statement prepared by the facility and provided to individuals or their representatives, and to individual’s families, prior to admission to the ASCU, disclosing the form of care, treatment, and related services especially applicable to, or suitable for residents of, the ASCU;

   28. (29)

       1. (A) “Elopement” means circumstances where a resident who has been identified as being cognitively impaired has left a facility without staff knowledge.
       2. (B) Facilities must comply with all reporting requirements of any special programs in which they participate;
   29. (30) “Emergency measures” means those measures that are necessary to respond to a serious situation that threatens the health and safety of residents;
   30. (31) “Endangered adult” shall have the same meaning as prescribed by Arkansas Code § 5-28-101 as amended;
   31. (32) “Exploitation” shall have the same meaning as prescribed by Arkansas Code § 5-28-101;
   32. (33) “First-aid measures” means temporary interventions necessary to treat trauma or injury;
   33. (34) “Healthcare service plan” means a written plan for healthcare services that is developed to meet the needs and preferences of the resident or his or her representative through a negotiated process that becomes a part of the resident’s occupancy admission agreement;

   34. (35)

       1. (A) “Healthcare services” means the provision of services in an assisted living facility that assists the resident in achieving and maintaining well-being, e.g., psychological, social, physical, and spiritual, and functional status.
       2. (B) “Healthcare services” may include nursing assessments and the monitoring and delegation of nursing tasks by registered nurses pursuant to the Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing, care management, records management, and coordinating basic health care and social services in such settings.
       3. (C) “Healthcare services” may not be provided in a Level I assisted living facility except as provided in 20 CAR § 410-901 et seq.;
   35. (36) “Home health services” means home health aide services, medical supplies suitable for use in the resident’s assisted living facility apartment, and nursing services as defined in the state Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing;
   36. (37) “IDR” means the informal dispute resolution process as described in this part;
   37. (38) “Imminent danger to health and safety” shall have the same meaning as prescribed by Arkansas Code § 5-28-101;
   38. (39) “Impaired adult” shall have the same meaning as prescribed by Arkansas Code § 5-28-101;
   39. (40) “Independence” means the maintenance and promotion of resident capabilities to enhance the resident’s preferences and choices within a barrier-free environment;
   40. (41) “Individual assessment team (IAT)” means a group of individuals possessing the knowledge and skills to identify the medical, behavioral, and social needs of residents of the ASCU, and to develop services designed to meet those needs;
   41. (42) “Individual support plan” means a written plan developed by an IAT that identifies services to a resident of the ASCU;

   42. (43)

       1. (A) “Limited nursing services” means acts that may be performed by licensed personnel while carrying out their professional duties, but limited to those acts that the Department of Human Services specified by rule.

       2. (B) Acts that may be specified by rule as allowable limited nursing services:

          1. (i) Shall be for persons who meet the admission criteria established by the Department of Human Services for facilities offering assisted living services;
          2. (ii) Shall not be complex enough to require twenty-four-hour nursing supervision; and
          3. (iii) May include such services as application and care of routine dressings and care of casts, braces, and splints;
   43. (44) “Medication assistance or monitoring” means services provided by the facility, either directly or through contract, in accordance with the Nurse Practices Act and interpretations thereto by the Arkansas State Board of Nursing, designed to ensure that residents receive necessary or prescribed medication and to prevent wastage of medication;
   44. (45) “Mental abuse” means verbal, written, or gestured communication to a resident or to a visitor or staff about a resident within the resident’s presence or in a public forum that a reasonable person finds to be a material endangerment to the mental health of a resident;
   45. (46) “Neglect” shall have the same meaning as prescribed by Arkansas Code § 5-28-101 and 42 C.F.R. § 488.301;
   46. (47) “New admission” means an individual who is being admitted to the facility for the first time, or who is returning after a formal discharge;
   47. (48) “Noncompliance” means any violation of this part or of applicable laws or rules;
   48. (49) “Nurse Practice Act” means the Nurse Practice Act referenced in Arkansas Code § 17-87-101 et seq., and interpretations thereto by the Arkansas State Board of Nursing;
   49. (50) “Office of Community Services” means the office within the Division of Provider Services and Quality Assurance of the Department of Human Services that has the responsibility for the licensure, certification, and rules of HCBS facilities, herein referred to as the Department of Human Services or Office of Community Services;

   50. (51)

       1. (A) “Operator” means the individual or entity that conducts the business of the facility.
       2. (B) The individual or individuals executing the licensure application form shall be deemed an operator;

   51. (52) “Person” means:

       1. (A) An individual;
       2. (B) A partnership;
       3. (C) An association;
       4. (D) A corporation; or
       5. (E) Other entity;
   52. (53) “Personnel”, “staff”, or “employee” means any person who, under the direction, control, or supervision of facility administration, provides services as defined in this part for compensation, or who provides services voluntarily, and may include the owner, operator, professional, management, and persons, firms, or entities providing services pursuant to a contract or agreement;
   53. (54) “Plan of correction” means a plan developed by the facility and approved by the Department of Human Services that describes the actions the facility will take to correct deficiencies and which specifies the date by which those deficiencies will be corrected;
   54. (55) “PRN” means a medication or treatment prescribed by a medical professional to a person, allowing the medication or ointment to be given “as needed”;
   55. (56) “Program requirements” means the requirements for participation and licensure under these and other applicable rules and laws as an assisted living facility;
   56. (57) “Proprietor” or “licensee” means any person, firm, corporation, governmental agency, or other legal entity issued an assisted living facility license and who is responsible for maintaining approved standards;
   57. (58) “Protective services” shall have the same meaning as prescribed by Arkansas Code § 5-28-101;
   58. (59) “Provisional licensure” means a temporary grant of authority to the purchaser to operate an existing facility upon application for licensure to the Department of Human Services;

   59. (60)

       1. (A) “Provisional placement” means placement in an assisted living facility made for the purposes of assessment to determine appropriateness of admission or emergency, such as placement by law enforcement or the Adult Protective Services Unit of the Department of Human Services.
       2. (B) A provisional placement shall be permitted for no longer than thirty (30) days, at which time the resident must either be discharged or admitted to the facility in conformity with this part.
       3. (C) A provisional placement shall not be an admission pursuant to this part, and any individual in an assisted living facility pursuant to a provisional placement shall not be deemed a resident of the facility;

   60. (61)

       1. (A) “Representative” or “responsible party” means an individual who, at the request of the applicant or resident, or by appointment by a court of competent jurisdiction, agrees to act on behalf of a resident or applicant for the purposes of making decisions regarding the needs and welfare of the resident or applicant.
       2. (B) This part and this definition do not grant or permit, and should not be construed as granting or permitting, any individual authority or permission to act for or on behalf of a resident or applicant in excess of any authority or permission granted by law.
       3. (C) A competent resident may select a representative or may choose not to select a representative.
       4. (D) In no event may an individual act for or on behalf of a resident or applicant when the resident or applicant has a legal guardian, attorney-in-fact, or other legal representative.
       5. (E) For purposes of this part only, “representatives” will also refer to the terms “responsible party”, “guardian”, “power of attorney”, or similar phrase;
   61. (62) “Separate premises” means buildings housing assisted living facility operations that are located on noncontiguous land;

   62. (63) “Significant change” means any improvement or decline in a resident’s medical, physiological, psychological, or social condition, in which the decline:

       1. (A) Cannot be reasonably expected to resolve itself; or
       2. (B) May cause a worsening of another or preexisting medical, physiological, psychological, or social condition;
   63. (64) “Standard survey” means a comprehensive survey conducted by the Department of Human Services on an average of every eighteen (18) months for each facility;

   64. (65) “Substandard quality of care” means one (1) or more deficiencies related to participation requirements, as set forth in this part or other applicable rules or laws, that constitute either:

       1. (A) Immediate jeopardy to resident health or safety;
       2. (B) A pattern of or widespread actual harm that is not immediate jeopardy; or
       3. (C) A widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm;
   65. (66) “Survey” means the process of inspection, interviews, or record reviews conducted by the Department of Human Services;
   66. (67) “Transfer” means the temporary or permanent relocation of a resident from one living unit within the facility to another living unit within the facility, or the temporary relocation of a resident to a location outside the facility;
   67. (68) “Twenty-four-hour nursing” means services that are ordered by a physician or advanced practice nurse for a resident whose condition requires the supervision of a physician or advanced practice nurse and continued monitoring of vital signs and physical status and whose condition is medically complex enough to require onsite nursing supervision on a twenty-four-hour-per-day basis; and

   68. (69)

       1. (A)

          1. (i) “Visually and functionally distinct area” means a space that can be distinguished from other areas within the apartment by sight.
          2. (ii) A visually and functionally distinct area need not be a separate room.

       2. (B) To create a visually distinct area, one (1) or more of the following methods must be employed:

          1. (i) Change in ceiling height;
          2. (ii) Separation by ceiling soffit or soffits or wall returns;
          3. (iii) Change in flooring color;
          4. (iv) Partial height partitions or counters;
          5. (v) Use of alcoves; or
          6. (vi) Use of permanent screening devices such as columns or fixed screens.
       3. (C) In the case of an L-shaped studio apartment or unit, kitchenettes and living areas may be combined and bedroom areas may be in a leg of an L-shaped plan and qualify without additional separation methods.

Codification Notes: The Americans with Disabilities Act is codified generally at 42 U.S.C. § 12101 et seq. "HCBS" means home and community-based services.