Can Someone on Oxygen Live in Assisted Living in California?

MedlinePlus, the National Library of Medicine's health site, describes oxygen therapy as a treatment that gives you extra oxygen to breathe, available only by prescription. Some devices use tanks of gas or liquid oxygen, and others use a concentrator that pulls oxygen out of the air. The oxygen reaches the person through a nose tube called a cannula, or a mask.

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 the administration of oxygen as a restricted health condition: a home may care for a resident who needs it, but only as section 87618 allows. The other restricted and prohibited conditions are covered in health conditions assisted living can accept.

Section 87618 gives two routes for oxygen gas. In the first, the resident is mentally and physically capable of operating the equipment, is able to determine their own need for oxygen, and is able to administer it. In the second, intermittent oxygen administration is performed by an appropriately skilled professional.

The resident, when all three parts of the first route are true. If the resident requires assistance, section 87618 makes the home responsible for seeing that the oxygen is administered by an appropriately skilled professional. Health and Safety Code section 1569.39 defines that as a person trained and licensed to perform the procedure, and its examples include a registered nurse, a licensed vocational nurse and a respiratory therapist.

Caregivers have a supporting role. The regulation requires facility staff to have knowledge of, and ability in, the operation of the oxygen equipment, and the home must monitor whether the resident can still operate it as the physician ordered. Before admission, the staff involved must complete hands-on training from a licensed professional. None of that makes a caregiver the person who administers the oxygen.

Notice the word intermittent in the second route. The section does not describe a professional giving oxygen around the clock. A parent who needs oxygen most of the day and can no longer manage the equipment, for example because of dementia, may not fit either route as written. That is the situation to raise with the doctor and with each home before you choose.

Section 87618 gives the home a list of duties. You can look for most of them on a tour:

• A written report to the local fire jurisdiction that oxygen is in use at the home.
• "No Smoking-Oxygen in Use" signs posted in the appropriate areas, and no smoking where oxygen is in use.
• All electrical equipment checked for defects that may cause sparks.
• Tanks that are not portable secured in a stand or to the wall.
• Tubing long enough for the resident to move around the room without becoming a hazard to the resident or others.
• Oxygen from a portable source when the resident is outside their room.
• Equipment that works, and that is removed from the home when the resident no longer uses it.
• A room large enough for the equipment.

The home must also keep the physician's documentation of the condition, including how stable it is and whether the resident is able to perform the procedure, with the names and phone numbers of the equipment vendor and any professional involved.

Yes. Section 87618 allows a home to accept or keep a resident who uses liquid oxygen under two conditions: the home obtains prior approval from the licensing agency, and the resident is mentally and physically capable of operating the equipment, able to determine the need for oxygen and able to administer it. The section gives no route for a professional to give liquid oxygen on the resident's behalf.

The regulation speaks of oxygen gas and liquid oxygen. It does not set out separate rules for each type of device, so tell the home exactly what equipment the doctor has prescribed, including any portable unit, and ask whether it has cared for a resident using the same kind.

A home is never required to accept a particular person. One home may have several residents on oxygen while the home next door declines, because of its staffing, its room sizes or its house rules on smoking, which are explained in alcohol and smoking rules.

There is also a licensing condition. 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 who needs oxygen.

When a resident does not fit the rule, section 87616 lets the home send the department a written exception request with current medical reports and its plan for meeting the person's needs. The home applies, and the department decides. For a resident who is terminally ill and on hospice, a home that holds a hospice care waiver does not need a separate exception as long as the hospice care plan addresses the oxygen. Section 87633 still bars facility staff from performing any procedure the law reserves for a licensed professional.

Bring the prescription and the name of the equipment company, and ask:

• Do you have residents on oxygen now, and what kind of equipment do they use?
• Who helps if my mother can no longer put on the cannula or change the setting?
• Is a nurse or respiratory therapist available, and how often?
• What happens during a power outage if she uses a concentrator?
• Where are tanks stored, and who deals with the supplier?
• Does she need a portable unit for the dining room and outings?

Ask the doctor, too, whether your parent can still operate the equipment and judge when oxygen is needed. Oxygen is often part of a larger picture, covered in heart failure and COPD in assisted living, and outside clinicians are covered in therapy and home health in an RCFE. Medicare Part B covers oxygen equipment for use in the home for people who are eligible, so ask the supplier what your parent would owe.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. When a parent uses oxygen, 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 it, and she goes on the tours with you. What a home may accept is decided by the home, the doctor and the state. To talk it through, contact Hamssa, or start with the California Assisted Living Placement Guide.