Does Georgia Have a Personal Care Program? Understanding Your Options and Regulations

Navigating the landscape of care options for yourself or a loved one can be complex, especially when it comes to personal care. If you’re wondering, “Does Ga State Have Personal Care Program?”, the answer is multifaceted. Georgia doesn’t have a single, overarching program explicitly named “Personal Care Program,” but it does have a robust regulatory framework and various avenues to access personal care services, primarily through licensed Personal Care Homes. This article will delve into the regulations governing personal care in Georgia, providing a comprehensive overview based on the official rules and guidelines set forth by the state. Understanding these regulations is crucial for anyone seeking or operating a personal care home in Georgia, ensuring quality, safety, and resident well-being.

Understanding Georgia’s Regulatory Framework for Personal Care

Georgia’s commitment to ensuring safe and supportive living environments for adults needing personal assistance is evident in its detailed regulations for Personal Care Homes. These regulations, officially known as Rule 111-8-62, are established by the Georgia Department of Community Health (DCH) and provide the minimum standards for the operation of these essential facilities.

Rule 111-8-62: Regulations for Personal Care Homes

Rule 111-8-62 is the cornerstone of personal care oversight in Georgia. It is legally authorized by the Official Code of Georgia Annotated, specifically Chapters 2 and 7 of Title 31. This rule meticulously outlines every aspect of Personal Care Home operation, from definitions and permits to resident rights and safety standards. Understanding this rule is the first step in grasping how Georgia addresses personal care.

Purposes of the Regulations: Safe, Humane, and Supportive Residential Settings

The core purpose of Rule 111-8-62 is to establish and maintain minimum standards for Personal Care Homes. These standards are designed to ensure that residents receive residential and personal services in environments that are:

• Safe: Protecting residents from harm, accidents, and unsafe conditions.
• Humane: Guaranteeing dignified and respectful treatment.
• Comfortable: Providing a residential setting that feels as much like home as possible.
• Supportive: Offering the necessary assistance and supervision for adults with varying needs.

These regulations aim to strike a balance: allowing Personal Care Homes to operate effectively while rigorously protecting the well-being of their residents.

Key Definitions: Clarifying the Language of Personal Care

To ensure clarity and consistent application of the rules, Rule 111-8-62 provides detailed definitions for key terms. These definitions are essential for understanding the scope and requirements of the regulations. Some of the most important definitions include:

• (aa) “Personal Care Home”, “home” or “facility”: This defines what constitutes a Personal Care Home under Georgia law. It’s any dwelling, operated for profit or not, that provides housing, food service, and at least one personal service for two or more adults unrelated to the owner or administrator. This definition is crucial in distinguishing Personal Care Homes from other types of residential facilities.

• (bb) “Personal Services”: This is the heart of what Personal Care Homes offer. “Personal Services” include assistance with or supervision of:

  • Self-administered medication
  • Ambulation and transfer
  • Essential activities of daily living such as:
    • Eating
    • Bathing
    • Grooming
    • Dressing
    • Toileting

  This definition clarifies the types of support that Personal Care Homes are mandated to provide or arrange.

• (b) “Activities of daily living”: This expands on the “essential activities” listed under Personal Services, providing a more comprehensive list including:

  • Bathing, shaving, brushing teeth, combing hair, toileting, dressing, eating
  • Laundering, cleaning private living space, managing money, writing letters, shopping
  • Using public transportation, making telephone calls, grooming, obtaining appointments, engaging in leisure and recreational activities, or other similar activities.

  This detailed list helps to understand the breadth of assistance residents might require and that Personal Care Homes are expected to address.

• (d) “Ambulatory Resident”: This definition is significant as it historically defined the primary type of resident Personal Care Homes were designed to serve. An “Ambulatory Resident” is capable of moving around and responding to emergencies with minimal assistance. However, aging in place exceptions (discussed later) now allow for some non-ambulatory residents under specific conditions.

• (j) “Direct care staff person”: This refers to any staff member who provides personal services to residents. This includes medication administration, assistance with mobility, and help with activities of daily living. Regulations concerning staffing ratios and qualifications are directly related to these direct care staff.

• (r) “Limited nursing services”: This definition is important in differentiating Personal Care Homes from facilities offering higher levels of medical care. “Limited nursing services” include assessment, health maintenance activities, and nursing care that can be completed within seven days or intermittently. Personal Care Homes are not authorized to provide continuous nursing care.

• (u) “Memory care center”: This definition highlights specialized units within Personal Care Homes (or Assisted Living Communities) that cater to residents with cognitive deficits, such as Alzheimer’s or dementia. Memory care centers are subject to additional regulations and certifications.

These definitions, among many others in Rule 111-8-62, establish a common language and understanding for all parties involved in personal care in Georgia.

Applicability and Exemptions: Who is Governed by These Rules?

Rule 111-8-62 applies to all Personal Care Homes in Georgia unless specifically exempted. This broad applicability ensures consistent standards across the state. However, certain types of facilities are explicitly exempted from these regulations, including:

• (2)(a) Boarding homes or rooming houses: Facilities providing only lodging and meals without personal services.
• (2)(b) Temporary emergency shelters: Shelters for the homeless or victims of family violence.
• (2)(c) Other licensed facilities: Facilities licensed by the DCH under different classifications, such as Assisted Living Communities, hospices, and others. This distinction is crucial as Assisted Living Communities, while also providing personal care, operate under a different set of regulations allowing for a higher level of care.
• (2)(d) Correctional facilities: Facilities under the criminal justice system.
• (2)(e) Facilities under the Department of Behavioral Health and Developmental Disabilities: Facilities serving individuals with behavioral health or developmental disabilities are regulated by a different state department.
• (2)(f) Host homes: As defined under specific Georgia law.
• (2)(g) Group residences: Independent living arrangements where residents manage their own care and share costs.
• (2)(h) Charitable organizations: Providing shelter and services without fees.
• (2)(i) Community Living Arrangements: Distinct dwellings classified separately by the DCH. Importantly, a Community Living Arrangement cannot be on the same premises as a Personal Care Home.

These exemptions clarify the specific types of residential settings that fall outside the scope of Personal Care Home regulations, highlighting the targeted nature of Rule 111-8-62.

Permit and Licensing: The Authorization to Operate

Operating a Personal Care Home in Georgia requires obtaining a permit from the Department of Community Health. This permit is the official authorization to operate and is subject to specific application processes and ongoing compliance.

• (5) Application for Permit: The governing body of each home must apply for a permit. The application process is detailed and requires comprehensive information, including:

  • Application form and fees
  • Sketch of the home and grounds
  • Documentation of ownership or lease
  • Name of the administrator (if known)
  • Disclosure of ownership details
  • Financial stability affidavit (for homes with 25+ beds)

• (6) Permits: Permits are facility-specific and must be:

  • Valid and current
  • Displayed conspicuously in the home
  • Limited to the approved licensed capacity
  • Returned to the Department if the home ceases operation, moves, changes ownership, or is suspended/revoked.
  • Required for each separate location even under the same governing body.
  • Restricted to providing services within the licensed premises.
  • Prohibited from providing “assisted living care” unless specifically licensed as an Assisted Living Community.
  • Prevented from operating other businesses on-site that disrupt resident well-being.

The permit system ensures that Personal Care Homes are formally recognized and authorized by the state, providing a mechanism for oversight and accountability.

Governing Body and Administration: Oversight and Management Responsibilities

The governing body of a Personal Care Home bears the ultimate responsibility for ensuring compliance with all applicable regulations. They delegate day-to-day management to an administrator.

• (7) Governing Body: Responsibilities of the governing body are extensive and include:

  • Ensuring compliance with all relevant laws, rules, and regulations.
  • Maintaining current contact information with the Department.
  • Implementing policies, procedures, and practices that support resident dignity, respect, choice, independence, and privacy in a safe environment. These policies must cover areas such as:
    • Services available
    • Admissions and discharges
    • Refunds
    • Staff training and evaluation
    • House rules
    • Resident rights
    • Medication management
    • Health and hygiene
    • Abuse/neglect reporting
    • Discipline procedures
    • Emergency preparedness
    • Quality assurance
    • Volunteer use
    • Proxy caregiver use
    • Resident safety and security
    • Staffing plans
  • Prohibiting governing body members, administrators, or staff from serving as resident representatives.
  • Ensuring proper handling of resident funds if they serve as representative payee.
  • Ensuring staff accepts certified mail from the Department.

• (8) Administration: The administrator or on-site manager is responsible for the daily operations of the home and must meet specific qualifications. Their duties include:

  • Ensuring effective and enforced policies and procedures.
  • Designating qualified responsible staff in their absence.
  • Investigating serious incidents.
  • Monitoring and documenting staff performance.
  • Complying with disaster preparedness rules.
  • Maintaining a working telephone accessible to residents.
  • Providing notifications for emergency relocation, bankruptcy/eviction, and change of ownership.

The division of responsibilities between the governing body and the administrator ensures both high-level oversight and effective daily management of Personal Care Homes.

Workforce Qualifications and Training: Ensuring Competent Caregivers

The quality of care in a Personal Care Home is directly linked to the qualifications and training of its staff. Rule 111-8-62 sets specific requirements in this area.

• (9) Workforce Qualifications and Training: Key requirements include:
  • Age Requirements: On-site managers and supervisory staff must be at least 21; non-supervisory direct care staff at least 18.
  • Initial Training (within 60 days of employment):
    • First aid certification
    • CPR certification
    • Emergency evacuation procedures
    • Understanding resident needs
    • Resident rights
    • Abuse/neglect reporting
    • Infection control
  • Minimum Staff Presence: At least one trained staff person must be present at all times residents are in the home.
  • Continuing Education: Direct care staff (including administrators) must complete 16 hours of relevant training annually.
  • Health Examinations: Administrators, on-site managers, and employees must have TB screenings and physical exams prior to employment and follow-up exams after significant illness.
  • Criminal History Background Checks: Required for owners, directors, administrators, on-site managers, and direct access employees.
  • Employment History Verification: 5-year employment history (if possible) or reference checks.
  • Personnel Files: Must be maintained and readily available, including:
    • Background check results
    • Physical exam reports
    • Training records
    • Employment history
    • Verification of qualifications
    • Performance reviews
  • Companion-Sitters/Proxy Caregivers Hired by Residents: Homes must ensure these individuals are aware of emergency procedures and comply with proxy caregiver rules.

These stringent workforce requirements aim to ensure that individuals working in Personal Care Homes are qualified, trained, and safe to provide care to vulnerable adults.

Staffing: Ensuring Adequate Support for Residents

Adequate staffing levels are crucial for resident safety and well-being. Rule 111-8-62 specifies minimum staffing ratios, but emphasizes that these are just minimums, and homes must staff according to resident needs.

• (10) Staffing: Key staffing regulations include:
  • Minimum Staff Ratios:
    • Homes < 25 beds: 1 awake staff per 15 residents (waking hours), 1 awake staff per 25 residents (non-waking hours).
    • Homes ≥ 25 beds: Average monthly minimum 1 awake staff per 15 residents (waking), 1 awake staff per 20 residents (non-waking).
    • Important: These are minimums. Homes must staff above these ratios to meet resident needs.
  • Staff Count Exclusions: Staff not involved in direct care (e.g., cooks, maintenance) and external personnel (e.g., private home care, hospice) cannot be counted in ratios.
  • 24/7 Availability: Administrator, on-site manager, or responsible staff must be on-premises 24/7, with at least one staff person per occupied floor.
  • Supervision: Residents must be supervised consistent with their needs.
  • Resident as Staff Prohibition: Residents cannot be considered staff.
  • Staffing Plans and Schedules: Homes must develop and maintain accurate staffing plans and schedules.
  • Resident Needs Fulfillment: Sufficient staff time must be provided to ensure residents receive proper care, medications, hygiene, dignity, and protection from harm.
  • Substance-Free Staff: Staff must not be under the influence of alcohol or controlled substances while working.
  • Identification Badges: Homes > 24 residents must ensure staff wear visible ID badges.

These staffing regulations are designed to ensure that Personal Care Homes have sufficient personnel to meet the diverse needs of their residents around the clock.

Home Accountability and Inspections: Ensuring Ongoing Compliance

To ensure ongoing compliance with regulations, Personal Care Homes are subject to inspections by the Department of Community Health.

• (11) Home Accountability and Inspections: Key aspects of accountability include:
  • Department Access: Homes and records must be accessible for review by Department representatives during announced and unannounced inspections.
  • Inspection Reports and Plans of Correction: Homes receive written reports of violations and must submit a written plan of correction within 10 days.
  • Disagreement with Report: Homes can submit a written statement of disagreement with the plan of correction.
  • Public Display of Reports: The most recent inspection report and plan of correction must be displayed in the home and, if applicable, on the home’s website.
  • Effectiveness Assessment: Homes must assess the effectiveness of their plan of correction and modify it as needed.
  • Licensed Residential Care Profile: Homes must maintain an accurate online profile with the Department.
  • Service Consistency: Services must align with the residential care profile, license, and rules.
  • Prohibition of “Assisted Living” Term: Personal Care Homes not licensed as Assisted Living Communities cannot use “assisted living” in their name or marketing.

These accountability measures, particularly inspections and public reporting, create transparency and incentivize ongoing compliance with regulations.

Home Design Requirements and Physical Plant Safety: Creating Safe and Accessible Environments

The physical design and safety features of a Personal Care Home are critical for resident well-being and independence. Rule 111-8-62 sets forth detailed requirements in these areas.

• (12) Home Design Requirements: Focus on:

  • Health, safety, and well-being of residents.
  • Resident independence, privacy, and dignity.
  • Safe access for residents with varying functional impairments.
  • Compliance with building and fire codes for new construction or major renovations.
  • Department approval for floor plan changes.
  • Common Areas:
    • Separate living and sleeping areas.
    • Comfortable and appropriately furnished living rooms.
    • Handrails, grab bars, and accessible doorways/corridors for mobility devices.
    • Private area for residents and visitors.
    • Calendar and clock in common area.
    • Comfortable and equipped dining area.
    • Locked storage for resident valuables.
    • Prohibition of sleeping in common areas.
    • On-site laundry facilities.
  • Bedrooms or Private Living Spaces:
    • Minimum 80 sq ft per resident (with exceptions for pre-1981 homes).
    • Maximum 4 residents per bedroom (with historical exceptions).
    • Exterior window in each bedroom.
    • Shared bedrooms allowed with resident consent.
    • Floor-to-ceiling walls for bedroom separation.
    • Bedrooms not used as pass-throughs.
    • Side-hinged doors with positive latching hardware and keys for occupant and administrator.
    • Restrictions on below-ground bedrooms.
    • Thorough cleaning after resident discharge.
  • Bathroom Facilities:
    • Minimum 1 toilet and lavatory per 4 residents; 1 bathing/shower facility per 8 residents.
    • Toilet and lavatory on each floor with bedrooms.
    • Grab bars and nonskid surfaces in showers/baths.
    • Ventilation in windowless bathrooms.
    • Privacy for toilets, bathtubs, and showers.
    • Plumbing and fixtures in good working order and sanitary.
    • At least one accessible bathroom for wheelchair/scooter users.
  • Interior Design and Construction:
    • Sturdy handrails on stairways and ramps.
    • Intact and secure floor coverings.
    • Sufficient ambient and task lighting throughout the home.

• (13) Physical Plant Health and Safety Standards: Address:

  • Compliance with fire and safety rules from the Safety Fire Commissioner and local ordinances.
  • Safe electrical outlets and lighting.
  • Safe installation of cooking appliances.
  • Restrictions on space heaters (except in emergencies with approval).
  • Fire screens and protective devices for fireplaces/heaters.
  • Smoke detectors with battery backup.
  • Fire extinguishers on each floor and basement.
  • Working doorbell/doorknocker.
  • Exterior doors with non-key exit locks.
  • Electrical service inspections before permit application and ongoing safe maintenance.
  • Water and sewage systems meeting standards.
  • Clean and repaired floors, walls, and ceilings.
  • Sanitized kitchens and bathrooms.
  • Proper bio-medical and hazardous waste disposal.
  • Solid waste management.
  • Pest control program.
  • Safe storage of poisons and dangerous materials.
  • Hot water system with temperature limits (max 120°F).
  • Hazard-free entrances, exits, sidewalks, and escape routes (including snow/ice removal).
  • Visible house number and name.
  • Maintained exterior in good repair.
  • Evacuation Requirements:
    • Ground-level or easily accessible exits for residents needing ambulation assistance.
    • Established emergency procedures and evacuation plans posted on each floor, with secondary exits in sleeping rooms.
    • Accessible exits for wheelchair/scooter users.

These design and safety regulations are paramount in creating environments that are not only comfortable but also inherently safe and accessible for all residents.

Furnishings and Fixtures: Creating a Homelike Environment

Beyond structural requirements, Rule 111-8-62 also addresses the furnishings and fixtures within a Personal Care Home to ensure a comfortable and homelike setting.

• (14) Furnishings and Fixtures: Requirements include:
  • Furnishings in living, dining, and bedrooms must be in good condition and functional.
  • Clean and orderly appearance of furnishings and housekeeping.
  • Resident Bedroom Furnishings: Must include:
    • Adequate closet or wardrobe.
    • Working lighting for reading and activities.
    • Bureau/dresser and at least one armchair per resident.
    • Grooming mirror (unless resident requests removal).
    • Individual bed (min. 36″ wide, 72″ long) with comfortable mattress.
    • Bedding (sheets, pillow, blanket, bedspread) with sufficient linen supply. No roll-aways, cots, bunks, or hide-a-beds.
  • Personalization: Residents should be allowed to personalize their bedrooms with their own furniture and pictures if desired.

These furnishing standards aim to create a residential atmosphere that promotes comfort and personalization for residents.

Admission and Admission Agreements: Ensuring Appropriate Placement and Clear Terms

The admission process and the admission agreement are crucial for setting expectations and ensuring that a Personal Care Home is the right fit for a prospective resident.

• (15) Admission: Criteria and regulations include:

  • Age: Residents must be at least 18 years old.
  • Ambulatory Residents: Historically, homes were primarily for ambulatory residents capable of self-preservation.
  • Aging in Place Exceptions: Allows up to three non-ambulatory residents under strict criteria, subject to Department revocation. Criteria include:
    • No significant change in condition making placement inappropriate.
    • Facility meeting ongoing care needs within its licensed scope.
    • Hospice services continuing (if applicable).
    • Safe evacuation within 13 minutes in fire drills.
    • Monthly fire drills covering all shifts.
    • Notification to local fire department about non-ambulatory residents.
    • Sufficient staffing for safe evacuation.
    • Substantial compliance with rules and no pending enforcement actions.
  • Prohibited Admissions/Retention: Homes cannot admit or retain individuals needing:
    • Physical or chemical restraints for behavior control.
    • Continuous medical services or nursing care.
  • Permissible Periodic/Short-Term Services: Medical, nursing, or therapeutic services needed periodically or for short-term illness must be purchased independently by the resident, not provided by the home. The home can assist in arranging these services.
  • Care Capability: Homes cannot admit or retain residents needing care beyond their permitted scope.
  • Pre-Admission Interview and Physical Exam: Administrator must interview the applicant and obtain a physical exam report (within 30 days of admission) using a Department-specified form to assess if the home can meet the applicant’s needs. Emergency admissions (from protective services, law enforcement, etc.) may proceed with a physical exam within 14 days post-admission.

• (16) Admission Agreement: A written agreement is mandatory and must include:

  • Statement of all fees and charges (including additional fee services).
  • 30-day written notice for service charge increases; 60-day notice for room and board increases.
  • Resident authorization to release medical information.
  • Provisions for ongoing needs assessment, referrals, and transfer/discharge if needed.
  • Transportation provisions for shopping, recreation, medical services, and emergency transport.
  • Refund policy (including pre-move-in, death, transfer/discharge scenarios).
  • Statement that residents cannot perform services for the home.
  • Copy of house rules (written and posted, consistent with resident rights, covering areas like tobacco/alcohol, phone use, visitors, TV/radio, pets, personal property).
  • Disclosure of policy on resident-hired proxy caregivers/sitters.
  • Disclosure of medication handling procedures (staff level, responsibility for acquisition/refills, packaging requirements).
  • Explanation of discharge/transfer procedures.
  • Explanation of social media/photo policies.
  • Opportunity for resident (and representative) to read the agreement before signing. Special communication steps for residents unable to read.
  • Signed copies for resident, representative, and home records.

The admission and agreement regulations ensure that residents are appropriately placed in Personal Care Homes and that the terms of residency are clearly understood and agreed upon upfront.

Services Provided: Meeting Resident Needs and Promoting Well-being

Rule 111-8-62 outlines the services that Personal Care Homes are expected to provide to support residents’ physical, mental, and social well-being.

• (17) Services: Regulations mandate:
  • Personal assistance for residents unable to maintain neatness and cleanliness.
  • Sufficient activities to promote physical, mental, and social well-being.
  • Provision of books, newspapers, and games.
  • Encouragement and assistance with hobbies, arts, religion, social, recreational, and cultural activities.
  • Operable, non-pay telephone accessible for staff emergencies.
  • Resident access to a private, non-pay telephone for personal calls.
  • Daily routines allowing residents to spend non-sleeping hours outside their bedrooms if they choose.
  • Unrestricted resident access to common areas (except in memory care centers, where access is within the center).
  • Prohibition of locking residents in or out of their bedrooms.
  • Resident Needs Assessment: Must be completed at admission and updated as needed, addressing: family supports, ADL function, physical care needs, medical information, cognitive/behavioral impairments, and care preferences.
  • Written Care Plan: Required for homes providing proxy caregivers or memory care, developed within 14 days of admission and used as a guide for care. Care plans must include:
    • Description of care and social needs and services to be provided (frequency).
    • Resident preferences.
    • Specific behaviors and interventions.
    • Physician orders for assistive devices.
    • Staff responsible for plan implementation.
    • Evidence of resident/family involvement.
    • Annual updates (or more frequent if needs change).

These service requirements emphasize a holistic approach to resident care, encompassing not just basic needs but also social, emotional, and recreational aspects of well-being.

Precautions for Residents at Risk of Elopement and Memory Care Centers: Specialized Care Considerations

Rule 111-8-62 addresses specific concerns related to residents with cognitive impairments, particularly the risk of elopement (wandering away) and the specialized care provided in Memory Care Centers.

• (18) Precautions for Residents at Risk of Elopement: Homes serving residents at risk of elopement must:

  • Develop, train staff on, and enforce policies/procedures for dealing with elopement, including actions to take if a resident wanders away.
  • Utilize effective safety devices (not impeding mobility or violating fire safety) to prevent elopement. This may include:
    • Electronic locks on exit doors (with fire alarm/power failure release, routine bypass).
    • Keypads for exits (with posted operating instructions). Non-electronic keyed locks and doors with keyed locks between residents and exits are prohibited.
  • Maintain current pictures of residents at risk of elopement.

• (19) Additional Requirements for Certified Memory Care Centers: Homes providing specialized memory care must meet additional requirements, including:

  • Written Description: Must develop and disclose a detailed written description of the memory care center, covering:
    • Philosophy and mission
    • Service differences from the rest of the home
    • Staffing (titles, training)
    • Admission procedures (screening)
    • Assessment and service planning
    • Staffing patterns
    • Physical environment (safety/security)
    • Activities (frequency, type, dementia-specific)
    • Fees
    • Discharge criteria
    • Emergency procedures
    • Family involvement
  • Disclosure of Description: Must be provided to anyone upon request and to families/representatives before admission.
  • Physical Design, Environment, and Safety: Memory care centers must be designed to accommodate residents with dementia in a homelike environment with:
    • Multipurpose rooms for dining/activities.
    • Secured outdoor spaces and walkways.
    • High visual contrasts (except for fire exits).
    • Adequate and even lighting.
    • Free resident movement within the center.
    • Individually identified room entrances.
    • Automated alert system for unauthorized exits (or staffed exits with logs).
    • Communication systems for staff and emergency services.
    • Compliance with building and fire codes for new construction/renovations.
  • Staffing Requirements: Sufficient specially trained staff at all times, including:
    • 1 dementia-trained direct care staff per 12 residents (waking), 1 per 15 (non-waking) monthly average (minimum, must be adequate for resident needs).
    • 1 RN, LPN, or CMA on-site at all times.
    • 2 direct care staff on-site at all times (at least one per occupied floor).
    • RN or LPN on-site or available in the building for specified hours per week based on center size.
  • Staff Training Requirements:
    • General Orientation: All staff receive 4 hours dementia-specific orientation within 30 days (nature of dementia, minimizing challenging behavior, safety risks, communication).
    • Direct Care Orientation: Within 30 days of independent care, includes:
      • General training: service plans, recognizing changes, resident rights, infection control, emergency preparedness, first aid, CPR.
      • 16 hours specialized, competency-based dementia training using Department forms: nature of dementia, center philosophy/policies, behavior problems, therapeutic interventions, safety, family role.
    • Ongoing Training: Direct care staff complete 8 hours annual specialized dementia training.
    • Hospice Training for CMAs Administering Morphine: Specific training from a licensed hospice.
    • Training Documentation: Maintained records of course content, instructors, agendas, attendance.
  • Special Admission Requirements for Memory Care Placement:
    • Physical exam report (within 30 days) showing probable Alzheimer’s/dementia diagnosis and symptoms needing center placement.
    • May admit companions without dementia diagnosis.
    • Physical exam must confirm resident does not need 24-hour skilled nursing care.
  • Post-Admission Assessment: Assess resident’s family supports, ADL function, physical care needs, and behavior impairment.
  • Individual Service Plans: Developed within 14 days of admission by a team (including direct care staff from each shift), signed by team members, shared with staff, and used as a care guide. Plans must include: care/social needs, preferences, behaviors/interventions, responsible staff, family involvement, and quarterly (or more frequent) updates.
  • Therapeutic Activities: Weekly (some daily) therapeutic activities appropriate for dementia residents, adapted for participation, including: gross motor, self-care, social, and sensory enhancement activities.
  • Restriction on Specialized Care Claims Without Certification: Homes cannot claim to provide specialized dementia care or charge differential rates without meeting these Memory Care Center requirements.

These specialized regulations for elopement risk and Memory Care Centers reflect the unique needs and vulnerabilities of residents with cognitive impairments, ensuring focused safety measures and specialized care programs.

Medications, Nutrition, and Temperature Conditions: Essential Aspects of Resident Well-being

Rule 111-8-62 addresses critical aspects of daily life in Personal Care Homes: medication management, nutrition, and environmental comfort.

• (20) Medications: Regulations cover:

  • Self-Administration: Residents capable of safe self-administration must be allowed to store and self-administer medications securely.
  • Assistance with Self-Administration: Staff can assist capable residents with tasks like bringing medication, reading labels, opening containers, placing oral doses in hand, applying topicals, and assisting with inhalers, drops, sprays, and EPI pens (with protocol and emergency call procedures for EPI pen use).
  • Staff Proficiency for Assistance: Staff assisting with self-administration must be proficient in English and able to follow written instructions.
  • Basic Medication Training for Staff: Homes must provide and document medication training for staff assisting with self-administration, covering: medication policies, label reading, “5 rights” of medication administration, actions for medication concerns, infection control, storage/disposal, side effects, medication classifications, and documentation.
  • Medication Skills Competency Determinations: Annual competency checks for staff assisting with self-administration.
  • Memory Care Medication Administration: Medications in memory care centers must be administered by proxy caregivers, RNs, LPNs, or CMAs.
  • Certified Medication Aide (CMA) Requirements: Homes using CMAs must:
    • Check the Georgia CMA Registry for good standing.
    • Administer skills competency checks upon hiring (for aides certified > 1 year).
    • Conduct quarterly random medication administration observations by RNs/pharmacists.
    • Secure quarterly drug regimen reviews by a licensed pharmacist.
    • Authorized CMA Tasks (unit/multi-dose packaging only): Oral, feeding tube, ophthalmic, topical, otic, nasal, vaginal, rectal medications; insulin, epinephrine, B12; inhalers; blood glucose testing; enemas; assisting self-administration; liquid morphine (hospice patients).
    • Annual competency reviews for CMAs.
    • Proper notice of separation for cause to CMAs.
    • Registry notification for terminations for cause related to medication aide tasks.
  • Homes Conducting CMA Training: Must use state-approved program, ensure training by RN/pharmacist/physician, require skills demonstration, prepare aides for written exam, verify CNA registry status, provide exam information, submit documentation to CMA registry, and not allow independent medication administration until CMA registry listing.
  • Maintaining Medication Records (MAR): Daily MARs required for residents receiving assistance or administration, including: resident info, allergies, provider info, medication details, administration chart (initials, time, date, refusals, errors). MARs must be updated with each medication offering/intake. Medication information (description, dosing, side effects) must be readily available. Unusual reactions must be documented and reported. Timely refills are required. MAR updates for new medications within 48 hours (sooner if immediate change is needed). Liquid morphine administration documentation requirements.
  • Orders for All Medications: Physician/NP/PA orders or prescription bottles required for all medications (including OTC).
  • Timely Medication Procurement: New prescriptions within 48 hours (sooner if immediate).
  • Storage of Medications:
    • Secure storage (locked) at all times, including controlled substances (locked cabinet and daily inventory log).
    • Resident-kept medications can be in locked containers in bedrooms (duplicate keys for resident and administrator).
    • Original containers with labels intact required.
    • OTC stock medications allowed for PRN orders. Daily OTC medications (prescribed) require individual bottles.
    • Proper disposal of unused/expired medications.
    • Liquid morphine supply limit (50ml per hospice patient).

• (21) Nutrition: Regulations mandate:

  • Minimum 3 regularly scheduled, well-balanced meals daily, 7 days a week, with no more than 14 hours between evening and morning meals. Meals must meet nutritional guidelines (Recommended Daily Diet Allowances) and be of sufficient quantity, proper form, consistency, and temperature. Nutritious snacks mid-afternoon and evening.
  • Food from satisfactory sources, clean, wholesome, unspoiled, unadulterated, and safe for consumption.
  • Properly Furnished Food Areas: Equipped kitchen with storage for utensils, kept clean and disinfected daily. Catered meals allowed from permitted food service establishments.
  • Handling of Food: Safe food handling practices: proper storage of perishables (≤ 41°F), proper thawing, hot/cold running water and sanitizers, cross-contamination prevention, hot food serving temp (≥ 140°F), cold food serving temp (≤ 41°F).
  • Food service permit required for homes ≥ 25 residents (or caterer permit).
  • Catered Food Service Requirements: Licensed caterer, meals meeting rules, satisfactory food safety record, proper transport and storage.
  • 3-day supply of non-perishable food and water for emergencies (rotated for freshness).
  • Menus written and posted 24 hours in advance, substitutions noted, alternatives for resident preferences.
  • Menu records maintained for 30 days.
  • Designated person responsible for meal preparation must enforce safe food handling practices.
  • Special therapeutic diets arranged as prescribed.

• (22) Temperature Conditions: Homes must maintain comfortable and healthy temperatures:

  • Adequate heating and cooling systems to maintain temperatures consistent with resident health needs and comfort.
  • Temperatures not below 68°F during waking hours, 62°F during sleeping hours. Mechanical cooling for areas exceeding 80°F; no resident area exceeding 85°F.
  • Emergency action for power outages or mechanical failures impacting temperature, including service calls, blankets/fans, or emergency power generators.

These regulations concerning medications, nutrition, and temperature are fundamental to ensuring the daily comfort, health, and safety of Personal Care Home residents.

Infection Control, Sanitation, and Resident Files: Maintaining Health, Hygiene, and Confidentiality

Rule 111-8-62 includes regulations focused on maintaining a clean and healthy environment and ensuring proper management of resident information.

• (23) Infection Control, Sanitation and Supplies: Homes must:

  • Maintain a supply of first-aid materials.
  • Provide hand-sanitizing agents or soap/water, clean towels, and toilet tissue at sinks/commodes.
  • Provide hot/cold water, soap, and towels at kitchen and bathroom handwashing facilities.
  • Have an effective infection control program, including:
    • Staff training on infection control and foodborne illness prevention.
    • Appropriate response to disease outbreaks and participation in investigations.
    • Staff demonstration of proper infection control practices.
    • Enforced work/return-to-work policies to minimize infection spread.
    • Public health notices regarding outbreaks/infestations to residents, staff, and visitors (homes ≥ 25 beds follow disaster preparedness rules for notification).
  • Maintain adequate supplies of sanitizing/cleaning agents, properly stored and used.
  • Thoroughly clean and sanitize resident bedrooms after move-out.
  • Periodically and as needed clean resident bedrooms to prevent health hazards.
  • Homes ≥ 25 beds must follow additional infection control requirements in disaster preparedness rules regarding pandemic plans, supplies, policies.

• (24) Resident Files: Detailed regulations for maintaining resident files:

  • Individual files for each resident, maintained by the administrator.
  • Confidentiality of personal information, disclosed only to resident, representative/legal surrogate, authorized Department agents, and others with written authorization.
  • Resident files must be available for inspection/copy by Department, resident, or representative/legal surrogate upon request.
  • Required File Contents:
    • Identifying information (name, SSN, age, sex, address, veteran status).
    • Next of kin, legal guardian/representative, representative payee contact information and documentation.
    • Contact information for agencies providing additional services (caseworker/case manager).
    • Admission and discharge log.
    • Physician, hospital, and pharmacy of resident’s choice.
    • Record of monetary transactions with itemized receipts.
    • Record of valuables entrusted to the home.
    • Health information (appraisals, diagnoses, diets, medications, physician instructions).
    • Inventory of personal items brought to the home.
    • Signed copy of Resident’s Rights form.
    • Signed copy of admission agreement.
    • Power of attorney or financial management documents.
    • Advance directive for health care (living will/POA) and POLST (if any).
    • Resident’s written waiver of personal needs allowance charge (if applicable).
    • Signed medical orders impacting end-of-life care (DNR, POLST).
    • Individual written care plans.
    • Informed consents for proxy caregiver health maintenance activities.
    • Sex offender registry search results and safety plan.
  • Optional File Contents (voluntary):
    • Spiritual preference information.
    • Insurance policies and funeral/burial prearrangements.
  • Resident files must be maintained for 3 years post-discharge.

These regulations ensure a focus on hygiene, sanitation, and infection control within Personal Care Homes, while also safeguarding resident privacy and ensuring proper documentation and record-keeping.

Resident Rights, Change in Condition, Death, and Transfer/Discharge Procedures: Protecting Resident Autonomy and Dignity

Rule 111-8-62 places a strong emphasis on protecting resident rights and outlines procedures for various significant events in a resident’s stay.

• (25) Supporting Residents’ Rights: Homes must operate in a manner that:

  • Respects resident dignity and human rights (which cannot be waived).
  • Provides adequate, appropriate care and services compliant with laws and regulations.
  • Prohibits punishment or harassment for residents enforcing their rights.
  • Resident Rights include:
    • Exercising constitutional rights.
    • Choosing activities and schedules.
    • Interacting with the community.
    • Making choices about life in the home.
    • Privacy in their room (staff knock before entering).
    • Free and private association and communication.
    • Treatment with dignity, kindness, respect, and privacy in personal care.
    • Freedom of religious practice.
    • Freedom from abuse, neglect, exploitation, restraints, isolation, and interference with daily functions.
    • Control over personal property (with safety exceptions) and safeguards for property.
    • Unopened mail delivery and private outgoing correspondence.
    • Access to a telephone and private phone at resident’s expense.
    • Immediate access for visitors (with resident consent) and right to refuse/terminate visits.
    • Managing personal finances and freedom from coercion to transfer assets (except for service payments).
    • Personal needs allowance ($20/week unless waived).
    • Right to receive or reject medical care (except as legally required).
    • Choosing and retaining a personal physician and other healthcare professionals, right to information about diagnosis/treatment, and access to medical records.
    • Participation in care planning, confidential case discussions.
    • Right to inspect and copy records.
    • Voluntary discharge/transfer (unless committed or with representative authority).
    • Access to the State Long-Term Care Ombudsman Program (contact info posted).
    • Right to form a Resident Council.
    • Right to file complaints with the Department (contact info posted).
  • Resident’s Bill of Rights: Must be provided at admission (communicated if resident cannot read).
  • Compliance with “Remedies for Residents of Personal Care Homes Act.”

• (26) Procedures for Change in Resident Condition: Homes must:

  • Take appropriate actions for accidents or sudden adverse changes, including notifying representative/legal surrogate and documenting incidents and responses.
  • For cardiac/respiratory arrest: follow hospice plan (if applicable), DNR orders, advance directives, or initiate CPR and call emergency services if no DNR or advance directive and not clearly futile.
  • Staff must have ready access to emergency phone numbers and resident emergency information.
  • Immediate investigation of accidents/injuries, reports to representative/legal surrogate, and quality assurance review.
  • Department may request current physical exam if significant condition change to verify continued eligibility for retention.

• (27) Death of a Resident: In case of resident death:

  • Administrator must immediately notify physician, next of kin, and representative/legal surrogate. Follow statutes for reporting sudden/unexpected death.
  • Refund security deposit to representative/legal surrogate as per Georgia law.

• (28) Immediate Transfer of Residents: Immediate transfer is required if:

  • Resident develops condition needing continuous medical/nursing care.
  • Resident’s behavior/condition directly threatens health/safety of resident or others.
  • Administrator must advise resident and representative/legal surrogate and case manager and arrange immediate transfer as per admission agreement. Document reasons for transfer.
  • Prior to immediate transfer, administrator must:
    • Inform resident and representative/legal surrogate of reason.
    • Inquire about transfer facility preferences.
    • Inform of chosen transfer facility.
    • Provide resident file to receiving facility within 24 hours.
    • Document reason, notification, and transfer destination in resident file.
  • Refund security deposit upon immediate transfer.

• (29) Discharge or Transfer of Residents: For non-immediate discharges/transfers:

  • Administrator must contact representative/legal surrogate.
  • Provide 30-day written notice of discharge/transfer (except immediate transfers).
  • For residents whose needs cannot be met or who choose to leave, discharge/transfer as per admission agreement. For residents incapable of informed decisions without representative action, petition probate court for discharge/transfer order. Provide resident file to receiving facility.
  • Department may require discharge if resident needs continuous medical/nursing care (periodic/short-term services from outside providers are permissible).
  • Refund security deposit upon discharge/transfer.

These regulations prioritize resident rights, autonomy, and dignity, while also establishing clear procedures for managing significant life events and transitions within the Personal Care Home setting.

Reporting, Deemed Status, Variance/Waiver, and Enforcement: Ensuring Accountability and Flexibility

The final sections of Rule 111-8-62 address reporting requirements, alternative compliance pathways, flexibility mechanisms, and enforcement measures.

• (30) Reporting: Personal Care Homes are mandated to report specific events:

  • Elopement (Mattie’s Call): Report resident elopement to local police within 30 minutes of knowledge, and report Mattie’s Call initiation/discontinuation to the Department within 30 minutes of police communication.
  • Serious Incidents (within 24 hours): Report using the Department’s complaint intake system:
    • Accidental or unanticipated resident death (not natural course of illness).
    • Serious resident injury requiring medical treatment.
    • Rape, assault, battery, abuse, neglect, or exploitation of a resident.
    • External disaster or emergency affecting safe operation.
    • Governing body/staff association with resident/former resident finances or assets (gifts).
    • Owner/director/employee criminal record acquisition.
  • Incident Report Content: Confidential peer review report to the Department must include: home name, administrator name, incident date, date home became aware, type of incident/brief description, and remedial/quality measures taken.
  • Department may initiate complaint investigation if rule violation is suspected based on incident report. Complaint investigation reports are subject to public disclosure.

• (31) Deemed Status: The Department may grant “deemed status” to homes certified or accredited by approved bodies if their standards are substantially equivalent to Rule 111-8-62. Deemed status does not prohibit Department inspections for compliance.

• (32) Variance and Waiver: The Department has discretion to grant variances and waivers of specific rules upon application:

  • Variance: May be granted if strict rule application causes undue hardship, and alternative standards provide adequate resident protection.
  • Waiver: May be granted to dispense with a rule entirely if its purpose is met through equivalent standards.
  • Experimental Variance/Waiver: May be granted for innovative service delivery approaches that maintain resident protection and potentially improve service.
  • Homes can request final review of initial decisions from the division chief.
  • Subsequent applications for denied variances/waivers require new evidence of substantial change in circumstances.

• (33) Enforcement and Penalties: Non-compliance with licensing requirements (Rule 111-8-62, Proxy Caregiver Rules, General Licensing Rules) subjects homes to civil and administrative actions by the Department as per law and rules, following the Georgia Administrative Procedures Act.

• (34) Severability: If any part of Rule 111-8-62 is deemed invalid, the remaining rules remain in effect.

These final regulations provide mechanisms for accountability, flexibility, and continuous improvement within the Personal Care Home system in Georgia.

Conclusion: Georgia’s Commitment to Quality Personal Care

While Georgia may not have a program explicitly named “Personal Care Program,” Rule 111-8-62 and the regulatory framework it establishes effectively serve as the state’s comprehensive approach to personal care. Through detailed regulations, licensing, inspections, and a focus on resident rights, Georgia ensures a baseline of quality and safety in Personal Care Homes. For individuals seeking personal care or those operating these essential facilities, understanding these regulations is paramount.

For complete and up-to-date information, it is essential to consult the official document, Rule 111-8-62 of the Georgia Department of Community Health, and to contact the Department directly with any specific questions or concerns. This article provides a detailed overview, but the official rule is the ultimate authority on the regulations governing Personal Care Homes in Georgia.

(Please note: This article is for informational purposes only and should not be considered legal advice. Always consult the official Rule 111-8-62 and legal professionals for specific guidance.)