Related Resources on Resident Care That You May Find Helpful

Technology Tips on Keeping ALF Records Confidential

For official DO NOT RESUSCITATE forms (2-page PDF) provided by Maryland Emergency Medical Services.

The Maryland Office of the Attorney General provides easy-to-use Advance Directive forms and instructions in a 17-page PDF document.

Your staffing plans need to make sure that the facility is covered 24 hours every day with qualified staff. Whenever a resident is present in the facility, a staff person must also be there. COMAR 10.07.14.14.

How do I find a delegating nurse?
The Maryland Board of Nursing maintains a county-by-county directory of delegating nurse for assisted living.

Find out more about delegating nurses and frequently asked questions (from the Maryland Board of Nursing).

Training of persons to administer medication: Who does what?
Over the past few years there have been three different titles used to describe persons formally trained to administer medications in long-term care settings in Maryland – “Medication Assistant”, “Medication Technician” and “Certified Medicine Aide”. The terms can be confusing.

• As the result of changes in the law in 2004, “medication assistants” are now certified and use the new title “medication technician”. Those medication assistants who were registered as of October 1, 2004 were automatically certified as a medication technician.
• You must be a at least 18 to be trained and certified as a medication Technician – More on the requirements for medication technicians in assisted living facilities.

What is the difference between a “medicine aide” and a “medication technician”? The Board of Nursing offers a quick summary of the differences. The most significant difference for ALF operators is that medicine aides have been trained to work in nursing homes and intermediate care settings.

• Overview table describing levels of care.

The Level of Care Scoring Tool is a 2 page PDF is provided by the Maryland Office of Health Care Quality and helps you to calculate an individual’s level of care.

• A helpful 18 page PDF draft guide to using the Scoring Tool is made available by the Maryland Office of Health Care Quality.

To calculate an individual's level of care, use the Level of Care Scoring Tool. Understanding and Using the Assisted Living Assessments and the Level of Care Scoring Tool.

Resources for Dealing with Dementia - Surprising study results on undiagnosed residents with dementia and psychiatric problems plus tips for managing their care.

Also see special issues on diet and resident care

Guidelines for Electronic Monitoring - DHMH developed these guidelines for nursing homes that may choose to use electronic monitoring to help protect residents who may wander.  ALF operators may find this guidance useful in some limited situations. Residents (or their legal representatives) must consent.

Reporting Abuse - An ombudsman is an advocate for residents of nursing homes, board and care homes, and assisted living. Ombudsmen have authority under state law to investigate resident complaints and to resolve problems. There is a statewide ombudsman as well as a program composed of a number of regional or local ombudsman programs. These operate within an area agency on aging or other community organization.

• State Ombudsman - Patricia Bayliss, Maryland Department of Aging, 301 W. Preston Street, Room 1007, Baltimore, MD 21201 Tel: (410)767-1100 Fax: (410)333-7943
• Local Ombudsman Programs

List of local departments of public services from the Maryland Department of Human Resources.

Fact sheet on Physical Restraint-Free Care from the National Coalition on Nursing Home Reform, a nonprofit advocacy group.

Fact sheet listing the Various Types of Behaviors Considered Abuse  from the National Coalition on Nursing Home Reform, a nonprofit advocacy group.
 

According to a national study the most frequent complaints involving assisted living facilities involve medication administration, menu quality, discharge eviction planning/notice, dignity/respect of staff, and equipment/building problems. (Report to Congress. Long-Term Care Ombudsmen Report, Fiscal Year 2004. Washington, DC: U.S. Department of Health and Human Services, Administration on Aging).

• Up to 96 percent of assisted living residents need help with medications. (Source )
• According to a study of assisted living facilities from the General Accounting Office, administering medications was cited as the service that was of "most concern" by researchers, inspector advocates, and residents' families.
• According to a national survey, a majority of states report that problems with medications occurred “frequently or very often”.

Understanding medications - The company that publishes the Physician’s Desk Reference offers a useful website written for lay persons that allows you to search for drugs by name and learn:

• A quick description of why it is prescribed;
• The most important fact to know about the drug;
• Possible food and drug interactions;
• Side effects;
• Symptoms of an overdose.

Understanding medications is particularly important because:

• the full adult dosage may not be appropriate for older patients and
• older adults may have more trouble with side effects.

ALF staff challenges with inappropriate medication prescriptions -Staff in assisted living facilities must deal with medicines that have been inappropriately prescribed or medicines that have not been prescribed that have been proven to decrease illness. (Source)

Tips on Administering Medications to Older Adults - A very useful article from the US Food and Drug Administration – see the sections on “reducing errors and “managing side effects”.

Assisted Living Cuing and Coaching Video - The order form for the DHMH video on assisting residents to manage their own medications.

Clinical Observations and Notes  - OHCQ provides these notes as a resource guide by using cases and different scenarios on "what to do / what not to do" in a given situation. The first Clinical Observations and Notes covers the topics of anticoagulation, the flu season, and physician notification and is entitled Alarm Complacency and Patient Safety (August 2006).

Clinical Alert Newsletter  - A periodic (1-4 times per year) newsletter for providers that covers problems that the Office of Health Care Quality has identified.  Each issue covers a single important clinical issue, with information and references on day-to-day patient care.

Drug manufacturer subsidies and free medication programs that may help residents cover the costs of medications.
 

• Simple basic questions to ask about a resident’s pain - The Foundation offers clear questions that can help guide residents in the report of his/her pain to a health care provider.
• Pain management for the end of life - An on-line resource center for the public, caregivers and health care providers.

Information from the National Pain Foundation - A section of interest to ALF operators includes one for consumers that allows searches for information on pain associated with certain medical conditions

Maryland Report on Pain Management – A policy-oriented document that is mostly not useful to ALF operators except for one recommendation.  Recommendation #1 suggests that providers monitor the results of pain treatment in addition to monitoring the medication level or other treatment for pain.

9 simple pain assessment tools will be useful to include in a resident’s medical record to monitor the results of pain treatment. The forms are free from a commercial company. Other materials are also free but require registration. You are likely to be solicited if you register.

Pain Advice Hotline for Doctors - Maryland is one of the few states that offer help to medical professionals when they need advice on managing pain. Volunteer Board-certified physicians trained in pain management staff the Hotline. If a resident is having pain that seems difficult to treat, you may want to ask if the doctor has used this resource.
 

Required Guidelines for ALFs - As an ALF operator, you are required to follow two sets of standards to control infection. COMAR 10.07.08.19 . This is true except if there is a life-threatening emergency when it is not reasonable to follow these guidelines. Note: The regulation mentions a “freestanding medical facility” and an ALF fits into this category. See the definition of “freestanding medical facility” and more definitions.

• Guidelines for standard precautions by the CDC – ALF operators are required to follow these guidelines, which are summarized in COMAR 10.52.11, “Universal Infection Control Precautions”  (as required by Health Occupations § 1-207) 
• OSHA’s Bloodborne Pathogen Standard – These are detailed in  29 CFR 1910.1030. ALF operators may wish to look at a  “sample plan” from the CDC.

In addition, some ALF operators may find the 40 page CDC Guidelines for Environmental Infections Control to also be helpful. They offer some very specific procedures and recommendations based on several studies.

Flu

• 10 Things to Do Before Flu Season – for long-term care facilities from the DHMH Office of Epidemiology and Disease Control Programs.
• Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities - 2007 update from the Centers for Disease Control and Prevention.
• Infection Control- Influenza - more detailed (22 pages) information from the US Health and Human Service Pandemic Influenza Plan on all aspects of controlling an outbreak of flu (May 17, 2007).
• Find a flu shot and other MD information - This is the Maryland state government’s portal to Maryland flu resources.

Hand washing

• Download a colorful poster reminding staff to wash their hands from the Clean Hands Campaign of the American Society for Microbiology.  Also see a free, downloadable and colorful calendar with hand washing story graphics for each month from the Massachusetts Department of Public Health.
• More hand washing articles from the Centers for Disease Control and Prevention.

Linens

The Maryland regulations on the appropriate disposal of soiled linens to reduce infection COMAR 10.07.14.44.

Reporting Disease

Health care providers are required to report certain diseases or infections COMAR 10.06.01.04.

• The Community Health Administration of DHMH offers a quick and clear summary of the specified diseases, reporting requirements, forms and local health officer contacts  (revised in May of 2007). Reports must be made within 48 hours. Although a resident’s physician or a nurse are also obligated to make the report, an ALF operator also has the obligation to make sure the report is made.
• See the October 2006 revision of guidelines on managing multidrug-resistant organisms - This links to the MD Office of Epidemiology and Disease Control Program’s website, which offers a set of slides on the topic as well as a link to the guidelines from the federal Centers for Disease Control and Prevention.

• Reportable diseases - A series of documents from the MD Office of Epidemiology and Disease Control. They include reporting instructions for healthcare providers on when and how to report certain diseases.
   

Because there are only a few minutes to save a life in the event of cardiac arrest, some ALF operators may wish to have an AED on the premises.

• American Heart Association states “AEDs are very accurate and easy to use. With a few hours of training, anyone can learn to operate an AED safely”.
• Presentation notes (14 page PDF) - a quick overview from a 2005 briefing for the ALF Forum.
• Procedures and Protocols for an AED Program - (44 page PDF) - from the MD Institute for Emergency Medical Services Systems. Materials include the application form.
• Complete Maryland Information on AED Programs - the MD Institute for Emergency Medical Services Systems website.
• FDA approval for defibrillator use in the home.

Date last reviewed (no legal content): 10/31//07 (MLAN/DL/AC)