Greenville Senior AdvisorWho can a South Carolina assisted living facility admit?
A South Carolina CRCF may admit adults whose needs fit the care, services and assistance it offers, using written admission criteria it applies consistently, and it must not admit anyone who needs hospitalization or nursing home care (Regulation 60-84, Section 801.A-C).
Before admission the resident must have a physical examination within the previous 30 days, and within 30 days after admission must have an attending physician licensed in South Carolina (Section 1101). Within 72 hours the facility completes a written assessment, and within seven days it develops an individual care plan with the resident and responsible party, reviewed at least every six months (Sections 702-703). Those documents are worth reading: they show what the facility believes it has agreed to do.
Which medical needs keep someone out of a CRCF in South Carolina?
Section 801.C of Regulation 60-84 lists the people a CRCF may not admit or retain, including anyone needing daily skilled monitoring for an unstable condition, sliding-scale insulin, IV medications, stage 2-4 pressure ulcer treatment, or catheter, feeding-tube or tracheostomy care they cannot manage themselves.
- A person likely to endanger themselves or others, as determined by a physician or other authorized healthcare provider
- A person needing hospitalization or nursing home care
- A person needing daily skilled monitoring for an unstable or complex medical condition (for example brittle diabetes)
- A person needing medications that require frequent dosage adjustment, such as sliding-scale insulin
- A person needing intravenous medications or fluids, or regular intramuscular or subcutaneous injections by staff (routine daily insulin is permitted)
- A person needing urinary catheter care they cannot manage independently
- A person needing treatment of stage 2, 3 or 4 pressure ulcers or widespread skin disorders
- A person needing nasogastric tube feeding, or gastrostomy feedings they cannot manage independently
- A person needing suctioning, or tracheostomy care they cannot manage independently
- A person receiving oxygen for the first time that requires adjustment and evaluation
Several items turn on whether the resident can manage the device independently. A person who handles their own catheter or gastrostomy feedings may be admitted; one who needs staff to do it may not. Routine insulin injections scheduled daily or less often are allowed; sliding-scale insulin given by staff is not.
When must a CRCF resident move out in South Carolina?
A CRCF may not keep a resident with uncontrollable aggressive or socially inappropriate behavior, a resident totally dependent in all activities of daily living for more than 14 consecutive days, or a resident needing the continuous daily attention of a licensed nurse (Regulation 60-84, Section 801.D).
The 14-day rule has a defined trigger: if a resident is bedridden or otherwise totally dependent and not improving, the facility must develop a plan for transfer on the 15th day. Short-term intermittent nursing for up to 14 consecutive days while recovering from an illness or injury is allowed when a staff nurse or home health nurse provides it, which is how many residents come back from a hospital stay without moving.
Can hospice or home health care for a resident inside a Greenville CRCF?
Yes. Regulation 60-84 lets a CRCF combine its own care with other appropriately licensed services, such as hospice and home health, as ordered by a physician; only when that combination no longer meets the resident's needs must the resident be transferred within 30 days (Section 801.F).
That is why many residents of Upstate CRCFs receive hospice where they live rather than moving to a nursing home at the end of life. Ask each facility about its written policy on outside providers, whether it allows private sitters (the regulation requires a formal private sitter program with background checks and orientation, Section 506), and how it coordinates with a hospice nurse. DPH's data shows 17 licensed hospice programs with offices in the four counties and 3 inpatient hospice houses: Bon Secours Hospice House by Compassus (Simpsonville, 30 beds), Callie & John Rainey Hospice House (Anderson, 22 beds), VIA Health Partners - Laurens County Hospice House (Clinton, 12 beds).
Who decides that a resident no longer fits, and what notice is required?
When a resident's condition changes so that nursing home care, daily nursing attention or hospitalization may be needed, a physician or other authorized healthcare provider must examine the resident, and the administrator coordinates any transfer with the resident, family and sponsor (Regulation 60-84, Sections 801.E-F).
The written admission agreement must also give at least 30 days' advance notice of any fee change and state the refund policy when a resident leaves (Section 901.A). If a family disagrees with a discharge, the regional long-term care ombudsman, an independent advocate for facility residents, can help at no cost: the Appalachian Council of Governments program for Greenville, Anderson and Pickens counties, and Upper Savannah's program for Laurens County.
At a glance
| A South Carolina CRCF can | A South Carolina CRCF cannot | |
|---|---|---|
| Medications | Have trained staff give routine medications and daily insulin | Have staff give sliding-scale insulin or IV medications |
| Nursing | Bring in short-term nursing for up to 14 consecutive days | Keep a resident who needs a nurse's continuous daily attention |
| End of life | Keep a resident on hospice when needs are met | Admit someone who needs nursing home care |
| Dependency | Care for a resident through a temporary decline | Keep a totally dependent, non-improving resident past day 14 |
Sources include S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS pages and bulletins, CareScout, CMS and VA rate tables as cited above; see our editorial standards.
