CALA News & Views | Issue 52 | Workforce

The new dementia care and related regulations, which went into effect on Jan. 1, 2025, bring the most significant regulatory changes to Residential Care Facilities for the Elderly in many years. This article addresses some of the most impactful changes as providers familiarize themselves with the new regulations. While the new regulatory package in large part addresses residents with dementia or Major Neurocognitive Development (major NCD), the changes go beyond dementia care to impact all Assisted Living providers.

By Selena Coppi Hornback, CALA Senior Director of Public Policy

T he focus for resident safety and making environmental changes to help minimize risk are no longer based on a diagnosis of dementia but are required when a resident displays behavioral expressions. Behavioral expression encompasses behaviors displayed by a resident that could result in harm to themselves or others. Some of the expressions listed in 87101(b)(3) include unsafe wandering, elopement, expressions of frustration and lacking hazard awareness or impulse control. The definition provides that there can be many causes that lead to these behaviors including, major NCD, fatigue, illness, overstimulation or medical interactions, among others. Ongoing appraisals and reappraisals are required to help identify changes that require additional interventions. In addition to the changes made based on behavioral expressions, significant changes have also been made regarding resident medical assessments. The intent is that resident need initiate action, rather than a diagnosis or lack of diagnosis. CALA is working to ensure that, while the focus of these regulations is to enhance the experience for residents with dementia, they don’t end up creating unnecessarily restrictive environments for residents without dementia. The Department of Social Services (DSS) has confirmed to CALA that the intent of the regulations and implementation is to be resident-centered and focused on ensuring the resident is not a danger to themselves or others due to behavioral expressions or access to toxic substances, medications, sharp objects, etc., not restricting other residents. Questions about implementation and additional guidance will likely be needed, and DSS is regularly asking CALA and other stakeholders for feedback to ensure clarity and consistency in the field. Please let us know about your experience with inspections and other areas where you have questions about the new regulations. Behavioral Expressions DSS added a new definition for behavioral expression to help guide Assisted Living providers and medical

care practitioners in making determinations regarding situations and items which may pose a risk of harm to residents if allowed unsupervised or direct access. Staff that interact with residents should be trained to identify these expressions in addition to caregivers who are required to receive initial and ongoing dementia care training. Everyone involved in the resident’s care and wellbeing are included in these discussions and the resulting care plans. Appraisals and Reappraisals Identifying whether a prospective resident or other residents would be at risk if the prospective resident is allowed access to specified items is the most significant change to the 87457 Pre-Admission Appraisal. DSS has clarified their intent is not that if one resident in 100 would be unsafe around scissors that no one in the building can possess scissors. The safety risk is meant to be person-centered and specific to the resident who, because of a behavioral expression, may not be allowed unsupervised or direct access to scissors. The RCFE will be responsible for identifying those safety risks during the pre-admission appraisal and through ongoing interaction and reappraisals to document these behaviors or risks, describe the behavioral expression, identify events occurring just prior to the behavioral expression, if known, and identify the interventions that will be implemented to minimize the health and safety of the resident and others using the least restrictive intervention. When behavioral expressions are identified, the RCFE must bring them to the attention of the resident’s medical professional and any specialized care providers, which must be documented, for their recommendations and document any resulting changes in care. Medical Assessments DSS has removed the requirement that a physician conduct the medical assessment and has recognized that other health care professionals, including Nurse Practitioners and Physician Assistants, can conduct medical assessments under the scope of their practice. DSS also struck references to LIC 602 in the regulations,

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