481-69.22 – Tenant Evaluations

Assisted living tenants must have evaluations which include assessments of the resident’s cognitive, functional, and health status at frequencies identified in 481-69.22. First, let’s cover the initial evaluation which must occur prior to the tenant’s service plan being developed, the occupancy agreement being completed, and the tenant occupying the assisted living unit. The initial evaluation must include all three elements (cognitive, functional, and health) to be considered compliant.

Cognitive evaluations shall utilize a scored, objective tool. This can include but is not limited to mini-mental status examinations (MMSE), brief interview for mental status (BIMS), or other similar cognitive testing that identifies if the tenant has any cognitive impairments and if they do, the extent of those cognitive impairments. If the score of the objective tool identifies that the tenant has moderate or severe cognitive impairment, the program must complete a Global Deterioration Scale (GDS) which shall be used at subsequent intervals unless the tenant returns to mild cognitive impairment. If this occurs, the program can return to the objective testing completed for other tenants.

Who can complete evaluations?

Health care or human services professionals are able to complete the tenant evaluations in assisted living settings. A health care professional includes a physician, physician assistant, registered nurse, or advanced registered nurse practitioner licensed in Iowa by the respective licensing board. In subsequent rules, it also identifies that a licensed practical nurse (LPN) may complete evaluations. In the rules, it states that an LPN may not complete initial or significant change evaluations; however, the Department of Inspection, Appeals and Licensing (DIAL) expressed that in accordance with a change in the scope of practice, they will not be enforcing these rules pending a formal rule change.

A human services professional includes an individual with a bachelor’s degree in a human service field including, but not limited to human services, gerontology, social work, sociology, psychology, or family science. Two years of experience in a human service field may be substituted for up to two years of required education. For example, an individual with an associate’s degree in a human service field and two years of experience in a human service field is considered a human service professional.

These terms are defined in 481-67.1.

This rule is routinely cited when evaluations are not completed prior to the service plan being developed, the occupancy agreement being signed, and/or before the tenant took occupancy of the dwelling. These evaluations should drive what care the tenant needs and delegates to the program during their stay at the assisted living. This care is then dictated to direct care staff in the service plan and agreed upon in the occupancy agreement.