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HomeMy WebLinkAbout7-05-11 Justus Position Statement JUSTUS POSITION STATEMENT REGARDING WOODLAND TERRACE'S COMPLIANCE WITH THE CARMEL ZONING ORDINANCE CCRC DEFINITION ISSUE: Whether a community such as Woodland Terrace which offers independent living, assisted living, skilled nursing, therapy and other services to its residents in their homes meets the Carmel Zoning Ordinance's definition of Continuing Care Retirement Community. CONCLUSION: Yes, a community such as Woodland Terrace offers more than three levels of "continued care" to its senior citizen residents and meets the Carmel definition of Continuing Care Retirement Community. I. FACTS Woodland Terrace is a proposed continuing care retirement community. Woodland Terrace will offer a number of services to its residents within a single community. The services that Woodland Terrace will provide include independent apartment living, assisted living, skilled nursing, and therapy services. These services will be provided to residents in their apartments or through the therapy center that will be located within the community. t Because Woodland Terrace will make these services available to re i 1- cam .us or in their homes the residents will not have to relocate to receive services as their needs change- Residents will be able to stay i their homes and receive the services they need to Nye comfortably and independently. Upon moving into Woodland Terrace, a typical resident will be someone who is still independent and, most frequently, not in need of any services. This individual will simply be moving into an apartment within the community. The new resident may be downsizing in retirement, simply Iooking to move to a community with more social options. While the resident is living at Woodland Terrace, their health care needs will be monitored and, as necessary, additional care options will be explained_ These options will be presented as just that, options. The individual resident will be allowed to pursue or not pursue additional care as the resident deems appropriate. Woodland Terrace will, however, have these services available and provide them as requested. As a patient's care needs increase, they will be able to obtain services necessary to allow them to continue to live independently in their home. These services are commonly referred to as "assisted living services" and include non skilled services such as homemaker services, companion services, assistance with cognitive tasks, assistance with hygiene and similar services intended to allow an individual to remain in their home. Thus, a resident at Woodland Terrace would be able to receive these types of non medical or non skilled support services while staying in the apartment which they have already come to consider their home. Eventually, this resident might require more intensive care. It may be the need for therapy to reduce the resident's fall risk or it might be the need for a nurse to visit to set up a med planner, change a dressing, or administer an injectable medication for the patient. The resident will be able to obtain these services at Woodland Terrace either through the on -site therapy .1 uslus_Woodland Terrace CCRC position statemetn 7/5/20112:47 PM/JES center or within the comfort of their home, because Woodland Terrace will have skilled nursing and therapy services available on campus. The skilled nursing and therapy staff members will be licensed an)! certified as required by state laws. A registered nurse or licensed therapist will assess the patients needs, develop an appropriate care plan and implement that plan. The resident will receive routine follow -up from the nurse or therapist. These providers will communicate with the resident's primary care physician as well in order to ensure treatment continues to be appropriate and any necessary changes are made. When a resident no longer needs the services, they would be discontinued. The facility will also provide pharmacy services to residents. This will allow a patient to more quickly and easily obtain necessary medications. Pharmacy will also regularly review drug regimens to check for interactions. Woodland Terrace will also make dietary services available through a licensed dietician. The dietician will be available to consult with other services to develop meal plans that support the plan of care. The dietician will also be able to recommend special eating equipment and utensils for clients who need such support. II. CCRC DEFINITION The Carmel Zoning Ordinance defines a Continuing Care Retirement Community .£:CCRC "1 as "[a] place where three (3) or more levels of continued care are provided to senior citizens, including, but not limited to: independent living, assisted living, and skilled nursing/memory care. It can include independent apartments, detached or attached cottages, and nursing home rooms in a congregate building, as well as support services and facilities." Carmel Zoning Ordinance, Chapter 3, Winter 2011, vl (emphasis added). In order for a facility to meet this definition it must provide three or more levels of continued care to senior citizens. The zoning ordinance specifically lists three levels of care: independent living, assisted living and skilled nursing/memory care. Although the definition lists three types of care, it notes that this list is not exhaustive. This means a continuing care retirement community might provide other types of care to its residents. Such other services might include therapy services or social worker type services. The Carmel Zoning Ordinance does not provide definitions of the listed types of care. It only provides definitions of facility types, but it does not reference these facility definitions as requirements for a continuing care retirement community. This leads to the conclusion that CCRC is not a collection of long term care facilities on one campus, but is rather a facility that provides specific levels of care along a continuum to residents as their needs change. This comports with the primary goal of Woodland Terrace to provide a place where an individual, .can live in retirement and not have to move as the individual's needs change. Because the CCRC zoning ordinance does not require multiple facilities on campus, whether Woodland Terrace is a CCRC depends solely upon whether it will offer three or more levels of continued care. 2 6694208 III. WOODLAND TERRACE MEETS THE DEF`INITION'S REQUIREMENTS, BECAUSE IT PROVIDES AT LEAST THREE LEVELS OF CONTINUED CARE. A. Woodland Terrace residents will live in their own fully functional apartments and have access to a number of community social functions and community options, this makes Woodland Terrace Independent Living. The first level of continued care Woodland Terrace will provide is independent living. The term independent living as it relates to Continuing Care Retirement Communities is not defined in the Carmel Zoning Ordinances'. It is also not defined in the Indiana Code or the Indiana Administrative Code. Within the industry, the term Independent Living generally means a retirement community where residents live in their own fully functional apartment, but where the facility offers shared meals and other community social activities. The primary purpose of independent living is that seniors can continue to live in their own home and maintain their independence, while having access to more social and other opportunities. Woodland Terrace's apartments will provide this level of service. Residents of Woodland Terrace will live in their own fully functional apartments within the Woodland Terrace community setting. The apartments will have all of the amenities of any apartment complex. Residents will be able to choose the number of bedrooms they wish to have. They will have their own living and dining areas, private patios/balconies, fully equipped kitchens, washer and dryer, etc. The apartments will be the individual resident's home and the residents will not be moved from them unless they chose to move for reasons such as downsizing due to the death of a spouse. The primary difference between Woodland Terrace and a more traditional, apartment community is the availability of additional services. For example, Woodland Terrace will provide transportation services, a library and business center, an activities room, a conference room, a resident lounge, and a barber and beauty boutique. In addition, Woodland Terrace will provide other community activities and social programming. Residents are free to participate in various activities or to not participate as they wish. Upon moving into Woodland Terrace, the majority of residents will be independently living. This is one level of continued care. B. As residents' needs change, Woodland Terrace will provide the residents with the necessary support services to allow the residents to remain in their homes. These services are more commonly known as assisted living services. The Justus Companies anticipate that as residents age, some will need additional supports to stay in their homes. Woodland Terrace will provide these supports. These supports include assistance with activities of daily living, attendant care, personal care I The terms independent living and independent living facility have different meanings depending upon whether you are discussing facilities for the aging or the disabled. 3 6694208 and similar services designed to allow an individual to remain independent in their home. These services are assisted living services. Assisted living, like independent living, is not a term that is specifically defined in the Carmel Zoning Ordinance. There is a definition that illustrates what are assisted living services contained with the Indiana Medicaid Waiver rules. The assisted living' e. icai• waiver re a ions e es asses vmg cai waiver services" as "the ,gray of services provided to a recipient including any of the following: (A) personal care services, (13) homemaker services, (U) (more Services, (V) Attendant tare Service, 0) Companion Services, (1-9 medication oversight, (U) Therapeutic social and recreational programming." 460 I.A.C. 8 -1 -2 (6). Many of the listed services are further defused within the regulation. Personal care services are defined as "assistance with: (A) eating; (B) bathing; (C) dressing; (D) personal hygiene; and (E) activities of daily living." 460 IAC §8 -1- 2(27). Homemaker services are defined as services consisting of general household activities, including meal preparation and routine household care. 460 I.A.C. 8- 1- 2(19). Attendant Care Services are services that are similar to personal care services, but also include services such as assistance getting into and out of bed, wheelchairs, etc. and medication reminders. See. I.C. 16 -18 -2 -28.5; see also, I.C. 16 -10- 17.1 -1. Woodland terrace will have staff present to provide these support services. Whether an individual needs assistance with getting dressed and personal hygiene, companionship or eating, Woodland Terrace will have staff on -site who can provide these services to the resident in the resident's home. The personnel providing this care will meet the appropriate regulatory criteria. By providing these services, Woodland Terrace is providing assisted living services and is providing two levels of continuing care. C. Woodland Terrace wilt employ nurses and therapists to meet the residents additional nee, these services will be at the level of skilled nursing or therapy services and present a third level of continued care to the rAside ts, The Justus Companies anticipate that as the residents of Woodland Terrace age, they may require additional services. Residents may need nursing and therapy care as they recover from surgery such as knee or hip replacement. A resident may need therapy to reduce the risk of falling. A resident may need nursing care for a chronic condition or other illness. ,Because of this potential need, Woodland Terrace will have registered nurses, licensed •ractical n .1 pathologists available to •rovide service t e erapy center. Nursing services provided will include assessing a resident's health condition, deriving a nursing diagnosis, executing nursing regimens, advocating the provision of health care services through collaboration with or referral to other health professionals, 4 6694208 executing regimens delegated by the patient's physician, dentist, chiropractor, optometrist, or podiatrist and other services. See, I.C. 25- 23 -1 -1. This might include visiting a patient who requires injectable medication, but who is unable to self inject, dressing a wound, assessing skin to avoid skin breakdown, discussing the patient's condition with the patient's physician in order to obtain additional or different services. By making these services available to the residents in their homes, the residents are able to avoid being institutionalized. These services would be provided by licensed registered nurses or by licensed practical nurses who are supervised by licensed registered nurses. As noted, these services would be provided in collaboration with the patient's physician and the physician would control the care provided by issuing written orders, which the nurses would follow. Providing skilled nursing care does not mean Woodland Terrace needs to be a licensed health facility. There has been some confusion regarding the levels of service Woodland Terrace will provide and state regulatory requirements related to health facilities, more commonly known as nursing homes. This appears to grow out of a misapprehension that the CCRC definition requires a CCRC to provide nursing facility type care. As noted above, nothing in the CCRC defmition requires Woodland Terrace to operate a skilled nursing facility in order to meet the defmition of a CCRC. The CCRC defmition only squires the CCRC to provide at least three levels of "continued care." The definition references skilled nursing care /memory a$ one of those levels of care. The definition k does not state that a CCRC is required include a skilled nursing facility. Skilled nursing care can be provided outside of a nursing facility, which is what Woodland Terrace will do for its residents. Examples of nursing services being provided outside of a nursing facility are provided by assisted living facilities and home health agencies. Assisted living facilities are not licensed by the state to provide "assisted living services." These facilities are unlicensed and are only required to register with Indiana's Medicaid Program as a requirement for being reimbursed for services. See, I.C. 12- 10 -5 -1, et. seq. The regulatory term for an assisted living facility is a housing with services establishment. The Indiana statutes that govern health facilities provide a way for non licensed residential facilities, such as housing with services establishments, to provide skilled nursing services to their residents without becoming licensed as a residential nursing care facility. See, 410 I.A.C. 16.2- 5- 0.5(c). Similarly, individuals across the state of Indiana receive skilled nursing, therapy services and other care in the privacy of their homes through the use of licensed home health agencies. See, LC. 16 -2 P• i therapists and other health care profession. e h u nurse who is licenses •y t e state, provides nursing care to the patient in the patients_ home. The availability of home health services allows many individuals to remain in their homes an avoi emg placed in a nursing home. The flexibility to provide nursing 5 6694208 services in this fashion is a reflection that individuals prefer to stay in their homes as they age and receive necessary care. They do not wish to be placed in a nursing home. In addition to the skilled nursing services, Woodland Terrace will have an on -site Therapy Center. This center will employ licensed physical therapists, licensed occupational therapists, ant tcense• speec' p. .pi .e avai a. e o needed. These services might include physical therapy regimens such as "gait training," which are designed to make a resident safer while walking and to reduce the risk of falls. A resident may have suffered from a stroke or other incident and might require therapy to regain speech or the ability to feed themselves. Woodland Terrace will provide this care to the residents either in their home or at the therapy center. The availability of these services within the community can result in a patient returning home from the hospital sooner or avoiding a hospitalization completely, by reducing falls in the home. The availability of therapy can e tNo help a resident avoid having to be placed in a nursing facility, by allowing maintenance or recovery of skills necessary to remain independent. D. BECAUSE IT WILL PROVIDE FOUR LEVELS OF CONTINUING CARE TO ITS RESIDENTS, WOODLAND TERRACE MEETS THE DEFINITION OF CONTINUING CARE RETIREMENT COMMUNITY. Woodland Terrace will provide at least four levels of continuing care to its residents. The residents will, in most cases, move into Woodland Terrace when they are completely independent and simply looking to move into an apartment either as part of a general downsizing or because they desire to live in a community with more social options. This is independent living and is the first level of "continued care." As the residents' needs change, Woodland Terrace will have appropriately qualified staff available to provide the residents with the support and assistance they need to remain independent in their homes. These services may include companionship, attendant services or personal care services. These "assisted living services" represent a second level of continued care. As residents' needs become more significant, Woodland Terrace will have skilled nursing and therapy services available for its residents. These services are in addition to the services of a dietician and a pharmacy that will be available on site. Woodland Ten may provide these services without having to become a licensed health facility. Woodland Terrace will provide independent apartment living, assisted living, skilled nursing, therapy, and other services to residents. Because it is a community that provides three or more levels of care, Woodland Terrace meets the definition of a Continuing Care Retirement Facility as defined in the Carmel Zoning Ordinance. 6 6694208 t r 4567 0 e 1. 0 t X D°N W IT''.1111rf n Ca IN THE C A EL PI() ISSI 0 Pe 9e 6, RE APPLICATION FOR DEVELOPMENT 4 1 rp PLAN AND ARCHITECTURAL DESIGN, lft EXTERIOR UGHTlNG, LANDSCAPLNG, AND SIGNAGE. APPROVAL of Docket Nos. 0703 035 DP andt7070009 ADLS MIDWEST HOSPITALITY GROUP, '%(7 Applicant April 15, 2008 DECISION Upon Application and after a public hearing pursuant to the Advisory Planning Law of the State of Indiana and the Rules of Procedure of the Commission, the Commission hereby denies, hy a 9-0 vote, the application for DPLADLS approval filed bv the Applicant. Members voting to deny: Leo Dierckman, Jay Dorman, Kevin Rider, Rick Ripma, Carol Schleif, Steve Stromquist, Sue Westenneier Member votin2 lo approve: None. Members absent and not voting: Dan Dutcher. Wayne Haney, Kevin Heber, Madeleine Torres. FINDINGS in accordance Nvitli the Carmel Zoning Ordinance (the "Ordinance"), the Commission hereby determines that the Applicant's Development Plan and ADLS Proposal (the "Proposal') should he disapproved pursuant to the following provisions of the Ordinance: CARMEL 0001284 §§2313.02.A.2.a: The Proposal is not compatible with existing site features including topography and wooded areas, in that the Proposal necessitates excessive utilization of retaining walls and calls for the destruction of virtually all of a mature woodland. ti2313.02.A.2.c: The Proposal is not compatible with the surrounding land uses, which uses have been developed without modifying the topography and woodlands so drastically. §23B.02.A.2.h: The Proposal does not provide for adequate vehicle and bicycle parking facilities and internal site circulation, in that the proposed bicycle path is only five feet wide, and the parking facilities would accommodate only 155 vehicles when the Ordinance requires 169 to he accommodated. with existing platted The Proposal is not compatible t'.tg l��a_teC1 I45IQ2Ililal uses, in that the building setbacks with accompanying landscape plans are not sufficient to safeguard the privacy- and quiet enicyrnent of the neighboring residents. 2 3B.fS: The Proposal does not orient the new building with its longest axis parallel to tile. i adjoining street as required to create sense n I e i t o 7 1.� street, th �•J to a e,. •L'.il:Ci:': c... _:n� t.;! �_x eet., T: �i d��?`.':� the Pr: ?nsal locate all parking? to the rear or the side of the building. as necessary to acco, "'plash, ihls The Proposal does ii or use o permitted materials for the building exteriors, ha .rcertain per„__.taYe c- EI S (Exterior l :J:'. r:. System- red a:: exterior finis:'. 23B.09. (2 The Ap iC s presentation tio, of the Proposal did n i 1 required �t _pl at I3re. I,ta_ .I o e P.� cic ,r nc�u,l:. all eqr., ed architectural exhibits, in that no perspective color renderings showing the proposed building from locations along.; LS. 31 were provided to the Conmmission, and the building elevations that CARMEL 0001285 A, were provided did not show how the parking structure would be ventilated nor how openings to the parking structure would fit in with the rest of the building. §2 3B.10.02.C(1): The Proposal does not show a planting area equal to an area measuring 25 feet in depth by the width of the front of the building plus 20 feet out on both sides along the building facade that faces U.S. 31, nor does it include as an alternative an innovative and original design for the planting area as encouraged by §238.!0.C(5). `238.10.04: The Proposal does not make a reasonable effort to protect and incorporate the existing stands of trees into the overall site design, in that fewer than 70% of all trees that are nine -inch DBH or larger and located within the perimeter buffering were preserved. §23B.16: The Proposal does not include a roof on the accessory structure for refuse storage. §24.02.8.3.a: The Applicant's presentation of the Proposal did not include a traffic study that provided a meaningful comparative analysis of present volumes on streets bordering the development, in that the traffic data that were provided were flawed due to the times of day studied (ice for r ai generated h\• Carmel High School n� traffic. Il: ool stud::nis at school start/close times) or dates of stndv (data having been compiled during Camel High School vacation periods). Filed in the Office of the Carmel Plan Commission this 3O day of May, 2008. Leo Dierckman President ATTST: Rtmona Hancock Secretary CARMEL 0001286 INDEPENDENT LIVING ON -SITE HEALTH CARE Independent residential communities are for seniors Some assisted living, independent living, continuing desiring a leisurely, hassle -free lifestyle. Choices care and maintenance free communities have partnered include apartments, condos, or garden homes offering with independent, third party home care or home some extra services and features that many retired health agencies. An arrangement like this can allow people would especially enjoy or find helpful. Beyond seniors to receive care or services above and beyond home maintenance, some services available might the community's capabilities from an outside agency. include social programs, transportation services, This allows the senior to age in place for longer, organized outings, shopping trips and sometimes and possibly delay or avoid moving into a different limited medical services. Features might include community to receive a new level of care. x' emergency pull cords within the home, first floor access or elevators that are handicap friendly. Community RESPITE CARE features may also include meals, housekeeping and Respite Care communities offer temporary or short laundry. term care solutions. This service is intended to give caregivers or adult children a well deserved break from CONTINUING CARE (CCRC) their daily responsibilities of caring for an older adult. These communities allow seniors to "age in place" with The length of a respite care stay can vary from 2 days flexible accommodations that are designed to meet their up to more than a full month. health and housing needs as these needs change over time. Residents entering Continuing Care Retirement Communities sign a long -term contract that provides for housing, services and nursing care, usually all in one location, enabling seniors to remain in a familiar setting as m -'k they grow older. 1. Many seniors enter into a CCRC contract while they s t ne.�. r a healthy and active R- knowing they will be able to stay in the same community r r and receive nursing care should this become necessa x r tF~ necessary. Continuing Care Retirement Communities offer service 0 -4' and housing packages that parallel independent living, assisted living, and skilled nursing facilities. Seniors s who are independent may live in a single family home, MEMORY CARE fig`' apartment or condominium within the Continuing Care Communities which offer specialized programs for retirement complex. If they begin to need help with residents suffering from Alzheimer's Disease, Dementia activities of daily living (e.g., bathing, dressing, eating, or other forms of memory loss. Some of these etc.), they may be transferred to an assisted living communities offer a "Secured Unit" which prevents or skilled nursing facility on the same site. Seniors Alzheimer's Dementia patients from dangerous who choose to live in a Continuing Care Retirement wandering in un- secured locations. Community find it reassuring that their long -term care y needs will be met without the need to relocate. NURSING CARE Nursing homes are facilities for seniors in need of ASSISTED LIVING 24 -hour nursing care. They provide many of the same Assisted Living communities are for persons who need care options offered in other senior communities such as help with daily living activities but do not require nursing room and board, personal care, protection, supervision home care. Typically they provide help with meals, and other types of therapy. bathing, dressing, housekeeping and other needs. Services are either included in the rent or provided REHABILITATION CARE at an extra charge. The Indiana Department of Health Facilities that offer rehabilitative care services on a -egulates and licenses assisted living facilities as short -term or long -term basis. "Residential Care" providers; however, many assisted 'iving facilities are not licensed.