2. Why Can’t This Be Easy? Handling Difficult Legal Situations in Assisted Living
Kenny Williamson Keith, Esq.
HARBUCK KEITH & HOLMES LLC
Grandview II
3595 Grandview Parkway, Suite 400
Birmingham, Alabama  35243
(205) (Main)
(205) (Direct)
(205) (Fax)
Website:

3. Issues in Advance Directives
What is a Portable DNAR?
Who can accept a Portable DNAR?
What are the requirements for entering a Portable DNAR order?
What are the obligations of a facility regarding a portable DNAR Order?

4. Understanding DNAR in Alabama
Competent Resident
Incompetent Resident-Advance Directive? Power of Attorney?
Health Care Proxy?
Alabama’s Health Decision Surrogate Provision

5. Documentation with DNAR
Portable DNAR form is Alabama specific. Must use that form and no other if a DNAR is to be portable.
The law still allows for facility specific orders, but they are not portable.
KNOW YOUR RESIDENTS’ CODE STATUS
Be sure your staff know exactly where to find code status and can do so immediately.
A reminder: CPR certified staff on each shift.

6. Collections and Discharge
Strategies for Getting Paid
It is acceptable, with the approval of the applicant, to conduct a background check PRIOR to admission.
It is acceptable to have family or others guarantee payment.
It is acceptable to impose late fees for payment that is past a certain point due.
Be sure that services for which there is an additional charge are identified.
And if you don’t….
Thirty day notice of discharge for non-payment as soon as the issue arises.
Overlap with admission agreement (including notation that the Ombudsman may help with disputes related to monies owed.
Special considerations: Financial exploitation of a vulnerable senior and resources for seniors in need of protection.

7. Documentation of Employee Training and Competency
Some Do’s and Some Don’t’s

8. Employee Orientation DO: DON’T:
Make sure to cover the required training under the regulations.
Cover facility specific policies and procedures.
Ensure sufficient hands-on orientation time for new employee to be able to demonstrate competencies required under your training program.
Document, document, document.
DON’T:
Forget pre-employment screening before care is provided.
Rely on “canned” presentations which don’t address Alabama rules and regulations.
Forget to appropriately manage your orientation documentation.
Hang on too long.

9. Difficult Issues in Training and Competency
Just can’t get it?
Personnel file?
Organize and Plan
Employee A has repeatedly failed to complete her resident care assignments. Residents have complained that they do not receive assistance with scheduled tasks such as bathing assistance or that the employee does not respond to their needs?
Employee has been retrained several times, but no improvement has been shown.
What have you documented regarding Employee A’s performance issues?
Are there any warnings regarding those issues?
Has the employee been on any type of improvement plan?
What if there’s nothing in the file at all?
Consider developing a progressive discipline policy.
Recognize that training is not always due to a specific issue with performance. It may be due to inclusion in a plan of correction or because new skills are needed.
Key termination phrases you need to avoid.