South Carolina DHEC Regulations on Assisted Living

In the state of South Carolina, the South Carolina Department of Health and Environmental Control (DHEC) regulates the establishment, operation and maintenance of nursing homes and community residential care facilities (CRCFs).

A nursing home is defined as a facility with an organized nursing staff to accommodate people over a period lasting over 24 hours. A CRCF, also known as an assisted living facility, is defined as a facility that provides room and board, and a degree of personal care for a period lasting over 24 hours.

South Carolina Healthy Connections is the state’s Medicaid program. It is funded by state and federal tax money. Medicaid is a medical assistance program for eligible families and individuals whose income is insufficient to meet the cost of necessary medical services.

The South Carolina Department of Health and Human Services (SCDHHS) administers Healthy Connections.

The program pays for medical bills and residential stays at nursing homes. It pays for health care, but not room and board, at CRCFs. It will pay for qualifying medical expenses and personal care services, such as assisting with laundry and transportation to and from appointments at CRCFs.

A person age 65 or above, or someone with mental health issues or disability can live in a CRCF if they sometimes, or usually, need the degree of personal care that the facility provides.

An individual can apply for Medicaid through South Carolina’s Healthy Choices website. This site allows a person to learn if they are eligible. It also helps them find their local health services office in order to ask questions or submit an application in person.

Medicaid and Medicare-qualifying individuals 55 and older who need a nursing home level of care are eligible for the program of all-inclusive health for the elderly (PACE). A Medicaid website ending in a “gov” address provides more information, as does the state website about PACE.

PACE covers medical and nursing care and services, such as assistance with bathing, eating and dressing. It does not cover the cost of meals or rent at a CRCF. PACE is available in these counties in South Carolina:

• Anderson
• Bamberg
• Calhoun
• Greenville
• Lexington
• Orangeburg
• Pickens
• Richland

A person who would otherwise live at a nursing home may be eligible for the community choices waiver. This waiver is part of South Carolina’s community long term care (CLTC) program. The program assists individuals who want to live at home, need assistance with their care and meet the income qualifications for Medicaid.

The waiver provides funding for an elderly person to get services such as help with bathing and eating. The program will allow payment for services rendered by adult children of elderly parents, but it does not allow payment to a spouse of an elderly person.

The community choice waiver can also be used to pay for adult day care, home modifications and supplies like walkers.

The OSS program is a monthly payment made for an eligible blind or elderly person or such a person with a disability who needs assistance paying the CRCF where they live. A person qualifies for OSS if they:

• Are 65 or older, or are blind or have a disability.
• Have income and assets that qualify them for Medicaid coverage.
• Are a resident of a licensed CRCF enrolled with the state to participate in OSS.

A CRCF may not charge a resident or their family for any difference over and above the OSS rate because the additional payment could be considered income for the resident, which would make them ineligible for OSS.

The types of health care facilities licensed by South Carolina DHEC include:

• Adult day care facilities.
• Community residential care facilities.
• Home health agencies.
• Hospice facilities and programs.
• Hospitals.
• Intermediate care facilities (15-bed and +16-bed building types).
• In-home care providers.
• Facilities for chemically dependent or addicted persons (inpatient and outpatient).
  
• Nursing homes.

A person can find a specific facility by providing the name or location of the facility at the DHEC’s website.

Clicking a pin on the map opens a detailed window for a facility. This provides information such as the facility’s address, the applicable DHEC licensing regulation, the number of licensed beds and the facility administrator’s name and direct phone number.

An individual can report a nursing home, CRCF or other facility licensed by DHEC by submitting a health facility complaint form online with DHEC. If they cannot submit the form online, they can call the DHEC office at 803-545-4370 in Columbia or 800-922-6735.

They should indicate they want to file a complaint against a health care facility. The reporting individual should include the following information in the complaint:

• Facility type, like nursing home or CRCF.
• Facility name.
• County in which facility is located.
• Facility’s address.
• Facility’s phone number.
• Facility’s email address.
• Contact name, such as staff member.
  
• Name of the complainant.
• Address of the complainant.
• Email address of the complainant.
• Phone number of the complainant.
• Name of resident about whom the complainant is concerned.
• Age of resident.
• Sex of resident.
• Room number of resident.
• Relationship between resident and complainant.
• Whether resident is still at the facility.
• Date of discharge if applicable.
  
• Where former resident is currently located.
• Description of the problem, including date, time, how often the concern has occurred and location where the concern occurred. List the people involved and any witnesses and attach additional pages and reports as needed.
• Whether the concern is ongoing.
• Complainant’s specific concerns and what they think should happen regarding the situation.
• Whether the complainant attempted a resolution regarding the concern and with whom.
  
• Documents supporting the complainant’s statements, such as photos of physical abuse by staff.

A staff member of a nursing home is required to report abuse of a resident of any kind or a serious injury of a resident within two hours. If the events that cause the suspicion result in serious bodily injury of the resident, the individual must report the suspicion immediately, but not later than two hours after forming the suspicion.

A staff member is required to report an incident that does not involve abuse and does not result in serious bodily injury within 24 hours. All allegations must be investigated and reported to DHEC certification within five working days of the initial two-hour or 24-hour report to certification.

In South Carolina, there are two forms, the initial 2/24-hour report form and five-day follow up report form.

If a person lives in a licensed nursing home or CRCF, they or their relative can call the state’s long term care ombudsman for the South Carolina Department of Social Services (DSS) at 800-868-9095.

If the person lives in a residential facility contracted or operated by the Department of Mental Health or the Department of Disabilities and Special Needs, they or a relative should call the SLED special victims unit at 866-200-6066.

If a person lives at home or in the community, they or their relative should call Adult Protective Services at DSS at 888-227-3487.

If the person has been affected by identity theft and/or scams, they or their relative should call the Department of Consumer Affairs at 800-922-1594.

The South Carolina Code of Laws provides that it is a crime to:

• Abuse, neglect or exploit a nursing home resident.
• Fail to report abuse, neglect or exploitation of a nursing home resident.
• Interfere with the investigation of a report of abuse, neglect or exploitation.

A person who knowingly and willfully fails to report such abuse, neglect or exploitation and has actual knowledge that such an incident occurred is guilty of a misdemeanor. The penalty includes up to one year incarceration and a fine up to $2,500.

A person who abuses, neglects or exploits a nursing home resident is guilty of a felony. Typically, the penalty includes up to five years' incarceration and a fine up to $5,000. The offender may also be required to pay restitution to the resident.

The penalty for abuse, neglect or exploitation may be more severe depending on the severity of the incident, whether the resident survives the incident and the offender’s criminal history.

A person who interferes with the investigation of a report of abuse, neglect or exploitation is guilty of a misdemeanor. The penalty includes up to three years' incarceration and a fine up to $5,000.

If the offender abused, neglected or exploited multiple residents at the facility, the state can charge them with a separate crime for each resident. The resident or their family may also sue the facility in civil court for wrongful acts like fraud, assault and battery and wrongful death.

The facility may face concerns as to its continuing licensing and operations. Further, the facility’s insurer may raise its rates, restrict its coverage or drop it as a client.