Crosswalk of
Current ALF Regulations (22 VAC 40-72) and Proposed ALF Regulations (22 VAC 40-73)
Substantive Changes
1. 22 VAC 40-72-90 and 22 VAC 40-73-100
Change provides for enhancement of infection control program. Added features include requirements
for (i) participation by licensed health care professional in program development and compliance, (ii)
annual program review and update, (iii) assignment of staff person as point of contact, (iv) provision of
information to staff on recommended vaccinations, (v) exposure control plan, and (vi) implementation
of recommendations made by Virginia Department of Health.
2. 22 VAC 40-72-160 and 22 VAC 40-73-250 and 120
Change eliminates required specified content for job descriptions, although staff person still must
receive copy of his job description. Change also deletes requirement that organizational chart be given
to staff person, although organizational structure was added to staff orientation. In addition, change
eliminates requirement for annual evaluation of staff performance.
3. 22 VAC 40-72-210 and 22 VAC 40-73-160
Change provides for additional training of administrators who supervise medication aides, but are not
licensed or registered to administer medications themselves. Added requirement that these
administrators complete annually four hours of training in medication administration or refresher
course in medication administration offered by Virginia Board of Nursing approved program.
4. 22 VAC 40-72-260 and 22 VAC 40-73-210
Change increases training hours for direct care staff. In facilities licensed for residential living care only,
annual training for direct care staff increased from 8 to 14 hours; in facilities licensed for assisted living
care, annual training for direct care staff increased from 16 to 18 hours.
5. 22 VAC 40-72 (not in current regulations) and 22 VAC 40-73-220
Change adds requirements for private duty personnel. Requirements regarding private duty personnel
include (i) facility agreement with care/services provided, (ii) tuberculosis screening, (iii) orientation and
training, (iv) documenting resident care, and (v) facility monitoring of delivery of care/services. In
addition, when private duty personnel are not employees of licensed home care organizations, facility is
responsible for ensuring private duty personnel are qualified.
1
6. 22 VAC 40-72-300 and 22 VAC 40-73-260
Change increases requirement regarding staff with certification in cardiopulmonary resuscitation (CPR).
Number of staff needed with CPR certification increased from 1 for every 100 residents, or portion
thereof, to 1 for every 50 residents, or portion thereof.
7. 22 VAC 40-72-320 and 22 VAC 40-73-280
Change limits exception to staffing requirement to facilities licensed for residential living care only, so it
no longer also applies to facilities licensed for assisted living care. Exception allows, in buildings housing
19 or fewer residents, direct care staff person to sleep at night if no residents need awake staff at night.
8. 22 VAC 40-72-340 and 22 VAC 40-73-310
Change includes additional requirements regarding hospice care provided in assisted living facility.
Added requirements involve written agreement between facility and hospice program that addresses
communication and coordination and specifies roles and responsibilities.
9. 22 VAC 40-72 (not in current regulations) and 22 VAC 40-73-325
Change adds requirement for fall risk assessment that applies to residents meeting criteria for assisted
living care. Fall risk assessment must be conducted by time individualized service plan is completed,
reviewed/updated annually, when resident condition changes, and after fall. If resident falls, facility
must show documentation of analysis of circumstances and interventions initiated to prevent or reduce
additional falls.
10. 22 VAC 40-72-480 and 22 VAC 40-73-490
Change reduces number of times required for health care oversight when facility employs full-time
licensed health care professional. For residents who meet criteria for residential living care, health care
oversight was reduced from every six months to once a year. For residents who meet criteria for
assisted living care, health care oversight was reduced from every three months to every six months.
Change adds requirement that all residents be included annually in health care oversight.
11. 22 VAC 40-72-540 and 22 VAC 40-73-540
Change involves revising requirement so that visiting hours may no longer be restricted, unless resident
so chooses. Also, adds allowance for facility policy/guidelines to prevent visiting from being disruptive
to other residents and compromising facility security.
12. 22 VAC 40-72-620 and 22 VAC 40-73-620
Change reduces number of times required for oversight of special diets. Oversight of special diets by a
dietitian or nutritionist was reduced from quarterly to every six months.
2
13. 22 VAC 40-72-730 and 22 VAC 40-73-750
Change adds a provision that allows resident to decide not to have certain furnishings otherwise
required in his bedroom. Also, provides that resident may decide differently at any time.
14. 22 VAC 40-72-840 and 22 VAC 40-73-860
Change permits resident, who does not have serious cognitive impairment, to keep cleaning supplies
and other hazardous materials in out-of-sight place in his bedroom, stored in a way not accessible to
other residents, rather than having to store them in locked area. Change also allows that if facility has
no residents with serious cognitive impairments, it may determine out-of-sight and inaccessibility to
other residents does not apply (unless mandated by building or fire code), rather than allow for cleaning
supplies/other hazardous materials not to be locked in independent living environment.
15. 22 VAC 40-72-860 and 22 VAC 40-73-880
Change adds provision that in bedroom with thermostat where only one resident resides, resident may
choose temperature other than what is otherwise required. This means that when temperatures of at
least 72°F or 68°F (heat) or temperatures not to exceed 80° (cooling)are required, resident may keep
temperature lower or higher, as long as resident’s health, safety, or welfare is not endangered.
16. 22VAC 40-72-910 and 22 VAC 40-73-930
Change adds to provision for signaling/call systems to address needs of resident who is unable to use
signaling device. For such resident, need for monitoring for emergencies and other unanticipated
needs is to be noted in individualized service plan, which must include minimal frequency of rounds to
be made by direct care staff and how rounds will be documented.
17. 22 VAC 40-72-960 and 22 VAC 40-73-980
Change adds antibiotic cream or ointment and aspirin to first aid kit and eliminates activated charcoal.
Change adds requirement for flashlight or battery lantern for each employee directly responsible for
resident care, not only for those working at night.
Change adds requirement to 96-hour supply of emergency food and water that 48 hours of supply must
be on-site.
18. 22 VAC 40-72-990 and 22 VAC 40-73-1010
Change removes exception to most of special requirements that applied under certain circumstances
when there is mixed population (mixed population includes residents with serious cognitive
impairments, but not special care unit). Exception that was removed allowed facilities licensed for 10 or
fewer residents, when no more than three had serious cognitive impairments, to not meet special
requirements. Only requirements where exception still applies relates to having two direct care staff at
all times, and sight and sound supervision of cognitively impaired residents on trips away from facility.
3
All other special requirements will apply (since no longer have exception) and they relate to staff
training, building and outdoor features, and environmental precautions.
19. 22 VAC 40-72-1010 and 22 VAC 22-73-1030
Change increases training for direct care staff and certain other staff in working with individuals with
cognitive impairment, when there is mixed population. Training for direct care staff that must be
completed within four months of employment increased from 4 to 6 hours. Training for staff other than
administrator and direct care staff that must be completed within one month of employment increased
from 1 to 2 hours.
20. 22 VAC 40-72-1100 and 22 VAC 40-73-1120
Change increases number of hours of activities available to residents in safe, secure environment, also
referred to as special care unit (safe, secure environment is for residents with serious cognitive
impairment due to primary psychiatric diagnosis of dementia). Activities increased from 16 hours
weekly, with no less than 1 hour each day, to 21 hours weekly, with no less than 2 hours each day.
21. 22 VAC 40-72-1110 and 22 VAC 40-73-1130
Change requires at least two direct care staff members on each floor in each special care unit, rather
than in each special care unit, unless exception is met.
22. 22 VAC 40-72-1120 and 22 VAC 40-73-1140
Change increases training, when there is special care unit, for administrator in cognitive impairment
from 10 hours within a year of employment (4 hours of which were within two months) to 12 hours
within three months. Although number of hours of training in cognitive impairment for direct care staff
who are employed in special care unit remains at 10 hours, time period for obtaining training has
changed from one year of employment (4 hours of which were within two months) to within four
months of employment in special care unit. Training in cognitive impairment, within one month of
employment, for other staff who have contact with residents in special care unit was changed from 1 to
2 hours.
9/4/15
4