2022 Georgia Code
Title 31 - Health
Chapter 7 - Regulation and Construction of Hospitals and Other Health Care Facilities
Article 1 - Regulation of Hospitals and Related Institutions
§ 31-7-12.2. Regulation and Licensing of Assisted Living Communities; Legislative Intent; Definitions; Procedures; Requirements for Medication Aides

1. It is the intention of the General Assembly to establish a new licensure category of long-term care provider which shall be referred to as “assisted living community.” An assisted living community shall be authorized, in accordance with this Code section, to provide certain services that are beyond the scope of services that a personal care home is authorized to provide.
2. As used in this Code section, the term:
   1. “Ambulatory” means the ability to move from place to place by walking, either unaided or aided by a prosthesis, brace, cane, crutches, walker, or hand rails, or by propelling a wheelchair and to respond to an emergency condition, whether caused by fire or otherwise, and escape with minimal human assistance using the normal means of egress.
   2. “Assisted living care” includes:
      1. Personal services, which includes, but is not limited to, individual assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting;
      2. The administration of medications by a medication aide in accordance with this Code section;
      3. The provision of assisted self-preservation in accordance with this Code section; and
      4. The provision of limited nursing services.
   3. “Assisted living community” means a personal care home with a minimum of 25 beds that is licensed as an assisted living community pursuant to Code Section 31-7-3.
   4. “Assisted self-preservation” means the capacity of a resident to be evacuated from an assisted living community, to a designated point of safety and within an established period of time as determined by the office of Safety Fire Commissioner. Assisted self-preservation is a function of all of the following:
      1. The condition of the individual;
      2. The assistance that is available to be provided to the individual by the staff of the assisted living community; and
      3. The construction of the building in which the assisted living community is housed, including whether such building meets the state fire safety requirements applicable to an existing health care occupancy.
   5. “Continuous medical or nursing care” means medical or nursing care required other than on a periodic basis or for a short-term illness.
   6. “Direct care staff person” means any employee, facility volunteer, or contract staff who provides to residents:
      1. Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or
      2. Any other limited nursing services.
   7. “Limited nursing services” means the assessment of the physical, mental, and emotional status to determine the appropriate level of care for an individual; the performance of health maintenance activities, as defined in division (a)(9)(C)(ii) of Code Section 43-26-12; and the provision of any nursing care within the direct care staff person’s scope of practice that can be completed within seven days or intermittently.
3. An assisted living community shall not admit or retain an individual who is not ambulatory unless the individual is capable of assisted self-preservation. In the event that the department determines that one or more residents of an assisted living community are not capable of assisted self-preservation due to the condition of the resident, the capabilities of the staff of the assisted living community, the construction of the building in which the assisted living community is housed, or a combination of these factors, the department shall have the authority to consider any of the following actions:
   1. An increase in the staffing of the assisted living community to a level that is sufficient to ensure that each resident is capable of assisted self-preservation;
   2. A change in the staffing assignments of the assisted living community if such change would ensure that each resident is capable of assisted self-preservation;
   3. A change in rooms or the location of residents as necessary to ensure that each resident is capable of assisted self-preservation;
   4. The utilization of any specialized equipment that would ensure that each resident is capable of assisted self-preservation. For purposes of this paragraph, specialized equipment shall only include a prosthesis, brace, cane, crutches, walker, hand rails, and a wheelchair;
   5. A cessation in the further admission of individuals who are not ambulatory until such time that the assisted living community has taken actions necessary to ensure that all residents are capable of assisted self-preservation;
   6. The transfer or discharge of any resident who is not capable of assisted self-preservation; and
   7. Any action set forth in Code Section 31-2-8.
4. An assisted living community shall maintain a current list of all residents who are not ambulatory but who are capable of assisted self-preservation. The list shall be provided upon request to the department and maintained at all times by the assisted living community.
5. An assisted living community shall maintain fire detection and prevention equipment, including visual signals with alarms for hearing impaired residents, in accordance with manufacturer instructions and the requirements of the Office of the Safety Fire Commissioner.
6. An assisted living community shall not admit or retain an individual who is in need of continuous medical or nursing care. Other than as permitted by a medication aide pursuant to paragraph (7) of subsection (g) of this Code section or for limited nursing services provided by a registered professional nurse or licensed practical nurse pursuant to subparagraph (b)(2)(D) of this Code section, medical, nursing, or health services required on a periodic basis, or for short-term illness, shall not be provided as services of an assisted living community. When such services are required, they shall be purchased by the resident or the resident’s representative or legal surrogate, if any, from appropriate providers managed independently from the assisted living community. An assisted living community may assist in arranging for such services, but not in the provision of such services.
7. 1. An assisted living community may employ certified medication aides for the purpose of performing the technical aspects of the administration of certain medications in accordance with this subsection. An assisted living community that employs one or more certified medication aides must have a safe medication and treatment administration system that meets all the requirements of this subsection.
   2. The department shall establish and maintain a medication aide registry containing the names of each individual in Georgia who is certified by the department as a medication aide. An assisted living community may not employ an individual as a medication aide unless such individual is listed in the medication aide registry in good standing.
   3. An applicant for certification as a medication aide shall meet the following qualifications:
      1. Be a Georgia certified nurse aide with current certification in good standing;
      2. Have successfully completed a state approved medication aide training program administered by a Georgia licensed registered nurse, pharmacist, or physician;
      3. Have successfully passed, with a minimum passing score of 80 percent, a written competency examination; and
      4. Have demonstrated the requisite clinical skills to serve as a medication aide in accordance with a standardized checklist developed by the department.
   4. A record of the successful completion of the written competency examination and clinical skills standardized checklist by an applicant for certification as a medication aide shall be included in the medication aide registry within 30 business days of evaluation. Each candidate for certification as a medication aide shall have the opportunity to take the written competency examination three times before being required to retake and successfully complete the medication aide training program.
   5. An assisted living community shall annually conduct a comprehensive clinical skills competency review of each medication aide employed by the assisted living community.
   6. Certificates issued pursuant to this subsection shall be renewed biennially according to schedules and fees approved by the department.
   7. A medication aide who meets the criteria established in this subsection shall be permitted to perform the following tasks in an assisted living community in accordance with the written instructions of a physician:
      1. Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal, and rectal medications;
      2. Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol;
      3. Administer medication via a metered dose inhaler;
      4. Conduct finger stick blood glucose testing following established protocol;
      5. Administer a commercially prepared disposable enema as ordered by a physician;
      6. Assist residents in the supervision of self-administration of medication; and
      7. Administer liquid morphine to a resident of the assisted living community who is the patient of a licensed hospice, pursuant to a hospice physician’s written order that contains specific instructions for indication, dosage, frequency, and route of administration, provided that the licensed hospice consents to the use and administration of liquid morphine as described in this subparagraph. The medication aide shall observe and document the resident’s need for all “as needed” (PRN) liquid morphine in such resident’s record and such indications of need may include verbalizations of pain, groaning, grimacing, or restlessness. The initial dose of any liquid morphine administered pursuant to this subparagraph shall be administered and assessed by a licensed hospice health care professional to observe and address any adverse reactions to such medication. The assisted living community shall ensure that any medication aides who will be administering liquid morphine to any hospice patients in such assisted living community pursuant to this subparagraph receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The assisted living community shall maintain documentation of all training provided and shall adhere to all security and storage requirements for liquid morphine required under state and federal law, including but not limited to any rules promulgated by the department. Notwithstanding the foregoing, the supply of liquid morphine on-site at the assisted living community shall be limited to no more than 50 ml for each hospice patient in the assisted living community and shall only be administered under limited circumstances when a licensed hospice health care professional is not otherwise available. The department shall promulgate rules and regulations to implement this subparagraph. The authority provided to a medication aide pursuant to this subparagraph shall be in addition to the authority provided to a medication aide pursuant to subparagraphs (A) through (F) of this paragraph and shall not be construed to limit any authority or practice of a medication aide in effect prior to May 11, 2019.
   8. A medication aide shall record in the medication administration record all medications that such medication aide has personally administered to a resident of an assisted living community and any refusal of a resident to take a medication. A medication aide shall observe a resident to whom medication has been administered and shall report any changes in the condition of such resident to the personal representative or legal surrogate of such resident.
   9. All medication administered by a medication aide in accordance with this Code section shall be in unit or multidose packaging.
   10. An assisted living community that employs one or more medication aides to administer medications in accordance with this subsection shall secure the services of a licensed pharmacist to perform the following duties:
       1. Perform a quarterly review of the drug regimen of each resident of the assisted living community and report any irregularities to the assisted living community administrator;
       2. Remove for proper disposal any drugs that are expired, discontinued, in a deteriorated condition, or when the resident for whom such drugs were ordered is no longer a resident;
       3. Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control; and
       4. Monitor compliance with established policies and procedures for medication handling and storage.
   11. An assisted living community that employs one or more medication aides to administer medications in accordance with this subsection shall ensure that each medication aide receives ongoing medication training as prescribed by the department. A registered professional nurse or pharmacist shall conduct random medication administration observations on a quarterly basis and report any issues to the assisted living community administrator.
8. An assisted living community shall establish a written care plan for each resident. Such care plan shall describe the needs of the resident and how such needs will be met.
9. An assisted living community shall not be permitted to enroll as a provider of medical assistance, as defined in paragraph (6) of Code Section 49-4-141, or receive any funds authorized or paid pursuant to Title XIX of the Social Security Act.
10. On and after July 1, 2021, all assisted living communities shall be required to meet the following staffing and training requirements:
    1. Ensure that each direct care staff person in the assisted living community receives initial and annual training covering topics specified by the department to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults; and
    2. Maintain the following minimum staffing requirements:
       1. An average monthly minimum on-site staffing ratio of one direct care staff person for every 15 residents during all waking hours and one direct care staff person for every 20 residents during all nonwaking hours; provided, however, that either such ratio is adequate to meet the needs of the residents;
       2. At least two on-site direct care staff persons at all times; and
       3. A registered professional nurse or licensed practical nurse on-site, as follows:
          1. For assisted living communities with one to 30 residents, a minimum of eight hours per week;
          2. For assisted living communities with 31 to 60 residents, a minimum of 16 hours per week;
          3. For assisted living communities with 61 to 90 residents, a minimum of 24 hours per week; or
          4. For assisted living communities with more than 90 residents, a minimum of 40 hours per week.
11. On and after July 1, 2021, all assisted living communities shall be required to meet the following financial stability requirements:
    1. Upon initial application for an assisted living community license, provide a financial stability affidavit from a certified public accountant affirming the applicant’s ability to operate as a going concern for the next two years;
    2. Provide a minimum of 60 days’ written notice to the department and all residents of any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight; and
    3. Provide a minimum of 14 days’ written notice to the department and all residents of any impending change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight.

History. Code 1981, § 31-7-12.2 , enacted by Ga. L. 2011, p. 227, § 1/SB 178; Ga. L. 2012, p. 775, § 31/HB 942; Ga. L. 2019, p. 1052, § 1/HB 374; Ga. L. 2020, p. 95, § 6/HB 987.

U.S. Code.

Title XIX of the Social Security Act, referred to in this Code section, is codified at 42 U.S.C. § 1396 et seq.

The 2019 amendment, effective May 11, 2019, substituted “such” for “the” in the second sentence of paragraph (g)(2) and in the first and second sentences in paragraph (g)(8); substituted “state approved” for “state-approved” in subparagraph (g)(3)(B); deleted “and” at the end of subparagraph (g)(7)(E); added “; and” at the end of subparagraph (g)(7)(F); and added subparagraph (g)(7)(G); inserted “shall” following “administered and” in the middle of the second sentence of paragraph (g)(8); and substituted “when” for “where” in the middle of subparagraph (g)(10)(B).

The 2020 amendment, effective June 30, 2020, in subsection (b), deleted “and” at the end of subparagraph (b)(2)(B); substituted “; and” for a period at the end of subparagraph (b)(2)(C); added subparagraph (b)(2)(D); substituted “office of Safety Fire Commissioner” for “Office of the Safety Fire Commissioner” at the end of paragraph (b)(4); added paragraphs (b)(6) and (b)(7); inserted “or for limited nursing services provided by a registered professional nurse or licensed practical nurse pursuant to subparagraph (b)(2)(D) of this Code section” in the second sentence of subsection (f); and added subsections (j) and (k).

Code Commission notes.

Pursuant to Code Section 28-9-5, in 2011, “31-2-8” was substituted for “31-2-11” at the end of paragraph (c)(7).

Pursuant to Code Section 28-9-5, in 2019, “aide in effect prior to May 11, 2019” was substituted for “aide in effect prior to the effective date of this subparagraph” at the end of the last sentence of subparagraph (g)(7)(G).

Editor’s notes.

For application of this statute in 2020 and 2021, see Executive Orders 04.08.20.03, 09.15.20.01, 09.30.20.02, 10.15.20.01, 10.30.20.02, 11.13.20.01, 11.30.20.02, 12.08.20.01, 12.30.20.02, 01.15.21.01, 01.29.21.02, 02.15.21.01, 02.26.21.02, 03.12.21.01, 03.31.21.03, 04.30.21.01, and 05.28.21.02.

A listing of Executive Orders issued in 2020 and 2021 can be found at https://gov.georgia.gov/executive-action/executive-orders.