As Reported by the Senate Health, Human Services and Aging Committee

126th General Assembly
Regular Session
Sub. S. B. No. 87

Senators Wachtmann, Hagan, Gardner, Mumper, Clancy 

To amend sections 3721.011 and 3721.04 of the Revised 1
Code regarding the provision of hospice care in 2
residential care facilities.3


       Section 1. That sections 3721.011 and 3721.04 of the Revised 4
Code be amended to read as follows:5

       Sec. 3721.011.  (A) In addition to providing accommodations,6
supervision, and personal care services to its residents, a7
residential care facility may provide skilled nursing care to its 8
residents as follows:9

       (1) Supervision of special diets;10

       (2) Application of dressings, in accordance with rules11
adopted under section 3721.04 of the Revised Code;12

       (3) Providing for theSubject to division (B)(1) of this 13
section, administration of medication to residents, to the extent 14
authorized under division (B)(1) of this section;15

       (4) OtherSubject to division (C) of this section, other16
skilled nursing care provided on a part-time, intermittent basis 17
pursuant to division (C) of this sectionfor not more than a total 18
of one hundred twenty days in a twelve-month period;19

        (5) Subject to division (D) of this section, skilled nursing 20
care provided for more than one hundred twenty days in a 21
twelve-month period to a hospice patient, as defined in section 22
3712.01 of the Revised Code.23

       A residential care facility may not admit or retain an24
individual requiring skilled nursing care that is not authorized25
by this section. A residential care facility may not provide26
skilled nursing care beyond the limits established by this27

       (B)(1) A residential care facility may admit or retain an29
individual requiring medication, including biologicals, only if30
the individual's personal physician has determined in writing that31
the individual is capable of self-administering the medication or32
the facility provides for the medication to be administered to the33
individual by a home health agency certified under Title XVIII of34
the "Social Security Act," 4979 Stat. 620 (19351965), 42 35
U.S.C.A. 3011395, as amended; a hospice care program licensed 36
under Chapter 3712. of the Revised Code; or a member of the staff 37
of the residential care facility who is qualified to perform38
medication administration. Medication may be administered in a 39
residential care facility only by the following persons authorized 40
by law to administer medication:41

       (a) A registered nurse licensed under Chapter 4723. of the42
Revised Code;43

       (b) A licensed practical nurse licensed under Chapter 4723.44
of the Revised Code who holds proof of successful completion of a45
course in medication administration approved by the board of46
nursing and who administers the medication only at the direction47
of a registered nurse or a physician authorized under Chapter48
4731. of the Revised Code to practice medicine and surgery or49
osteopathic medicine and surgery;50

       (c) A physician authorized under Chapter 4731. of the Revised 51
Code to practice medicine and surgery or osteopathic medicine and 52

       (2) In assisting a resident with self-administration of54
medication, any member of the staff of a residential care facility55
may do the following:56

       (a) Remind a resident when to take medication and watch to57
ensure that the resident follows the directions on the container;58

       (b) Assist a resident by taking the medication from the59
locked area where it is stored, in accordance with rules adopted60
pursuant to section 3721.04 of the Revised Code, and handing it to61
the resident. If the resident is physically unable to open the62
container, a staff member may open the container for the resident.63

       (c) Assist a physically impaired but mentally alert resident, 64
such as a resident with arthritis, cerebral palsy, or Parkinson's 65
disease, in removing oral or topical medication from containers 66
and in consuming or applying the medication, upon request by or 67
with the consent of the resident. If a resident is physically 68
unable to place a dose of medicine to the resident's mouth without 69
spilling it, a staff member may place the dose in a container and 70
place the container to the mouth of the resident.71

       (C) A residential care facility may admit or retain72
individuals who require skilled nursing care beyond the73
supervision of special diets, application of dressings, or74
administration of medication, only if the care will be provided on75
a part-time, intermittent basis for not more than a total of one76
hundred twenty days in any twelve-month period. In accordance with 77
Chapter 119. of the Revised Code, the public health council shall 78
adopt rules specifying what constitutes the need for skilled79
nursing care on a part-time, intermittent basis. The council shall 80
adopt rules that are consistent with rules pertaining to home 81
health care adopted by the director of job and family services for 82
the medical assistance program established under Chapter 5111. of 83
the Revised Code. Skilled nursing care provided pursuant to this 84
division may be provided by a home health agency certified under 85
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 86
U.S.C.A. 301, as amended, a hospice care program licensed under 87
Chapter 3712. of the Revised Code, or a member of the staff of a 88
residential care facility who is qualified to perform skilled 89
nursing care.90

       A residential care facility that provides skilled nursing91
care pursuant to this division shall do both of the following:92

       (1) Evaluate each resident receiving the skilled nursing care 93
at least once every seven days to determine whether the resident 94
should be transferred to a nursing home;95

       (2) Meet the skilled nursing care needs of each resident96
receiving the care.97

       (D) A residential care facility may admit or retain a hospice 98
patient who requires skilled nursing care for more than one 99
hundred twenty days in any twelve-month period only if the 100
facility has entered into a written agreement with a hospice care 101
program licensed under Chapter 3712. of the Revised Code. The 102
agreement between the residential care facility and hospice 103
program shall include all of the following provisions:104

        (1) That the hospice patient will be provided skilled nursing 105
care in the facility only if a determination has been made that 106
the patient's needs can be met at the facility;107

        (2) That the hospice patient will be retained in the facility 108
only if periodic redeterminations are made that the patient's 109
needs are being met at the facility;110

        (3) That the redeterminations will be made according to a 111
schedule specified in the agreement;112

        (4) That the hospice patient has been given an opportunity to 113
choose the hospice care program that best meets the patient's 114

        (E) Notwithstanding any other provision of this chapter, a116
residential care facility in which residents receive skilled117
nursing care pursuant to this section is not a nursing home.118

       Sec. 3721.04.  (A) The public health council shall adopt and 119
publish rules governing the operation of homes, which shall have 120
uniform application throughout the state, and shall prescribe 121
standards for homes with respect to, but not limited to, the 122
following matters:123

       (1) The minimum space requirements for occupants and124
equipping of the buildings in which homes are housed so as to125
ensure healthful, safe, sanitary, and comfortable conditions for126
all residents, so long as they are not inconsistent with Chapters127
3781. and 3791. of the Revised Code or with any rules adopted by128
the board of building standards and by the state fire marshal;129

       (2) The number and qualifications of personnel, including 130
management and nursing staff, for each class of home, and the131
qualifications of nurse aides, as defined in section 3721.21 of132
the Revised Code, used by long-term care facilities, as defined in 133
that section;134

       (3) The medical, rehabilitative, and recreational services to 135
be provided by each class of home;136

       (4) Dietetic services, including but not limited to137
sanitation, nutritional adequacy, and palatability of food;138

       (5) The personal and social services to be provided by each 139
class of home;140

       (6) The business and accounting practices to be followed and 141
the type of patient and business records to be kept by such homes;142

       (7) The operation of adult day-care programs provided by and 143
on the same site as homes licensed under this chapter;144

       (8) The standards and procedures to be followed by 145
residential care facilities in admitting and retaining a resident 146
who requires the application of dressings, including requirements 147
for charting and evaluating on a weekly basis;148

       (9) The requirements for conducting weekly evaluations of149
residents receiving skilled nursing care in residential care 150

       (B) The public health council may adopt whatever additional 152
rules are necessary to carry out or enforce the provisions of 153
sections 3721.01 to 3721.09 and 3721.99 of the Revised Code.154

       (C) The following apply to the public health council when155
adopting rules under division (A)(2) of this section regarding the 156
number and qualifications of personnel in homes:157

       (1) When adopting rules applicable to residential care 158
facilities, the public health council shall take into159
consideration the effect that the provisionfollowing may have on 160
the number of personnel needed:161

        (a) Provision of personal care services and;162

       (b) Provision of part-time, intermittent skilled nursing care 163
pursuant to division (C) of section 3721.011 of the Revised Code 164
may have on the number of personnel needed;165

        (c) Provision of skilled nursing care to hospice patients 166
pursuant to division (D) of section 3721.011 of the Revised Code.167

       (2) The rules prescribing qualifications of nurse aides used 168
by long-term care facilities, as those terms are defined in 169
section 3721.21 of the Revised Code, shall be no less stringent 170
than the requirements, guidelines, and procedures established by 171
the United States secretary of health and human services under 172
sections 1819 and 1919 of the "Social Security Act," 49 Stat. 620 173
(1935), 42 U.S.C.A. 301, as amended.174

       Section 2. That existing sections 3721.011 and 3721.04 of the 175
Revised Code are hereby repealed.176