Can Assisted Living Care for a Catheter or an Ostomy in California?

MedlinePlus, the National Library of Medicine's health site, describes a urinary catheter as a tube placed in the body to drain urine from the bladder. An indwelling catheter is one that is left in the bladder and attached to a drainage bag. An ostomy is surgery that creates an opening, called a stoma, so that waste can leave the body a new way. In a colostomy the colon is attached to the stoma, and in an ileostomy the bottom of the small intestine is.

Assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), are non-medical homes. Title 22, section 87612, lists catheter care and colostomy or ileostomy care as restricted health conditions. A home may care for a resident with one of them, but only as the section written for that condition allows: 87623 for an indwelling urinary catheter and 87621 for a colostomy or ileostomy.

Section numbers in this part of Title 22 are easy to mix up. Section 87622, which sits between the two, covers enemas, suppositories and fecal impaction removal, not catheters. The whole list is in our guide to health conditions assisted living can accept.

Section 87623 lets a home accept or keep a resident with an indwelling catheter if the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation. Those two tasks, and removal, are reserved for an appropriately skilled professional. Health and Safety Code section 1569.39 defines that as a person trained and licensed to perform the procedure, such as a registered nurse or licensed vocational nurse, who may work for a home health agency, the resident or the home.

When the resident needs help, the section divides the work as follows.

Section 87621 gives two routes. In the first, the resident is mentally and physically capable of providing all routine care for the ostomy, and the physician has documented that the ostomy is completely healed. In the second, assistance with the ostomy is provided by an appropriately skilled professional.

On the second route, the section allows one task to be handed to caregivers: the ostomy bag and adhesive may be changed by facility staff who have been instructed by the professional. The professional must put in writing which procedures were delegated and the names of the staff who were instructed, and must review the procedures and techniques no less than twice a month. That is a much closer check than the yearly review for catheter bags.

The section names colostomy and ileostomy. It does not mention a urostomy, the kind of ostomy that carries urine, and section 87623 is written for an indwelling catheter and does not address a catheter the resident puts in and takes out through the day. If either applies to your parent, ask each home how it would handle it and whether it has checked with its licensing office.

Both sections add duties that apply whoever does the care:

• Privacy whenever catheter or ostomy care is provided.
• Disposal of used bags and waste materials as the regulations specify.
• Hands-on training from a licensed professional for the staff involved, completed before they provide the care.
• The physician's documentation on file, covering how stable the condition is and whether the resident is able to perform the procedure.
• Monitoring of the resident's ability to keep doing their own care, with any change documented.
• Staff who can recognize a problem and contact the physician or the professional.

One more condition applies to ostomies only. Under section 87611, a home that in the last two years has had a probationary license, an administrative action, a non-compliance conference that ended in a corrective plan, or certain serious deficiency notices must get approval from the Department of Social Services before accepting or keeping a resident with a colostomy or ileostomy.

Not for the home's convenience. The section on incontinence, 87625, makes the home responsible for seeing that an incontinent resident is not catheterized to control incontinence for the convenience of the licensee. Whether a catheter is used is a medical question for the physician. Our guide to incontinence in assisted living covers what homes may and may not do.

Most small homes have no nurse on staff, so the skilled tasks are usually done by a visiting nurse. Title 22 requires a written agreement between the home and a home health agency covering the services, how often they are provided and how the two communicate. See therapy and home health in an RCFE for how that works and who pays. Medicare Part B covers medically necessary ostomy supplies for people who have had a colostomy, ileostomy or urinary ostomy.

If a resident's needs go past what the two sections allow, section 87616 lets the home send the Department of Social Services a written exception request with current medical reports and its plan. The home applies, and the department decides.

A home that holds a hospice care waiver does not need a separate exception for a terminally ill resident whose hospice care plan addresses the catheter or ostomy care. Section 87633 keeps one limit in place: facility staff may not perform a procedure that by law only a licensed professional may perform. More on this is in hospice in assisted living.

Ask who inserts and changes the catheter and how often a nurse visits, which caregivers have been instructed and by whom, what happens at night or on a weekend if a catheter blocks or a bag leaks, and who orders supplies. A home is never required to accept a particular person, so two licensed homes can answer differently.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She can help a family in the South Bay and Harbor area look for a licensed board and care home or assisted living community that says it can manage a catheter or an ostomy, and she goes on the tours with you. To talk it through, contact Hamssa, or start with the California Assisted Living Placement Guide.