411-049-0155 Ventilator-Assisted Care Requirements (1) AFHs that provide ventilator-assisted care for residents must meet the requirements of this rule, in addition to the other requirements set forth in these rules. (2) LICENSE REQUIRED. A person or entity may not represent themselves as operating an AFH that provides ventilator-assisted care or accept placement of an individual requiring ventilator-assisted care without being licensed as a ventilator-assisted care AFH. (3) The licensee must comply with all HCB Settings requirements as described in these rules. (4) To apply for an initial license to provide ventilator-assisted care, and to renew the license, an applicant must complete the Department's ventilator-assisted care application form (APD 0448V) and submit the application with the required information and nonrefundable fee as outlined in OAR 411-049-0105 to the LLA. Applications are processed according to OAR 411-049-0135. (5) QUALIFICATIONS AND TRAINING. An applicant, licensee, and all other caregivers must meet and maintain compliance with OAR 411-049-0125. Additionally: (a) The applicant, licensee, administrator, resident manager, floating resident manager, or shift caregivers, as applicable, must demonstrate one year of full-time experience in providing ventilator-assisted care. (b) The applicant, licensee, or administrator, as applicable, must have experience operating a Class 3 AFH in substantial compliance with these rules for at least one year. (c) An applicant for an AFH providing ventilator-assisted care must be the primary caregiver and live in the home where ventilator-assisted care is to be provided for a minimum of one year from the date the initial ventilator-assisted care license is issued. The licensee may employ a resident manager to be the primary live-in caregiver after providing ventilator-assisted care for the one-year period. The resident manager must be approved by the LLA and the Department. (d) The applicant, licensee, and all other caregivers must successfully complete the Department's approved training pertaining to ventilator-assisted care and other training as required. Training is required on an annual basis and must be completed by the licensee, resident manager, floating resident manager, shift caregivers, and substitute caregivers, as applicable, prior to approval of a renewed ventilator-assisted care license. (6) CLASSIFICATION. An applicant for a ventilator-assisted care license must possess the minimum qualifications outlined in section (5) of this rule. The applicant and licensee must meet and maintain compliance with OAR 411-049-0105. The LLA shall issue a Level A, Level B, or Level C ventilator-assisted care AFH license to qualified applicants. (a) A licensee with a Level C ventilator-assisted care license may admit a maximum of one resident who requires ventilator-assisted care. The LLA may issue a Level C license if the applicant has: (A) Satisfied the requirements described in section (5) above; and (B) Successfully operated a Class 3 home in substantial compliance with these rules for a period of not less than one year. (b) A licensee with a Level B ventilator-assisted care license may admit a maximum of three residents who require ventilator-assisted care. The LLA may issue a Level B license if the licensee has: (A) Satisfied the requirements described in section (5) above; and (B) Successfully operated and provided ventilator-assisted care in their Level C home in substantial compliance with these rules for a period of not less than one year. (c) A licensee with a Level A ventilator-assisted care license may admit a maximum of five residents who require ventilator-assisted care. The LLA may issue a Level A license if the licensee has: (A) Satisfied the requirements described in section (5) above; and (B) Successfully operated and provided ventilator-assisted care in their Level B home in substantial compliance with these rules for a period of not less than one year. (7) CAPACITY. An applicant and licensee must meet and maintain compliance with OAR 411-049-0105. The number of residents permitted to reside in a ventilator-assisted care AFH is determined by the level of the home, the ability of the staff to meet the care needs of the residents, the fire and life safety standards, and compliance with these rules. A licensee may only admit or continue to provide ventilator-assisted care for residents according to the level of the home's license. A licensee may admit other residents who do not require ventilator-assisted care within the approved license capacity listed on the home's license. (8) OPERATIONAL STANDARDS. In addition to the standards set forth in these rules: (a) FOR LEVEL A AND LEVEL B. A minimum of two qualified and approved caregivers must be on site and available to meet the routine and emergency care and service needs of the residents 24 hours a day. A minimum of one of the two qualified and approved caregivers must be awake during nighttime hours. (b) FOR LEVEL C. At least one qualified and approved caregiver must be on site, available, and awake to meet the routine and emergency care and service needs of the residents 24 hours a day. (c) All caregivers must demonstrate competency in providing ventilator-assisted care. (d) The applicant and licensee must have a satisfactory system in place to ensure the caregivers are alert to the 24-hour needs of residents who may be unable to independently call for assistance. (e) All caregivers must know how to operate the back-up generator without assistance and be able to demonstrate how to operate the back-up generator upon request by the Department or LLA. (9) FACILITY STANDARDS. An applicant and licensee must meet and maintain compliance with OAR 411-050-0715. In addition: (a) The residents' bedrooms must be a minimum of 100 square feet, or larger if necessary, to accommodate the standard requirements of OAR 411-050-0715, the needs of the resident, and the equipment and supplies necessary for the care and services needed by individuals requiring ventilator-assisted care. (b) Homes that provide ventilator-assisted care for residents must have a functional, emergency back-up generator. The generator must be adequate to maintain electrical service for resident needs until regular service is restored. Hard wired, back-up generators must be installed by a licensed electrician. Back-up generators must be tested monthly and the test must be documented in the facility records. (c) The home must have a functional, interconnected carbon monoxide and smoke alarm system with back-up batteries. (d) The home must have a functional sprinkler system and maintenance of the sprinkler system must be completed as recommended by the manufacturer. A home that does not have a functional sprinkler system, but was approved to provide ventilator-assisted care prior to September 1, 2013, must install a functional whole-home sprinkler system. (See OAR 411-050-0725(3) for evacuation requirements with sprinklers). (e) Each resident's bedroom must have a mechanism in place that enables the resident to summon a caregiver's assistance when needed. The mechanism must be within the abilities of the resident to use. The summons must be audible in all areas of the AFH. (10) STANDARDS FOR CARE. Licensees must meet and maintain compliance with OAR 411-051-0110. In addition: (a) Prior to admitting a resident requiring ventilator care to the AFH, the licensee must obtain preauthorization from the Department. (b) The licensee must have a primary care physician identified for each resident being considered for admission. (c) The licensee, including a licensee who is an Oregon licensed practical nurse (LPN), must retain the services of a registered nurse (RN) consultant to work in the home who is licensed by the State of Oregon and trained in the care of individuals requiring ventilator-assisted care. RN services include, but are not limited to, the provision of medical consultation and supervision of resident care, skilled nursing care as needed, and delegation of nursing care to caregivers. When the licensee is an RN, a back-up RN licensed by the State of Oregon and trained in the care of individuals requiring ventilator-assisted care must be identified and available to provide nursing services in the absence of the licensee. (d) The licensee must develop individual care plans for each resident with the RN consultant addressing the expected frequency of nursing supervision, consultation, and direct service intervention. The RN consultation must be documented on the resident's completed care plan with the RN's signature and date signed. (e) The licensee must have physician, RN, and respiratory therapist consultation services, all licensed by the State of Oregon and trained in the care of individuals requiring ventilator-assisted care available on a 24-hour basis and for in-home visits as appropriate. The licensee must call the appropriate medical professional to attend to the emergent care needs of the residents. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775 & 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 443.001 - 443.004, 443.705 - 443.825, 443.875 & 443.991 History: APD 49-2022, minor correction filed 09/26/2022, effective 09/26/2022 APD 61-2021, amend filed 12/23/2021, effective 01/01/2022 APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019