231B.1 DEFINITIONS.
1. "Department" means the department of inspections and
appeals or the department's designee.
2. "Elder" means a person sixty years of age or older.
3. "Elder group home" means a single-family residence that is
operated by a person who is providing room, board, and personal care
and may provide health-related services to three through five elders
who are not related to the person providing the service within the
third degree of consanguinity or affinity, and which is staffed by an
on-site manager twenty-four hours per day, seven days per week.
4. "Governmental unit" means the state, or any county,
municipality, or other political subdivision or any department,
division, board, or other agency of any of these entities.
5. "Health-related care" means services provided by a
registered nurse or a licensed practical nurse, on a part-time or
intermittent basis, and services provided by other licensed health
care professionals, on a part-time or intermittent basis.
6. "Medication setup" means assistance with various steps of
medication administration to support a tenant's autonomy, which may
include but is not limited to routine prompting, cueing and
reminding, opening containers or packaging at the direction of the
tenant, reading instructions or other label information, or
transferring medications from the original container into suitable
medication dispensing containers, reminder containers, or medication
cups.
7. "Occupancy agreement" means a written agreement entered
into between an elder group home and a tenant that clearly describes
the rights and responsibilities of the elder group home and the
tenant, and other information required by rule. "Occupancy
agreement" may include a separate signed lease and signed service
agreement.
8. "Personal care" means assistance with the essential
activities of daily living which may include but are not limited to
transferring, bathing, personal hygiene, dressing, grooming, and
housekeeping that are essential to the health and welfare of a
tenant.
9. "Tenant" means an individual who receives elder group home
services through a certified elder group home.
10. "Tenant advocate" means the office of the long-term care
resident's advocate established in section 231.42.
11. "Tenant's legal representative" means a person appointed
by the court to act on behalf of a tenant, or a person acting
pursuant to a power of attorney. Section History: Recent Form
93 Acts, ch 72, § 2; 2003 Acts, ch 166, §3; 2005 Acts, ch 62, §1;
2007 Acts, ch 215, §135
Referred to in § 142D.2, 144C.2, 231.44, 235E.1
231B.1A FINDINGS -- PURPOSE.
1. The general assembly finds that elder group homes are an
important part of the long-term care continua in this state. Elder
group homes emphasize the independence and dignity of the individual
while providing housing in a cost-effective manner.
2. The purposes of establishing and regulating elder group homes
include all of the following:
a. To encourage the establishment and maintenance of a safe
and homelike environment for individuals of all income levels who
require assistance with personal care to live independently but who
require health-related care only on a part-time or intermittent
basis.
b. To establish standards for elder group homes that allow
flexibility in design, which promotes a model of service delivery by
focusing on individual independence, needs and desires, and
consumer-driven quality of service.
c. To encourage public participation in the development of
elder group home programs for individuals of all income levels. Section History: Recent Form
2005 Acts, ch 62, §2; 2007 Acts, ch 215, §136
231B.2 CERTIFICATION OF ELDER GROUP HOMES -- RULES.
1. The department shall establish by rule, in accordance with
chapter 17A, minimum standards for certification and monitoring of
elder group homes. The department may adopt by reference, with or
without amendment, nationally recognized standards and rules for
elder group homes. The standards and rules shall be formulated in
consultation with affected state agencies and affected industry,
professional, and consumer groups; shall be designed to accomplish
the purposes of this chapter; and shall include but not be limited to
rules relating to all of the following:
a. Provisions to ensure, to the greatest extent possible, the
health, safety, well-being, and appropriate treatment of tenants.
b. Requirements that elder group homes furnish the department
with specified information necessary to administer this chapter. All
information related to the provider application for an elder group
home presented to the department shall be considered a public record
pursuant to chapter 22.
c. Standards for tenant evaluation or assessment, which may
vary in accordance with the nature of the services provided or the
status of the tenant.
d. Provisions for granting short-term waivers for tenants who
exceed occupancy criteria.
2. Each elder group home operating in this state shall be
certified by the department.
3. The owner or manager of a certified elder group home shall
comply with the rules adopted by the department for an elder group
home. A person, including a governmental unit, shall not represent
an elder group home to the public as an elder group home or as a
certified elder group home unless and until the program is certified
pursuant to this chapter.
4. a. Services provided by a certified elder group home may
be provided directly by staff of the elder group home, by individuals
contracting with the elder group home to provide services, or by
individuals employed by the tenant or with whom the tenant contracts
if the tenant agrees to assume the responsibility and risk of the
employment or the contractual relationship.
b. If a tenant is terminally ill and has elected to receive
hospice services under the federal Medicare program from a
Medicare-certified hospice program, the elder group home and the
Medicare-certified hospice program shall enter into a written
agreement under which the hospice program retains professional
management responsibility for those services.
5. The department may enter into contracts to provide
certification and monitoring of elder group homes. The department
shall:
a. Have full access at reasonable times to all records,
materials, and common areas pertaining to the provision of services
and care to the tenants of a program during certification,
monitoring, and complaint investigations of programs seeking
certification, currently certified, or alleged to be uncertified.
b. With the consent of the tenant, visit the tenant's unit.
6. A department, agency, or officer of this state or of any
governmental unit shall not pay or approve for payment from public
funds any amount to an elder group home for an actual or prospective
tenant, unless the program holds a current certificate issued by the
department and meets all current requirements for certification.
7. The department shall adopt rules regarding the conducting or
operating of another business or activity in the distinct part of the
physical structure in which the elder group home is operated, if the
business or activity serves persons who are not tenants. The rules
shall be developed in consultation with affected state agencies and
affected industry, professional, and consumer groups.
8. An elder group home shall comply with section 135C.33.
9. The department shall conduct training sessions for personnel
responsible for conducting monitoring evaluations and complaint
investigations of elder group homes.
10. Certification shall be for two years unless revoked for good
cause by the department. Section History: Recent Form
93 Acts, ch 72, § 3; 99 Acts, ch 129, §16; 2003 Acts, ch 166, §4,
5; 2005 Acts, ch 62, §3; 2006 Acts, ch 1010, §70; 2007 Acts, ch 215,
§137--141
231B.3 REFERRAL TO UNCERTIFIED ELDER GROUP HOME
PROHIBITED.
1. A person shall not place, refer, or recommend the placement of
another person in an elder group home that is not certified pursuant
to this chapter.
2. A person who has knowledge that an elder group home is
operating without certification shall report the name and address of
the home to the department. The department shall investigate a
report made pursuant to this section. Section History: Recent Form
93 Acts, ch 72, §4; 2003 Acts, ch 166, §6; 2007 Acts, ch 215, §142
231B.4 ZONING -- FIRE AND SAFETY STANDARDS.
An elder group home shall be located in an area zoned for
single-family or multiple-family housing or in an unincorporated area
and shall be constructed in compliance with applicable local housing
codes and the rules adopted for the special classification by the
state fire marshal. In the absence of local building codes, the
facility shall comply with the state plumbing code established
pursuant to section 135.11 and the state building code established
pursuant to section 103A.7 and the rules adopted for the special
classification by the state fire marshal. The rules adopted for the
special classification by the state fire marshal regarding second
floor occupancy shall be adopted in consultation with the department
and shall take into consideration the mobility of the tenants. Section History: Recent Form
93 Acts, ch 72, § 5; 2005 Acts, ch 62, §4; 2007 Acts, ch 215, §143
Referred to in § 335.33, 414.31
231B.5 WRITTEN OCCUPANCY AGREEMENT REQUIRED.
1. An elder group home shall not operate in this state unless a
written occupancy agreement, as prescribed in subsection 2, is
executed between the elder group home and each tenant or the tenant's
legal representative prior to the tenant's occupancy, and unless the
elder group home operates in accordance with the terms of the
occupancy agreement. The elder group home shall deliver to the
tenant or the tenant's legal representative a complete copy of the
occupancy agreement and all supporting documents and attachments and
shall deliver, at least thirty days prior to any changes, a written
copy of changes to the occupancy agreement if any changes to the copy
originally delivered are subsequently made, unless otherwise provided
in this section.
2. An elder group home occupancy agreement shall clearly describe
the rights and responsibilities of the tenant and the elder group
home. The occupancy agreement shall also include but is not limited
to inclusion of all of the following information in the body of the
agreement or in the supporting documents and attachments:
a. A description of all fees, charges, and rates describing
tenancy and basic services covered, and any additional and optional
services and their related costs.
b. A statement regarding the impact of the fee structure on
third-party payments, and whether third-party payments and resources
are accepted by the elder group home.
c. The procedure followed for nonpayment of fees.
d. Identification of the party responsible for payment of
fees and identification of the tenant's legal representative, if any.
e. The term of the occupancy agreement.
f. A statement that the elder group home shall notify the
tenant or the tenant's legal representative, as applicable, in
writing at least thirty days prior to any change being made in the
occupancy agreement with the following exceptions:
(1) When the tenant's health status or behavior constitutes a
substantial threat to the health or safety of the tenant, other
tenants, or others, including when the tenant refuses to consent to
relocation.
(2) When an emergency or a significant change in the tenant's
condition results in the need for the provision of services that
exceed the type or level of services included in the occupancy
agreement and the necessary services cannot be safely provided by the
elder group home.
g. A statement that all tenant information shall be
maintained in a confidential manner to the extent required under
state and federal law.
h. Occupancy, involuntary transfer, and transfer criteria and
procedures, which ensure a safe and orderly transfer.
i. The internal appeals process provided relative to an
involuntary transfer.
j. The program's policies and procedures for addressing
grievances between the elder group home and the tenants, including
grievances relating to transfer and occupancy.
k. A statement of the prohibition against retaliation as
prescribed in section 231B.13.
l. The emergency response policy.
m. The staffing policy which specifies if nurse delegation
will be used, and how staffing will be adapted to meet changing
tenant needs.
n. The refund policy.
o. A statement regarding billing and payment procedures.
3. Occupancy agreements and related documents executed by each
tenant or tenant's legal representative shall be maintained by the
elder group home from the date of execution until three years from
the date the occupancy agreement is terminated. A copy of the most
current occupancy agreement shall be provided to members of the
general public, upon request. Occupancy agreements and related
documents shall be made available for on-site inspection to the
department upon request and at reasonable times. Section History: Recent Form
2005 Acts, ch 62, §5; 2007 Acts, ch 215, §144
231B.6 INVOLUNTARY TRANSFER.
1. If an elder group home initiates the involuntary transfer of a
tenant and the action is not a result of a monitoring evaluation or
complaint investigation by the department, and if the tenant or
tenant's legal representative contests the transfer, the following
procedure shall apply:
a. The elder group home shall notify the tenant or tenant's
legal representative, in accordance with the occupancy agreement, of
the need to transfer, the reason for the transfer, and the contact
information of the tenant advocate.
b. The elder group home shall provide the tenant advocate
with a copy of the notification to the tenant.
c. The tenant advocate shall offer the notified tenant or
tenant's legal representative assistance with the program's internal
appeals process. The tenant is not required to accept the assistance
of the tenant advocate.
d. If, following the internal appeals process, the elder
group home upholds the transfer decision, the tenant or the tenant's
legal representative may utilize other remedies authorized by law to
contest the transfer.
2. The department, in consultation with affected state agencies
and affected industry, professional, and consumer groups, shall
establish by rule, in accordance with chapter 17A, procedures to be
followed, including the opportunity for hearing, when the transfer of
a tenant results from a monitoring evaluation or complaint
investigation conducted by the department. Section History: Recent Form
2005 Acts, ch 62, §6; 2007 Acts, ch 215, §145, 146
231B.7 COMPLAINTS.
1. Any person with concerns regarding the operations or service
delivery of an elder group home may file a complaint with the
department. The name of the person who files a complaint with the
department and any personal identifying information of the person or
any tenant identified in the complaint shall be kept confidential and
shall not be subject to discovery, subpoena, or other means of legal
compulsion for its release to a person other than department
employees involved with the complaint.
2. The department shall establish procedures for the disposition
of complaints received in accordance with this section. Section History: Recent Form
2005 Acts, ch 62, §7; 2007 Acts, ch 215, §147
231B.8 INFORMAL REVIEW.
1. If an elder group home contests the findings of regulatory
insufficiencies of a monitoring evaluation or complaint
investigation, the program shall submit written information,
demonstrating that the program was in compliance with the applicable
requirement at the time of the monitoring evaluation or complaint
investigation of the regulatory insufficiencies, to the department
for review.
2. The department shall review the written information submitted
within ten working days of the receipt of the information. At the
conclusion of the review, the department may affirm, modify, or
dismiss the regulatory insufficiencies. The department shall notify
the program in writing of the decision to affirm, modify, or dismiss
the regulatory insufficiencies, and the reasons for the decision.
3. In the case of a complaint investigation, the department shall
also notify the complainant, if known, of the decision and the
reasons for the decision. Section History: Recent Form
2005 Acts, ch 62, §8; 2007 Acts, ch 215, §148
231B.9 PUBLIC DISCLOSURE OF FINDINGS.
Upon completion of a monitoring evaluation or complaint
investigation of an elder group home by the department pursuant to
this chapter, including the conclusion of informal review, the
department's final findings with respect to compliance by the elder
group home with requirements for certification shall be made
available to the public in a readily available form and place. Other
information relating to an elder group home that is obtained by the
department which does not constitute the department's final findings
from a monitoring evaluation or complaint investigation of the elder
group home shall not be made available to the public except in
proceedings involving the denial, suspension, or revocation of a
certificate under this chapter. Section History: Recent Form
2005 Acts, ch 62, §9; 2007 Acts, ch 215, §149; 2008 Acts, ch 1048,
§1, 4
231B.10 DENIAL, SUSPENSION, OR REVOCATION --
CONDITIONAL OPERATION.
1. The department may deny, suspend, or revoke a certificate in
any case where the department finds that there has been a substantial
or repeated failure on the part of the elder group home to comply
with this chapter or minimum standards adopted under this chapter or
for any of the following reasons:
a. Appropriation or conversion of the property of an elder
group home tenant without the tenant's written consent or the written
consent of the tenant's legal representative.
b. Permitting, aiding, or abetting the commission of any
illegal act in the elder group home.
c. Obtaining or attempting to obtain or retain a certificate
by fraudulent means, misrepresentation, or by submitting false
information.
d. Habitual intoxication or addiction to the use of drugs by
the applicant, administrator, executive director, manager, or
supervisor of the elder group home.
e. Securing the devise or bequest of the property of a tenant
of an elder group home by undue influence.
f. Founded dependent adult abuse as defined in section
235B.2.
g. In the case of any officer, member of the board of
directors, trustee, or designated manager of the elder group home or
any stockholder, partner, or individual who has greater than a five
percent equity interest in the elder group home, having or having had
an ownership interest in an elder group home, assisted living or
adult day services program, home health agency, residential care
facility, or licensed nursing facility in this or any state which has
been closed due to removal of program, agency, or facility licensure
or certification or involuntary termination from participation in
either the medical assistance or Medicare programs, or having been
found to have failed to provide adequate protection or services for
tenants to prevent abuse or neglect.
h. In the case of a certificate applicant or an existing
certified owner or operator who is an entity other than an
individual, the person is in a position of control or is an officer
of the entity and engages in any act or omission proscribed by this
chapter.
i. For any other reason as provided by law or administrative
rule.
2. The department may as an alternative to denial, suspension, or
revocation conditionally issue or continue a certificate dependent
upon the performance by the elder group home of reasonable conditions
within a reasonable period of time as set by the department so as to
permit the program to commence or continue the operation of the elder
group home pending full compliance with this chapter or the rules
adopted pursuant to this chapter. If the elder group home does not
make diligent efforts to comply with the conditions prescribed, the
department may, under the proceedings prescribed by this chapter,
deny, suspend, or revoke the certificate. An elder group home shall
not be operated on a conditional certificate for more than one year.
Section History: Recent Form
2005 Acts, ch 62, §10; 2006 Acts, ch 1030, §23; 2007 Acts, ch 215,
§150, 151
231B.11 NOTICE -- APPEAL -- EMERGENCY PROVISIONS.
1. The denial, suspension, or revocation of a certificate shall
be effected by delivering to the applicant or certificate holder by
restricted certified mail or by personal service a notice setting
forth the particular reasons for such action. Such denial,
suspension, or revocation shall become effective thirty days after
the mailing or service of the notice, unless the applicant or
certificate holder, within such thirty-day period, requests a
hearing, in writing, of the department, in which case the notice
shall be deemed to be suspended.
2. The denial, suspension, or revocation of a certificate may be
appealed in accordance with rules adopted by the department in
accordance with chapter 17A.
3. When the department finds that an imminent danger to the
health or safety of a tenant of an elder group home exists which
requires action on an emergency basis, the department may direct
removal of all tenants of the elder group home and suspend the
certificate prior to a hearing. Section History: Recent Form
2005 Acts, ch 62, §11; 2007 Acts, ch 215, §152
231B.12 DEPARTMENT NOTIFIED OF CASUALTIES.
The department shall be notified within twenty-four hours, by the
most expeditious means available, of any accident causing substantial
injury or death to a tenant, and any substantial fire or natural or
other disaster occurring at or near an elder group home. Section History: Recent Form
2005 Acts, ch 62, §12; 2007 Acts, ch 215, §153
231B.13 RETALIATION BY ELDER GROUP HOME PROHIBITED.
An elder group home shall not discriminate or retaliate in any way
against a tenant, a tenant's family, or an employee of the elder
group home who has initiated or participated in any proceeding
authorized by this chapter. An elder group home that violates this
section is subject to a penalty as established by administrative rule
in accordance with chapter 17A, to be assessed and collected by the
department, paid into the state treasury, and credited to the general
fund of the state. Section History: Recent Form
2005 Acts, ch 62, §13; 2006 Acts, ch 1010, §71; 2007 Acts, ch 215,
§154
Referred to in § 231B.5
231B.14 CIVIL PENALTIES.
The department may establish by rule, in accordance with chapter
17A, civil penalties for the following violations by an elder group
home:
1. Noncompliance with any regulatory requirements which presents
an imminent danger or a substantial probability of resultant death or
physical harm to a tenant.
2. Following receipt of notice from the department, continued
failure or refusal to comply within a prescribed time frame with
regulatory requirements that have a direct relationship to the
health, safety, or security of elder group home tenants.
3. Preventing or interfering with or attempting to impede in any
way any duly authorized representative of the department in the
lawful enforcement of this chapter or of the rules adopted pursuant
to this chapter. As used in this subsection, "lawful
enforcement" includes but is not limited to:
a. Contacting or interviewing any tenant of an elder group
home in private at any reasonable hour and without advance notice.
b. Examining any relevant records of an elder group home.
c. Preserving evidence of any violation of this chapter or of
the rules adopted pursuant to this chapter. Section History: Recent Form
2005 Acts, ch 62, §14; 2007 Acts, ch 215, §155, 156
231B.15 CRIMINAL PENALTIES AND INJUNCTIVE RELIEF.
A person establishing, conducting, managing, or operating an elder
group home without a certificate is guilty of a serious misdemeanor.
Each day of continuing violation after conviction or notice from the
department by certified mail of a violation shall be considered a
separate offense. A person establishing, conducting, managing, or
operating an elder group home without a certificate may be
temporarily or permanently restrained by a court of competent
jurisdiction from such activity in an action brought by the state.
Section History: Recent Form
2005 Acts, ch 62, §15; 2007 Acts, ch 215, §157
231B.16 COORDINATION OF THE LONG-TERM CARE SYSTEM --
TRANSITIONAL PROVISIONS.
1. A hospital licensed pursuant to chapter 135B, a health care
facility licensed pursuant to chapter 135C, an assisted living
program certified pursuant to chapter 231C, or an adult day services
program certified pursuant to chapter 231D may operate an elder group
home, if the elder group home is certified pursuant to this chapter.
2. This chapter shall not be construed to require that a facility
licensed as a different type of facility also comply with the
requirements of this chapter, unless the facility is represented to
the public as an elder group home.
3. A certified elder group home that complies with the
requirements of this chapter shall not be required to be licensed or
certified as a different type of facility, unless the elder group
home is represented to the public as another type of facility. Section History: Recent Form
2005 Acts, ch 62, §16
231B.17 IOWA ELDER GROUP HOME FEES.
1. The department shall collect elder group home certification
and related fees. Fees collected and retained pursuant to this
section shall be deposited in the general fund of the state.
2. The following certification and related fees shall apply to
elder group homes:
a. For a two-year initial certification, seven hundred fifty
dollars.
b. For a two-year recertification, one thousand dollars.
c. For a blueprint plan review, nine hundred dollars.
d. For an optional preliminary plan review, five hundred
dollars. Section History: Recent Form
2005 Acts, ch 62, §17; 2007 Acts, ch 215, §158
231B.18 APPLICATION OF LANDLORD AND TENANT ACT.
Chapter 562A, the uniform residential landlord and tenant Act,
shall apply to elder group homes under this chapter. Section History: Recent Form
2005 Acts, ch 62, §18
231B.19 RESIDENT ADVOCATE COMMITTEES.
The commission on aging shall adopt by rule procedures for
appointing members of resident advocate committees for elder group
homes. Section History: Recent Form
2005 Acts, ch 62, §19; 2009 Acts, ch 23, §42
231B.20 NURSING ASSISTANT AND MEDICATION AIDE --
CERTIFICATION.
The department, in cooperation with other appropriate agencies,
shall establish a procedure to allow nursing assistants or medication
aides to claim work within an elder group home as credit toward
sustaining the nursing assistant's or medication aide's
certification. Section History: Recent Form
2005 Acts, ch 62, §20; 2007 Acts, ch 215, §159
231B.21 MEDICATION SETUP -- ADMINISTRATION AND
STORAGE OF MEDICATIONS.
1. An elder group home may provide for medication setup if
requested by a tenant or the tenant's legal representative. If
medication setup is provided following such request, the elder group
home shall be responsible for the specific task requested and the
tenant shall retain responsibility for those tasks not requested to
be provided.
2. If medications are administered or stored by an elder group
home, or if the elder group home provides for medication setup, all
of the following shall apply:
a. If administration of medications is delegated to the elder
group home by the tenant or tenant's legal representative, the
medications shall be administered by a registered nurse, licensed
practical nurse, or advanced registered nurse practitioner licensed
or registered in Iowa or by the individual to whom such licensed or
registered individuals may properly delegate administration of
medications.
b. Medications, other than those self-administered by the
tenant or provided through medication setup, shall be stored in
locked storage that is not accessible to persons other than employees
responsible for administration or storage of medications.
c. Medications shall be labeled and maintained in compliance
with label instructions and state and federal law.
d. A person, other than a person authorized to prescribe
prescription drugs under state and federal law, shall not alter the
prescription of a tenant.
e. Medications shall be stored in their originally received
containers.
f. If medication setup is provided by the elder group home at
the request of the tenant or tenant's legal representative, or if
medication administration is delegated to the elder group home by the
tenant or tenant's legal representative, appropriate staff of the
elder group home may transfer the medications in the tenant's
presence from the original prescription container to medication
dispensing containers, reminder containers, or medication cups.
g. Elder group home assistance with medication administration
as specified in the occupancy agreement shall not require the elder
group home to provide assistance with the storage of medications. Section History: Recent Form
2005 Acts, ch 62, §21