This Hawaii Administrative Rules chapter establishes licensure standards for assisted living facilities, covering application and renewal procedures, building and structural requirements, emergency and disaster planning, staffing and administration, inservice education, range of services (including personal care, nursing oversight, and medication management), recordkeeping, and admission/discharge policies. Operators must obtain a license from the Department of Health before admitting residents, undergo inspections at least every two years, and comply with all minimum standards set forth in the chapter. The chapter emphasizes aging-in-place principles, negotiated care plans, and resident dignity and independence.
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§11-90-1
§11-90-2
§11-90-3
§11-90-4
§11-90-5
§11-90-6
§11-90-7
§11-90-8
§11-90-9
§11-90-10
§11-90-11
HAWAII ADMINISTRATIVE RULES
TITLE 11
DEPARTMENT OF HEALTH
CHAPTER 90
ASSISTED LIVING FACILITY
Purpose
Definitions
Licensing
Minimum building and structural
requirements
Emergency care and disaster planning
General policies, practices and
administration
Inservice education
Range of services
Records and reports
Admission and discharge requirement
Severability
§11-90-1 Purpose. The purpose of this chapter is
to establish a new category of community based
residential care setting to be named "assisted living
facility" and to establish minimum standards and
requirements for licensure to protect the health,
welfare, and safety of residents in such facilities.
Assisted living facilities shall serve the purpose of
providing a combination of housing, meal services,
health care services, and personalized supportive
services designed to respond to individual needs. The
following principles are applied:
(1) Aging in place;
(2) Negotiated plan of care· and
(3) Managed risk. [Eff AU 23 999 ] (Auth:
HRS §§321-1, 321-9, 321-10, 321-11(10),
3 21-15 . 1) (Imp: HRS § § 3 2 1-9 , 3 21-11 ( 1 O) ,
321-15.1)
§11-90-2 Definitions. As used in this chapter:
"Abuse" means actual or imminent physical injury,
psychological abuse or neglect, sexual abuse, financial
exploitation, negligent treatment, or maltreatment as
90-1
2212. ,j'.~
§11-90-2
further defined in section 346-222, HRS.
"Activities of Daily Living" or "ADL" means those
personal functional activities required by an
individual for continued well-being including eating,
dressing, personal hygiene, mobility, toileting, and
behavior management.
"Aging in place" means the process of remaining in
his or her living environment ("home") despite the
physical or mental decline that may occur due to the
aging process. For aging in place to occur, needed
services are provided, increased or adjusted to
compensate for the physical or mental decline of the
individual .within the ability of the facility.
"Assistance" means the resident can perform some
part of an activity, but cannot do it entirely alone.
"Assisted living" means encouraging and supporting
individuals to live independently and receive services
and assistance to maintain independence. All
individuals have a right to live independently with
respect for their privacy and dignity, and to live in a
setting free from restraints.
"Assisted living facility" means an assisted
living facility as defined in section 321-15.1, HRS.
This facility shall consist of a building complex
offering dwelling units to individuals and services to
allow residents to maintain an independent assisted
living lifestyle. The environment of an assisted
living facility shall include one in which meals are
provided, staff are available on a 24-hour basis and
services are based on the individual needs of each
resident. Each resident, family member, and
significant others shall work together with facility
staff to assess what is needed to support the resident
so that the resident can achieve his or her greatest
capacity for living independently. The facility shall
be designed to maximize the independence and self
esteem of limited-mobility persons who feel that they
are no longer able to live on their own.
"Choice" means viable options created for
residents to enable them to exercise greater control
over their lives.
"Department" means the department of health.
"Dependent" means the resident cannot perform any
part of an activity; the activity must be done entirely
b:y someone else.
"Dietitian" means a person who is registered or
90-2
§11-90-2
eligible for registration by the Commission on Dietetic
Registration of the American Dietetic Association.
"Dignity" means providing support in such a way as
to validate the self-worth of the individual. Dignity
is supported by designing a residential program that
delivers services in a manner which shows courtesy and
respect for a resident's right to make decisions.
"Direct care staff" means an employee of an
assisted living facility who is responsible and
available for providing services directly to residents
including assistance with activities of daily living,
such as assistance with bathing, dressing, grooming,
eating, money management, or recreation.
"Director" means the director of health or the
director's designated representative.
"Emergency" means a life-threatening situation.
It also means those conditions specific to a resident
which are identified in the resident's care plan as
requiring emergency care which may include behavior
that poses a danger to staff or others.
"Health care services" means the provision of
services in an assisted living facility that assist the
individual in achieving and maintaining the highest
state of positive well-being (i.e., psychological,
social, physical, and spiritual) and functional status.
This may include nursing assessments and the monitoring
and delegation of nursing tasks by registered nurses
pursuant to chapter 457, HRS, care management, records
management, and coordinating basic health care and
social services per residents in such settings.
"Homelike" means a type of environment which
promotes the dignity, security, and comfort of
residents through the provision of personalized care
and services to encourage independence, choice and
decision-making by each resident. A homelike
environment is also supported by the use of residential
building materials and furnishings.
"Independence" means supporting resident
capabilities and facilitating use of their abilities.
Independence is supported by creating barrier free
structures and careful design of assistive devices.
"Independent" means the resident can perform the
ADL with assistance.
"Individuality" means recognizing variability in
residents' needs and preferences and having flexibility
to organize services in response to such needs and
90-3
§11-90-2
preferences.
"Legal representative or designee" means an
attorney at law, a person holding a general power of
attorney or special power of attorney for health care,
guardian, conservator, or any person appointed by a
court to manage the personal or financial affairs of
the resident or person or agency legally responsible
for the welfare or support of the resident, other than
the facility.
"License" means an assisted living facility
license.
"Licensed nurse" means a person who is licensed as
a registered nurse in the State of Hawaii pursuant to
chapter 457, HRS.
"Licensee" means the person or entity (the owners)
to whom a license to operate an assisted living
facility is issued and who is legally responsible for
the operation of the facility.
"Managed risk" means a formal process of
negotiating and developing a plan to address resident
needs, decisions, or preferences to reduce the
probability of a poor outcome for the resident or of
putting others at risk for adverse consequences.
"Misappropriation of resident's property" means
the illegal or improper use of a client's funds or
property for profit or advantage.
"Modified diet" means a diet for a diabetic, a low
fat diet, low sodium diet, or soft diet, or a special
diet otherwise ordered by a physician.
"Neglect" means a type of action or conduct,
performed without the resident's informed consent,
which results in the deprivation of food, water,
medication, medical services, shelter, or other
services necessary to maintain minimum physical or
mental health.
"Negotiated Plan of Care or Service Plan or
Agreement" means a written plan for services developed
with the resident or significant others and which
includes a recognition of the resident's capabilities
and choices. The plan defines the division of
responsibility in the implementation of services and
specifies measurable goals.
"Personal care" means the following two categories
of activities:
(1) Activities of daily living such as
ambulation, mobility, transfer and lifting,
90-4
§11-90-2
positioning and turning, bowel and bladder
care, toileting, bathing, dressing, grooming,
feeding, exercise, and range of motion; and
(2) Instrumental activities of daily living which
are directly related to the well-being of the
resident such as meal preparation, bed,
kitchen and bathroom cleanliness,
housekeeping, laundry, essential errands,
transportation, medication assistance, and
maintenance of health records.
"Physician" means a person who is licensed to
practice medicine or osteopathy under chapter 453 or
chapter 460, HRS.
"Primary care provider" means a person who is
licensed to practice medicine or osteopathy under
chapter 453 or chapter 460, HRS, or a person who is
licensed and recognized as an advanced practice
registered nurse under chapter 457.
"Privacy" means a specific area or time over which
the resident maintains a large degree of control.
Privacy is supported with services that are delivered
with respect for the resident's civil rights.
"Resident" means any person who is receiving room,
board, care, and services in an assisted living
facility for a fee on a 24-hour basis.
"Self-administration of medication" means the act
of a resident placing medication in or on his or her
own body without assistance. This means the resident
manages and takes his or her own medications, the
resident identifies his or her own medication, the time
and manner of administration.
"Service plan" means a written plan for services
developed with input from a facility staff
representative, the resident or significant other (if
the resident consents) and includes recognition of the
resident's capabilities and choices. The plan defines
the division of responsibility in the implementation of
the services to be provided and specifies measurable
goals. The service plan also specifies who will be
responsible for providing services and when and how
often care and services will be provided or arranged.
The plan shall be developed at the time of admission
and shall be reviewed and updated at least semi
annually or when the condition of the resident changes,
or when the need arises.
"Services" means activities or care provided by
90-5
§11-90-2
the facility which assist the residents in developing
appropriate skills to increase or maintain their level
of functioning or which assist them in performing
personal care or activities of daily living.
"Social work services" means the professional
activity of helping individuals, groups, or communities
to enhance or restore their capacity for social
functioning and to create societal conditions favorable
to their goals.
"Unlicensed assistive personnel" means an
individual who is not licensed to practice nursing, but
who provides tasks of nursing care in the State of
Hawaii pursuant to chapter 457, HRS.
"Waiver" means an exemption from a specific rule
for a duration not longer than one year which may be
permitted a facility, for a specified period of time,
at the discretion of the director.
Whenever the singular is
may include the plural. [Eff
---u-:,,. chapter it
HRS §§321-1, 321-9, 321-10, 321-11(10),
HRS §§321-9, 321-11(10), 321-15.1)
] (Auth:
321-15.1} (Imp:
§11-90-3 Licensing. (a) The facility shall meet
all requirements for licensure under state law. All
assisted living facilities shall be licensed except
those operated by the federal government. The licensee
shall file an application with the director and the
facility shall be licensed pursuant to this chapter
prior to admitting residents.
(b) The director or designated representative
shall inspect each assisted living facility no less
than every two years for relicensing. The director or
designated representative, without prior notice, may
enter the premises at any reasonable time to secure
compliance with or to prevent a violation of this
chapter.
(c) Summary reports of licensing inspections
shall be kept on file in the facility and shall be
available upon request.
(d) No facility licensed under the provisions of
this chapter, shall deny admission to any individual on
account of race, religion, ancestry, sexual
orientation, or national origin.
(e) The director shall prescribe the content and
form of the license, and may authorize a waiver or
§11-90-3
waivers for a particular facility.
(f) In the event of a change of name, location,
ownership, or licensed occupancy, the director shall be
notified fifteen days prior to the change; an
inspection at the discretion of the director shall be
conducted and, if the provisions of this chapter are
met, a new license issued.
(g) Every license shall continue in force for a
period of no less than two years unless otherwise
specified, or unless suspended or revoked.
(h) Following inspection of the facility by the
department, a list of deficiencies, if any, shall be
presented to the facility. The facility shall return a
plan of correction to the department within ten days
that addresses each of the deficiencies identified by
the department. Facilities shall be allowed a
reasonable time to implement the plan of correction. A
follow-up survey and inspection shall be made by the
department to determine the progress in the plan of
correction. If there has not been substantial progress
in carrying out the plan of correction, the license
shall not be renewed. At the discretion of the
director, a provisional license may be issued.
(i) The current license shall be posted in a
conspicuous place visible to the public within the
facility. A facility which has fulfilled the
requirements of licensure shall be known as an assisted
living facility and this designation shall be reflected
on the facility's license.
(j) The director may suspend, revoke, or refuse
to issue a license for failure to comply with the
requirements of this chapter, or for any cause deemed a
potential hazard to the health and safety of the
residents, employees, or the general public. Any
person affected by the director's final decision of
denial, suspension, or revocation may appeal in
accordance with chapter 91, HRS.
(k) An applicant for a license or relicensing may
be denied a license or relicense for any of the
following reasons:
(1) Failure to meet requirements of this chapter;
(2) Financial inability to operate and conduct
the facility in accordance with these minimum
standards and rules;
(3) Conviction in a court of law; or
(4) Had a substantiated finding of abuse, neglect
90-7
§11-90-3
or misappropriation of resident funds or
property in any civil action.
(1) Penalties, hearing, and appeals. In addition
to any other appropriate action to enforce this chapter
pursuant to state law, the director may initiate
procedures for invoking fines as provided in section
321-20, HRS and to revoke the license after hearing
held in accordance with chapter 91, HRS.
Infractions which may require invoking the
procedures in this subsection include, but are not
limited to the operation of an assisted living facility
without a license granted by the department or if
substantive violations of this chapter are found as a
result of routine or unannounced inspection of a
facility which has a license.
(m) Applicants for licensure or existing
licensees applying for license renewal shall pay
appropriate fees, as determined by the director. Prior
notice of the amount of the fee shall be provided the
licensee.
(n) Separate buildings located contiguously and
operated as an integrated unit by the same management
are not required to have separate licenses. Distinct
staffing plans are required for each building and must
be approved in advance by the department.
(o) Applications for licensure shall be made to
the department on a form provided by the department and
shall include full and complete information as follows:
(1) Identity and financial interest of any
person, including stockholders, who have
ownership in the facility representing an
interest of ten per cent or more in such
assisted living facility;
(2) Each officer and director of the corporation
if the facility is organized as a
corporation, each general partner if the
facility is organized as a partnership, or
the governing body if the facility is
government owned;
(3) A summary of all lease, management, and sales
agreements and contracts relative to the
direct operation and ownership of the
facility. The applicant shall provide a copy
of any of the above, if requested by the
department;
(4) Name of the administrator of the facility and
90-8
§11-90-4
a list of three references;
(5) Location (address) of the facility and
mailing address;
(6) Maximum number of residents to be served at
any one time;
(7) Information and supporting documentation
regarding qualifications and training of
staff as required in these rules;
(8) Verification of evacuation capacity
designation for fire and life safety
protection;
(9) Proposed annual budget identifying sources of
revenue; and
(10) Evidence that the premises comply with state
and county building, housing, fire, and other
codes, ordinances, and laws for the type of
occupancy to be licensed. Compliance shall
include but not be limited to the following:
(A) Occupancy requirement of the county
building code;
(B) Applicable zoning ordinance of the
county;
(C) The obtainment of a use permit if
required by the county; and
(D) Applicable state laws and administrative
rules relating to sanitation, health,
and e 'ronmental safety.
[Eff G 2 3 1999 ] (Auth: HRS
§§321-1, 321-9, 321-10, 321-11(10),
321-15.1) (Imp: HRS §§321-9, 321-11(10),
321-15.1)
§11-90-4 Minimum building and structural
reauirements. The facility shall provide each resident
with the following:
(1) Apartment unit with a bathroom, refrigerator,
and cooking capacity, including a sink;
(2) The unit shall be a minimum of 220 square
feet, not including the bathroom;
(3) The cooking capacity may be removed or
disconnected depending on the individual
needs of the resident;
(4) The unit shall have a separate and complete
bathroom with a sink, shower, and toilet;
(5) The unit shall accommodate physically
90-9
§11-90-4
challenged persons and persons in
wheelchairs, as needed;
(6) The unit shall have a call system monitored
24-hours a day by facility staff;
(7) The unit shall be wired for telephone and
television;
(8) Access to common areas such as activity
rooms, lounges, dining rooms, and laundry;
and
(9) Private accessible mailbox in which the
resident may send and receive mail, which
meets~9~tal standards.
[Eff AUb 231999 ) (Auth: HRS §§321-1,
321-9, 321-10, 321-11(10), 321-15.1) (Imp:
HRS §§321-9, 321-11(10), 321-15.1)
§11-90-5 Emergency care and disaster planning.
(a) There shall be written policies and procedures to
follow in an emergency which shall include provisions
for the following:
(1) Arranging for rapid primary care provider
attention or arranging for other available
assistance;
(2) Transportation arrangements for
hospitalization or other services which are
appropriate;
(3) Maintenance of an appropriate first aid kit
for emergency use; and
(4) Quarterly rehearsal of emergency evacuation
plans for staff and residents to follow in
case of fire, explosion, or other civil
emergency occurring in or within the environs
of the facility.
(b) The facility shall develop and maintain a
written disaster preparedness plan to be followed in
case of emergency or disaster. A copy of the plan
shall be readily available at all times within the
facility. Such plan shall include procedures for
evacuating all individuals in the facility, which shall
include the following:
(1) Provisions for evacuating residents with
impaired mobility or cognitive impairments;
(2) Provisions for transporting all of the
residents of the facility to a predetermined
appropriate facility or facilities that will
90-10
§11-90-7
accommodate all the residents of the facility
in case of a disaster requiring evacuation of
the facility; and
(3) A written transfer agreement, renewed every
two years, with the appropriate facility or
facilities for accommodating all of the
residents of the facility in case of a
dis~s~er requiri~~ 1~vfl~u~hh@ of the
facility. [Eff AUO ;:t 3 i!,8~ J (Auth: HRS
§§321-1, 321-9, 321-10, 321-11(10), 321-15.1)
(Imp: HRS §§321-9, 321-11(10), 321-15.1)
§11-90-6 General policies, practices, and
administration. (a) The administrator or director of
the assisted living facility shall:
(1) Have at least two years experience, in a
management capacity, in the housing or health
care services or personal care industries, or
any combination thereof;
(2) Show evidence of having completed an assisted
living facility administrator's course or
equivalent course acceptable to the
department; and
(3) Be accountable for providing training for all
facility staff in provision of services and
principles of assisted living.
(b) All facility staff shall be in compliance
with current department tuberculosis clearance
procedures.
(c) All staff shall be trained in cardiopulmonary
resuscitation and first aid.
(d) The facility shall have written policies and
procedures which incorporate the assisted living
principles of individuality, independence, dignity,
home-like environment.
] (Auth: HRS §§321-1, 321-9,
3 21-10 , 3 21- 1 ( 10) , 3 21-15 . 1) (Imp: HRS § § 3 21-9 ,
321-11(10), 321-15.1)
§11-90-7 Inservice education. There shall be a
staff inservice education program for the entire staff
that includes:
(1) Orientation for all new employees to acquaint
them with the philosophy, organization,
90-11
§11-90-7
practice, and goals of assisted living; and
(2) Ongoing inservice training on a regularly
scheduled basis (minimum of six hours
annually) . [ Eff AUG 2 J (Auth: HRS
§§321-1, 321-9, 321-10, (10), 321-15.1)
(Imp: HRS §§321-9, 321-11(10), 321-15.1)
§11-90-8 Range of services. (a) Service plan.
(1) The assisted living facility staff shall
conduct a comprehensive assessment of each
resident's needs, plan and implement
responsive services, maintain and update
resident records as needed, and periodically
evaluate results of the plan. The plan shall
reflect the assessed needs of the resident
and resident choices, including resident's
level of involvement; support principles of
dignity, privacy, choice, individuality,
independence, and home-like environment; and
shall include significant others who
participate in the delivery of services;
(2) A service plan shall be developed and
followed for each resident consistent with
the resident's unique physical,
psychological, and social needs, along with
recognition of that resident's capabilities
and preferences. The plan shall include a
written description of what services will be
provided, who will provide the services, when
the services will be provided, how often
services will be provided, and the expected
outcome. Each resident shall actively
participate in the development of the service
plan to the extent possible;
(3) The initial service plan shall be developed
prior to the time the resident moves into the
facility and shall be revised if needed
within 30 days. The service plan shall be
reviewed and updated by the facility, the
resident, and others as designated by the
resident at least annually or more often as
needed; and
(4) The facility shall designate a staff member
to review, monitor, implement, and make
appropriate modifications to the service plan
90-12
for each resident.
(b) Services.
§11-90-8
(1) The assisted living facility shall provide
the following:
(A) Twenty-four hour on-site direct staff to
meet the needs of the residents;
(B) Three meals daily, seven days a week,
including modified diets and snacks
which have been evaluated and approved
by a dietitian on a semi-annual basis
and are appropriate to residents' needs
and choices;
(C) Laundry services to the extent that the
resident is unable to perform these
tasks for himself or herself;
(D) Opportunities for individual and group
socialization;
(E) Services to assist the resident in
performing all activities of daily
living, including bathing, eating,
dressing, personal hygiene, grooming,
toileting, and ambulation;
(F) Nursing assessment, health monitoring,
and routine nursing tasks, including
those which may be delegated to
unlicensed assistive personnel by a
currently licensed registered nurse
under the provisions of the state Board
of Nursing; and
(G) Household services essential for the
health and comfort of the resident (e.g.
floor cleaning, dusting, bed making,
etc.) .
(2) The assisted living facility shall also have
the capability to provide or arrange access
to the following services:
(A) Transportation for medical and social
appointments;
(B) Ancillary services for medically related
care (e.g. physician, pharmacist,
therapy, podiatry, etc.), barber or
beauty care services, social or
recreational opportunities, and other
services necessary to support the
resident;
(C) Services for residents who have behavior
90-13
§11-90-8
problems requiring ongoing staff
support, intervention, and supervision;
(D) Social work services; and
(E) Maintenance of a personal fund account
for residents showing deposits and
withdrawals.
(3) The assisted living facility shall have
policies and procedures relating to
medications to include but not be limited to:
(A) Self-medication:
(i) Residents must have physician or
prescribing advanced practice
registered nurse's written order of
approval for self-medication of
prescription medications;
(ii) Residents able to handle their own
medication regimen may keep
prescription medications in their
unit;
(iii) Residents may keep and use over
the-counter medications in their
unit without a written order unless
otherwise indicated by a physician
or prescribing advanced practice
registered nurse's written orders;
(iv) If more than one resident resides
in the unit, an assessment shall be
made of each person's ability to
safely have medications in the
unit. If safety is a factor, the
medication shall be kept in a
locked container in the unit; and
(v) Residents who self-medicate with
prescription drugs or maintain
over-the-counter drugs in their
units shall have all their
medications reviewed by either a
registered pharmacist, registered
nurse, or physician at least every
90 days.
(B) Administration of medication:
(i) Prescription and non-prescription
medications which the facility has
responsibility for administering to
a resident must be identified in
the resident's record and must be
90-14
§11-90-9
prescribed in writing for the
resident by a physician or
prescribing advanced practice
registered nurse; and
(ii) The facility shall provide and
implement policies and procedures
which assure that all medications
administered by the facility are
reviewed at least once every 90
days by a registered nurse or
physician, and is in compliance
with applicable state laws and
administrative rules.
(4) Recreational or social activities are to be
made available to residents on a daily basis.
(c) Licensed nursing staff shall be available
seven days a week to meet the care managel\~~t
monitoring needs of the residents. [Efff\UO J
(Auth: HRS §§321-1, 321-9, 321-10, 321-11(10),
321-15.1) (Imp: HRS §§321-9, 321-11(10), 321-15.1)
§11-90-9 Record and reports system. (a) The
facility shall establish policies and procedures to
maintain a system of records and reports which shall
include the following:
(1) Copy of a current physician or primary care
provider's report of resident's physical
examination which includes tuberculosis
clearance and verification that the resident
is free from other infectious or contagious
diseases;
(2) Service plan;
(3) Contracts or other documents which set forth
details of services to be delivered, charges,
and other conditions agreed to between the
resident and the facility; and
(4) Incident reports of any bodily injury or
other unusual circumstances affecting a
resident which occurs within the facility, on
the premises, or elsewhere, shall be retained
by the facility under separate cover, and be
available to authorized personnel and the
department. The resident's physician or
primary care provider shall be called
immediately if medical care is necessary or
90-15
§11-90-9
indicated.
(b) The facility records and reports shall be
available for review at any time by authoriz
personnel and the department. [Eff AUG 2 3 J
(Auth: HRS §§321-1, 321-9, 321-10, 321-11(10,
321-15.1) (Imp: HRS §§321-9, 321-11(10), 321-15.1)
§11-90-10 Admission and discharge. (a) The
facility shall develop admission policies and
procedures which support the principles of dignity and
choice. The admissions process shall include
completion of or the providing of the following:
(1) A service listing which details the services
available, the base rates, the services
included in the base rate, and the fees for
all other additional services. A service
listing shall also describe services which
the facility does not provide, but will
assist to arrange or coordinate;
(2) Handbook or house rules which state the
assisted living philosophy and clearly define
the privileges and responsibilities of the
resident and the conditions under which
apartment units may be occupied by the
residents;
(3) A service plan for the resident developed by
facility staff with the resident and
significant others, specifying care and
services to be provided, based on resident
needs and choices;
(4) A service contract which documents a
completed agreement between the resident and
the facility, describing services to be
provided, rates charged, and conditions under
which additional services or fees may be
charged;
(5) The resident shall be informed of his or her
rights, including steps for complaints and
appeals upon admission; and
(6) Designation of alternative decision-maker or
legal representative.
(b) The facility shall develop discharge policies
and procedures that include, but not be limited to, the
following:
(1) Residents shall receive a written 14 day
90-16
(
§11-90-11
notice when:
(A) Resident's behavior imposes an imminent
danger to self or others;
(B) The facility cannot meet the resident's
needs wi th available support services or
services are not available; and
(C) Resident or responsible person has a
documented established pattern in the
facility of not abiding by agreements
necessary for assisted living; or
(2) Residents shall receive a written notice
when:
(A) The facility has had its license
revoked, not renewed, or voluntarily
surrendered; or
(B) Non-payment of charges by the resident.
(3) Residents shall be given the opportunity of
an informal conference if requested, in
writing, within 10 days of receip t of
discharge notice. The purpose of the
conference is to determine if a satisfactory
resolution can be reached. Participants in
the conference may include the facility
representative, the resident, and others as
designated by the resident, a family member,
or al \ ok these indi victuals.
[Eff AUo 2 3 1999 ] (Auth: HRS §§321-1,
321-9, 321-10, 321-11(10), 321-15.1) (Imp:
HRS §§321-9, 321-11(10), 321-15.1)
§11-90-11 Severability. If any provision of this
chapter or the application thereof to any person or
circumstance is held invalid, the remainder of this
chapter, or the application of the provision to other
persons or circUJ1) 9ha Rc&srg fit-Q.all not be affected
thereby. [Eff AUb ,J ~~ J (Auth: HRS §§321-1,
321-9, 321-10, 321-11(10), 321-15.1) (Imp: HRS §§321-9,
321-11(10), 321-15.1) ,,
90-17
221!