Esta ley establece la "Ley para la Creación de Proyectos de Vivienda de Vida Asistida para Personas de Edad Avanzada en Puerto Rico". Declara como política pública fomentar la creación y mantenimiento de proyectos de vivienda con el concepto de Vida Asistida, establece un modelo de proyecto, un esquema regulatorio especial, derechos y responsabilidades para su implementación, y penalidades por incumplimiento. Define términos clave como Actividades de la Vida Diaria, Vida Asistida, Residencia, y Persona de Edad Avanzada. Regula la certificación de los proyectos por el Departamento de la Vivienda, los servicios especiales que deben proveer, los servicios médicos y de enfermería permitidos, los requisitos de personal y capacitación, y las funciones de la Oficina para Asuntos de la Vejez y el Ombudsman para Residentes de Edad Avanzada. Establece derechos para los residentes, procedimientos de revisión de certificaciones, penalidades por violaciones, exenciones contributivas y municipales, y la creación de un proyecto modelo. Autoriza acuerdos de colaboración entre agencias y la promulgación de reglamentos y formas para su implementación. Excluye a estas residencias de la aplicación de la "Ley de Establecimientos para Personas de Edad Avanzada".
(H. B. 1763) (Conference) (Approved September 3, 2003)
To set forth the "Act for the Creation of Assisted Living Housing Projects for the Elderly in Puerto Rico;" to declare as Public Policy of the Commonwealth of Puerto Rico the furthering of the creation and maintenance of housing projects that incorporate the structural and conceptual framework of Assisted Living; to establish a model Assisted Living project; and to establish the special regulatory scheme for this housing concept, establish rights and responsibilities for its implementation, and penalties for noncompliance with this Act, and for other purposes.
As scientific and technological advances have contributed toward an increase in life expectancy and the hope for well being has been redefined, the elderly population has increased at an unprecedented accelerated rate. Concurrently, the noticeable progress of medicine entails, at an advanced rate, the neutralization or amelioration of many incapacitating and weakening conditions typical of advanced years. Consequently, with the current state of science, in many cases, being elderly is not equivalent to being senile or virtually disabled. There are numerous elderly persons who are self-sufficient in many aspects of their daily lives, thus they deserve more consideration and respect for their privacy, autonomy and individuality.
All social components should become aware of this reality and act upon it, so that many of our elderly persons may recover the individuality and freedom of action that have been taken away from them. In this liberating
feat, the State must assume a starring role in the interest of harboring and lodging pursuant to the protection of the Law, the thousands of elderly persons who, since they are not an active part of the work force and the economy, are denied their demands for more personal autonomy. In addition, the intervention of the State to safeguard the privacy and private spaces for them becomes ever more peremptory, in view of the fact that many of our elderly depend upon persons and entities foreign to their nuclear family for room and board. For these reasons, there is urgent need for legislation that sets forth new organizational structures that are less invasive of privacy and contribute toward the development and free expression of the personality and individuality of our elderly persons.
For these purposes, this Act is hereby promulgated, setting forth a special regulatory framework known as "Assisted Living," originated in the region of Scandinavia and developed in the United States in the mid 80s. It applies to housing projects that, wholly or in part, look after elderly persons who do not suffer from serious physiological, cognitive or psychological limitations and who are able to manage by themselves in some aspects of their daily lives.
Likewise, this Act is promulgated taking in consideration that the concept of housing within the conceptual framework of assisted living shall be a cost efficient means of seeing to their care, given that in the same measure that there is less invasion of their individual space, in that same proportion innumerable services that unjustifiably increase the price of care for elderly persons who are self-sufficient to a certain extent shall be rendered unnecessary.
It must be made clear that this Act is geared only toward a segment the elderly population in Puerto Rico, and therefore is not an attempt to apply generically to the members of this population. Thus, this Act does not intend to take the place of Act No. 94 of June 22, 1977, as amended, known as the "Establishments for the Aged Act," which shall continue to be the general Law applicable to elderly care centers established in Puerto Rico. This Act intends to set forth a new modality of housing with special services in behalf of this segment of the population that still has the vitality and the potential to fend for themselves in many phases of daily living, and offer accordingly a lifestyle alternative to them that differs from the one existing in Puerto Rico, in which they receive the services they truly need for their safety and well being, instead of those of a foreign entity establishes as what they need. It should be the natural passage of time that determines which services the elderly person needs to receive from a foreign entity. By setting forth the boundaries of the variety of services offered to elderly persons more precisely, this Act pursues the lessening of the costs to be faced for the enjoyment of assistance in this phase of life. By establishing such limits, this Act also promotes the eradication of the paternalist view that limits and hinders the freedom to decide and the range of action of the elderly. Developers and administrators may also serve and attend to the actual needs of this population segment without unjustifiably extending the rendering of services, thus discouraging the elderly due to the increase in service costs.
It must be said that the federal Department of Housing has consolidated most of its grants into a SuperNOFA, in which said Department announced the availability of approximately $2.2 billion dollars in federal funds by fiscal year 2002 to finance grants that span forty-one (41) categories within
programs operated and managed by the Offices of the federal Department of Housing. In addition, there are federal funds pursuant to Section 202 Supportive Housing for the Elderly Program and pursuant to the Assisted Living Conversion Program for Eligible Multifamily Projects of the federal Department of Housing, Section 8, HOME Program, among others. Therefore, one of the crucial aspects for the creation of this Act is that the federal Department of Housing does not ensure any loans for this type of facilities, unless the establishment is regulated by a state law. Moreover, with the creation of this Act, the Commonwealth of Puerto Rico and any other developer of this type of housing are hereby allowed to procure the necessary federal financing for the development of these facilities, extending same to low income persons, contributing in this manner toward the economic development of both our country and our elderly persons.
Section 1. - Title This Act shall be known as the "Act for the Creation of Assisted Living Housing Projects for the Elderly in Puerto Rico."
Section 2. -Definitions: For purposes of this Act, the definitions set forth herein shall have the following meanings:
a) Activities of Daily Living- everyday tasks that include personal hygiene, bodily hygiene, sanitary needs, the acts of dressing and bathing, feeding, walking and all other related tasks within the personal care needs that are within the proposed scope of this Act. b) Incidental Activities of Daily Living - includes tasks such as cooking, laundry, domestic chores, shopping for groceries and other items, use of transportation, assistance in the management of finances if
so requested by the resident, assistance for the use of essential services, and other related tasks within the proposed scope of this Act. c) Alterations - any of the following changes performed after the date of the last certification of the housing complex:
h) Therapeutic Diet - Meal Plan that has been prescribed or ordered by the primary physician or nutritionist of the resident. i) Entity - any profit or non profit organization or corporation duly authorized pursuant to Act No. 144 of August 10, 1995, as amended, known as the "Corporations Act of the Commonwealth of Puerto Rico." j) Commonwealth of Puerto Rico - all agencies, instrumentalities and other subdivisions, as well as all public corporations and each of the municipalities of Puerto Rico. k) Bathroom Facilities - room equipped with a shower and/or bathtub, lavatory and a toilet in which a person may shower or bathe and perform hygienic activities.
q) Person - any natural or juridical person. r) Elderly Person - any natural person sixty (60) years old or more, who meets the qualification criteria pursuant to this Act that are consistent with the concept of Assisted Living. When due to medical necessity and in the best interest of the person's safety, said person requires personal or medical care different from that set forth in this Act, said person shall not be pursuant to the provisions of this Act, and therefore, the residence cannot give lodging to said person pursuant to this Act. The administrators shall make this determination in those cases in which the safety, welfare, or comfort of the person may be affected adversely by the fact that their specific needs cannot be adequately met, nor can the limitations they suffer be dealt with thoroughly, given that they are not within the conceptual framework of Assisted Living.
Said determination shall be in agreement with the guiding criteria prepared by means of regulation to be set forth by the Office for such purposes. s) Office - the Office for the Affairs of the Elderly, Office of the Governor. t) Medication Monitoring Plan - a program for reminding the residents to take their scheduled medication. For the purposes of this Plan, residents shall be reminded to take their medication as scheduled, which includes opening the container, reading the labels, observing and documenting the residents while they take their medication, and verification of the dose that the resident shall self-administer against the instructions on medication labels. The Service Coordinator or the person designated by same shall make sure that said resident has obtained and taken the dose as prescribed and shall keep a written record indicating the
actions of the resident concerning said medication. u) Ombudsman - the Ombudsman for Aged Persons Residing in Long-Term Care Establishments, created by Act No. 308 of October 3, 1999. v) Sponsor - person or legal entity named on the certification of an Assisted Living Residence, or the person named in the application for renewal of certification of a previously certified residence. w) Legal Representative - a tutor, guardian or representative of an elderly person, duly authorized by a court with jurisdiction, or by means of a duly granted power of attorney, when legally appropriate. x) Residence - entity that provides room and board and administers personal care services for the elderly who require assistance with their activities of daily living. This shall include any non profit entity that provides daily living assistance to three (3) or more elderly persons who have neither consanguinity nor affinity with the persons that manage said entity. For purposes of this Act, the residence shall have not less than five (5) residential units and shall display the certification for the operation of said residence issued by the Department of Housing in a location that is visible to all visitors and residents. Excluded from the foregoing definition are long term care centers that provide rehabilitation, convalescence or nursing services to individuals; hospices that render services to terminal patients and all centers that render services to elderly persons with substantial cognitive, physical limitations, or limitations of any other nature which greatly limits their self sufficiency, or any establishment pursuant to Act No. 94 of June 22, 1977, as amended, known as the "Establishments for the Aged Act."
The determination of which type of resident is pursuant to the
preceding definition shall be made by the Office for the Affairs of the Elderly. For said purpose, the Office shall seek advice from an interdisciplinary team of experts in the care of elderly persons to establish the guidelines for making the corresponding determination. The residences shall follow said guiding criteria and guidelines set forth by the Office for the determination of whether or not a patient is protected by this Act at all times. Said determination shall be the object of a review during the periodic visits of the Office and in the process of certification of the residence pursuant to this Act. The residence shall not combine the structural and conceptual framework of assisted living with any other organizational arrangements that include elderly care establishments. y) Resident - elderly person that lives in a residence within the conceptual framework of assisted living and who receives individualized services within a program designed individually by means of a Residency Agreement who does not require continuous or supervised medical care. z) Serious Risk - any situation in which one or more residents of a residence established within the conceptual framework of assisted living is in imminent danger of death or exposed to immediate and serious emotional or physical harm resulting from any act or omission by the Sponsor or persons pursuant to the supervision of the Sponsor of said entity. aa) Secretary - Secretary of the Department of Housing of the Commonwealth of Puerto Rico. bb) Unit - section within the conceptual framework of assisted living residence that is designed to be occupied according to the Residency Agreement by one (1) or two (2) persons as their private room, with a door with an external lock, a bathroom, and a small kitchen
(kitchenette). Nevertheless, the Department of Housing is hereby empowered to vary the design of the kitchenette as long as each resident has direct access to kitchen facilities. cc) Assisted Living - the concept of assistance created in housing projects in which any entity shall comply with the following requirements:
i) to provide spacious rooms; and ii) to provide separate personal care for three (3) or more elderly persons that are not related within the fourth degree of consanguinity or second of affinity to the provider of said services, either directly through the employees of said entity or by means of agreements with other personal care organizations; and iii) to be able to accept payment or reimbursements from third parties in behalf of or from the residents, as payment or installments toward the lease rent rate set forth by means of the Residency Agreement.
Section 3. - Public Policy Statement It shall be the public policy of the Commonwealth of Puerto Rico to care for elderly persons by means of housing programs created within the structural and conceptual framework of Assisted Living, as defined and regulated herein.
In this sense, it shall be understood that all the system components of the government of the Commonwealth of Puerto Rico shall be bound to collaborate and expedite the maintenance and development of housing projects within the concept of assisted living to the extent that its respective duties and fiscal resources allow. It shall also be the public policy of the Commonwealth of Puerto Rico to grant priority treatment in state public financing to housing projects within the concept of assisted living, in cases in which the defining criteria set forth herein are met.
Section 4. - Construction of the Law
This Act shall be interpreted in favor of the elderly person in such a manner that the guarantees and rights provided in the Bill of Rights of Elderly Persons.
This Act shall be interpreted liberally regarding all matters leaning toward respect toward the individuality and autonomy of elderly persons.
Section 5. - Certification a) Any entity seeking to operate a housing project within the concept of assisted living shall submit an application for certification to the Department of Housing along with an internal revenue stamp in the amount of one hundred (100) dollars to defray expenses for the processing of same. No person or entity shall establish, maintain, or alter any housing project within the conceptual framework of assisted living without first obtaining a certification from the Department of Housing for a term of two (2) years. The certification must be renewed within not less than thirty (30) days prior to the expiration of the term of the original certification. If any person or entity wishes to promote any project within the conceptual framework adopted pursuant to this Act, and a certification for the operation of said project has not been issued, the Sponsor or the applicant shall notify the Department of Housing in writing of his/her intention to request said certification, and indicate in the advertising or promotional materials that the sponsored project has not completed the certification project of said Department. b) The certification request shall also include as minimum requirements, subject to any other additional requirement of the Department of Housing, the following:
i) the number of units and residents per unit that the residence shall have and for which the certification is being requested; ii) the location of the units, common areas and exits per floor; iii) the organizational structure of services, meals and lodgings; iv) the characteristics and types of services, activities and security to be offered, the arrangements made to provide same, including agreements or contracts with third parties and the arrangements made with hospital and care institutions;
v) the design of the Medication Monitoring Plan for the residents and the Plan for Immediate Assistance to the residents in response to emergency situations; vi) the number of employees to be contracted for the operation of the residence and their duties and schooling; vii) a copy of the Residency Agreement that shall be used in the residence; viii) a copy of all construction certifications, municipal licenses and permits required by the Commonwealth of Puerto Rico and its instrumentalities for the operation of said residence in which the applicant or Sponsor shall be responsible for the costs incurred as a result of such requirements; and ix) the notification procedures for residents or their legal representation when there is any change in the Residency Agreement. c) The Department of Housing shall determine by means of regulation any additional information or procedure necessary for the certification of the housing project developed pursuant to this Act. d) The renewal and maintenance of the certification of all projects within the conceptual framework of assisted living may be subject to the opinion and recommendations of the Office.
Section 6. - Special Services For a housing project within the conceptual framework of assisted living
to be certified as such, the Sponsor shall provide or establish arrangements for the rendering of services to persons with an Individualized Service Plan to ensure for the elderly person, as a minimum, the following:
a) Supervision and assistance for the performance of daily living activities or incidental activities of daily living; a Medication Monitoring Plan ; a minimum of two (2) daily meals if the units of the residence have a kitchenette. If the units of the residence do not have a kitchenette, it shall be the responsibility of the residence to make available a kitchen facility accessible to all the units; timely assistance in emergency situations supplied by personnel available twenty-four (24) hours for such purposes and complemented by an emergency response system for emergencies or any other additional emergency response system required by the Department or the Office. b) As part of the incidental activities of daily living, each resident shall be provided, at least once per week, with a recreational, educational or leisure activities of the resident's choice, as long as it does not contravene the law, morals or the public order. For this purpose, the Office shall obtain cooperative agreements with internal tourism and entertainment entities to establish special service offers to such residents. The activity shall be chosen by the resident, pursuant to his/her intellectual or recreational interests. c) In addition, professional or technical courses or seminars that are in tune with the interests and aspirations of the residents must be one of the components of the incidental activities of daily living. For this purpose, the residences may establish collaborative agreements with the Department of Education, the Department of the Family, and with any other agency that is capable of offering courses or programs of interest to
the residents of any assisted living housing project. d) Provide up to three (3) daily meals or therapeutic diets, but not less than two (2) per day. All housing projects pursuant to this Act shall use the dietary criteria recommended by means of regulation by the Office, in coordination with the Department of Health.
Those who in spite of having met the criteria set forth by law initially, later require services beyond the service coverage pursuant to this Act shall not be able to continue to live in the units covered by this Act.
Section 7. - Medical and Nursing Services The Sponsor of the residence shall provide or make arrangements to provide health services pursuant to the following conditions:
a) The rendering of high skilled and complex medical and nursing services are hereby restricted in all residences to legally authorized certified providers that do not have any sort of bonds with the residence in question. Said provider or external hospice shall not, pursuant to any circumstances, train or instruct the personnel of the residence in these areas. However, it may advise the personnel regarding aspects of health care that the resident must carry out by himself/herself, or that do not require specialized knowledge or procedures. The latter shall be allowed to the extent that the powers of the resident to manage his/her own treatment are not restricted. b) It shall be allowed to provide nursing services such as insulin injections, or other medication used daily for maintenance therapy provided by a certified health care services provider or a hospice authorized by law. c) Excluded from housing projects within the conceptual
framework of assisted living are potential residents that require more than ninety (90) consecutive days of high skilled or complex medical treatment or nursing. Likewise, elderly persons who suffer seriously substantial physiological, cognitive or psychiatric conditions and incapacitating effects requiring intense, continuous and complex medical care, or who cannot self-administer a substantial part of their own treatment, nor sustain themselves without the continuous assistance of another person without risking their own safety are hereby excluded from the coverage of this Act. Also beyond the scope of the housing projects pursuant to this Act are elderly persons who require twenty four (24) hour high skilled medical attention.
Section 8. - Services Provided All housing projects within the conceptual framework of assisted living shall hereby:
a) Provide units for one (1) or two (2) persons with locked doors, to restrict unwanted entries by other residents and to achieve greater mobility, individual space and privacy in their room for the elderly residents. Single units shall have an area of at least eighty (80) square feet, while double units shall have, as a minimum, an area of one hundred sixty (160) square feet. All units shall have free access to the common areas of the residence and shall be furnished for the use of cooking equipment and food storage. The resident shall have exclusive rights to the enjoyment of his/her unit with external lock.
An individual bathroom shall be provided for every two (2) persons in residences built prospectively after this Act takes effect. Those residences already rendering services to elderly persons at the time this Act takes effect and who wish to convert to the conceptual framework of
assisted living shall provide, as a minimum, one private bath per unit, equipped with a lavatory, shower or bathtub, and one toilet, or at least with one bathroom facility for every three (3) residents. b) Design an Individualized Services Plan for each resident, which shall include a detailed description of the services needed by each person. Same shall be configured prior to the admission of elderly persons to the residence and shall be updated at least every six (6) months, or when substantial changes in the circumstances so do warrant.
The Individualized Services Plan, which shall be strictly confidential, shall identify the specific services to be provided to the person, including frequency and duration; identify the providers of the different services rendered; specify, if required by the resident, the Medication Management Plan to be used. Said plans shall be configured in such a manner that the physical, cognitive and psychosocial capabilities of each resident are taken into account. c) Contribute toward the development of a health care system that contributes toward the development of a health care system that tends toward the creation of a home environment in behalf of the residents that need to receive assistance with their daily living activities and incidental activities of daily living. d) Set forth measures that protect the individuality of the residents, while tending toward affording them independence and privacy. e) Facilitate for residents the use and retention of their personal property. f) Allow the residents to configure ways in which the medical services shall be received, while never risking their safety. g) The residence shall be responsible for the supervision of the
general condition of the residents, even when the residents do not use the assistance services provided by the residence.
Section 9. - Personnel Requirements and Training A. Administrator and Services Coordinator
Every residence shall have an Administrator of proven administrative and professional capabilities, with at least a Bachelor's degree or its equivalent in experience in Human Resources, Housing Administration, or in Health Care Services.
Such Administrator shall render full time services during work hours and be not less than twenty-one (21) years old. The personnel providing personal health care services shall be not less than twenty-one (21) years old and shall comply with a training program of seventy (70) hours per year in an institution accredited to offer said training by the Higher Education Council.
In addition, all residences shall have a Services Coordinator that shall have at least a Bachelor's degree or its equivalent in experience, which shall be in rendering direct services to elderly persons, and shall have at least one graduate nurse, one social worker, one occupational therapist and one psychologist, duly authorized to practice their profession rendering services to the residents in the jurisdiction of the Commonwealth of Puerto Rico. B. Personnel Records Maintenance
Every residence shall keep a personalized record of each employee and manager in which shall include a description of their tasks, and their technical or professional credentials and evaluations.
The residence shall be bound to keep at least one employee on call at all times for every eight (8) residents. In the residence, the personnel records shall be developed and maintained in a confidential manner. Said records shall contain at least the following information:
a) Job description;
b) Academic background and employment experience;
c) Professional licenses or certifications, if applicable;
d) Documentation on personnel orientations and trainings offered;
e) Evaluations of work performance or memoranda. C. Personnel Training
The Sponsor of the residence shall provide all personnel and contract providers who have direct contact with the residents and all food services personnel with continued training and seminars designed for the needs of the elderly persons. However, prior to commencing work in the residence, they shall take, as a minimum, an orientation of at least one (1) day on the following matters:
a) Independent living in a residence within the conceptual framework of assisted living Philosophy;
b) Rights of the Residents;
c) Prevention of Abuse, Negligence, and Financial Exploitation of the Elderly;
d) Safety Measures and Emergency Management;
e) Prevention of transmittable diseases, including AIDS/HIV and Hepatitis B, management and control of infections in the residency and the principles of universal awareness based on the guidelines set forth in the Occupational Safety Health Act;
f) Communication techniques;
g) Awareness about the ageing process;
h) Solution of possible health problems of the residents;
i) General review of the employment requirements; and j) Sanitation and Hygiene in the preparation of foods.
All personnel working in the residence shall be aware of the needs of the residents and shall be capable of responding to any emergency twenty-four (24) hours a day.
Section 10. - Duties of the Office for the Affairs of the Elderly The Office for the Affairs of the Elderly shall perform the following actions:
a) Follow up on the operations of the residences and develop the creation of housing projects within the conceptual framework of assisted living. b) Prepare advertising campaigns in the different communications media to inform about the potential of housing project developments within the conceptual framework of assisted living, instruct elderly persons regarding the benefits of the institutional concept of assisted living and give orientations to the citizenry on the principles that inspire the development of housing projects pursuant to this Act. c) Procure, in coordination with the Department of Housing, the availability of funds and federal programs to defray expenses for assisted living services for qualified residents. d) Promulgate regulations on all matters that tend toward expediting the implementation of the provisions of this Act and of all matters that pursue the protection of the rights of elderly persons pursuant to this Act. e) Work and prepare, in collaboration with the Department of Housing, a statistical framework that allows the creation of a profile of residents that use this type of housing concept and allows the evaluation of the quality and scope of the services rendered therein. Section 11. - Rights of the Residents
a) Residents shall have a non-waiverable right to have all their documentation kept pursuant to the strictest confidentiality. b) Residents shall have the right to demand a Residency Agreement stating in detail, as a minimum, the following: the charges for each service, as well as the means for billing and the arrangements for the payment of same, explaining the manner in which the residence shall address claims from the residents, the procedure for residents to file their claims, reasonable rules for the behavior of the personnel, the administration and the residents. Said agreement, if in contravention to the letter and spirit that motivate this Act, shall be deemed non-existent. The Residency Agreement shall contain an agreement in which the residence binds itself to denounce and eradicate all acts that violate human dignity and degrade the elderly. In addition, residents shall bind themselves to occupy the unit individually, and if they wish to share their unit with another resident, they must consent to same in writing. The Residency Agreement shall also include the conditions for the termination of the residence's services, which shall be determined bilaterally. If necessary, the elderly person may seek the advice of a third party to consent to certain service termination terms and any other clause in said agreement.
A requirement which cannot be changed by an agreement of both parties is that all service terminations shall be preceded by a notice in writing thirty (30) days in advance, and that the Sponsor shall contact the Department and the Office at such time to notify the termination of the Residency Agreement of the resident for same to commence to seek government assistance for said resident, if necessary. The Residency Agreement shall be personalized to suit each resident of the housing
project within the conceptual framework of assisted living and shall be mindful of the care peculiarities of each resident in an effort to maximize the freedom of action and decision making of the resident. In addition, it shall include a clause in which the Sponsor binds himself/herself to comply with all federal and state legislation or regulation pertaining to consumer protection and to the protection, abuse, negligence or financial exploitation of elderly persons;
c) The right to live in an inhabitable, safe and decent environment;
d) The right to be treated with consideration, dignity, and individuality, as well as respect for their privacy and their personal belongings;
e) The right to privacy between resident's units, subject to rules of behavior that are reasonably designed for the residence for the development of health, safety and well being of the residents;
f) The right to receive and issue private written or verbal communications, respecting their right to privacy, having access to a telephone and being able to receive the visitors of their choice in an unsupervised manner;
g) The right to manage their own financial matters;
h) The right to submit claims, recommendations, and changes to the procedures, services and policies to the Sponsor, Administrator or to the personnel of the residence, or the Office of the Ombudsman, public officials, state agencies, or any others, without interference, coercion, discrimination or treat of any type. 1)[sic] The right to have all their claims or requests addressed in a timely and adequate manner within the capabilities of the
residence;
m) The right to obtain a copy of any rule or regulation of the residence that applies to the manner of conduct required from the residents;
n) The right to participate freely in or freely benefit from activities or services rendered by the community and to reach the highest possible degree of independence, autonomy and community interaction;
o) The right to be informed of the resources of the Government, the Department of the Family, the Office for the Affairs of the Elderly and the Department of Housing, available in the event of an eviction or the termination or cancellation of the Residency Agreement;
p) The right to exercise their civil and religious rights;
q) The right to contract a certified health care services provider to obtain necessary health care services in their unit, room, or any other location within the residence that is equipped for said purposes.
Section 12. - Procedure for Review The Secretary of the Department shall have the right to repeal, deny, modify or refuse to renew a certification for the operation of a residence or housing project within the conceptual framework of assisted living when the Sponsor or applicant fails to comply with the requirements set forth herein. It shall be the duty of the Department to set forth by means of regulation a review procedure pursuant to Act No. 170 of August 12, 1988, as amended, known as the "Uniform Administrative Procedures of the Commonwealth of Puerto Rico", taking into consideration the following matters:
A. Repeals, Denials, Modifications or Refusals to Renew a Certification for the Operation of a Residence
When the Department repeals, denies, modifies, or refuses to renew a certification for the operation of a residence or housing project within the conceptual framework of assisted living, same shall notify the Sponsor of said decision in writing within the next ten (10) days after the decision is made by means of certified mail with return receipt requested. Said notice shall specify the motives or reasons for said decision. In addition, the Department shall notify the Sponsor of his right to appeal the decision made based on the regulation set forth for such purposes by the Secretary of the Department of Housing. B. Suspension of a Certification for the Operation of a Residence
If the Secretary of the Department of Housing deems that a residence is not in compliance with the provisions set forth in this Act, and later determines in consultation with the Office that the deficiencies or noncompliances found to not put at serious risk the health and safety of the residents, instead of repealing or denying the renewal of a certification for the operation of a residence, he/she may suspend the certification of said residence. This means that the residence may continue to operate, but it cannot accept new residents until the deficiencies or non-compliances found are corrected and the Secretary of the Department of Housing, with the approval of the Office, determines that the residence is in complete compliance with the provisions herein.
In the case of the suspension of a certification, the Department shall notify the Sponsor of said decision in writing within the next seventy-two (72) hours from having made the decision. The Department shall not make the decision to suspend a certification until the Sponsor has been notified
previously that the residence does not comply with the requirements set forth in this Act, that the decision to limit the acceptance of new residents is being considered, and that the Sponsor has had a reasonable term to correct the deficiencies.
The decision of not accepting new residents may be repealed by the Department, with the approval of the Office, when the Department finds that the deficiencies or non-compliance found have been corrected completely. However, if the deficiencies or non-compliance found are not corrected within the term set forth by the Department, with the approval of the Office, the Department may repeal the certification set forth by this Act. Said decision shall be notified in writing within the next seventy-two (72) hours by certified mail with return receipt requested. Said notice must specify the motives or reasons for said decision. In addition, the Department shall notify the Sponsor of his/her right to appeal the decision made based upon the regulation to such effects set forth by the Secretary of the Department of Housing. C. Emergency Repeal of a Certification to Operate a Residence
If the Secretary of the Department of Housing determines that a residence does not comply with the provisions set forth in this Act, and later determines in consultation with the Office, that the deficiencies or noncompliance found puts at serious risk the health and safety of the residents, the Department shall repeal immediately the certification of the residence. The Department shall notify said decision in writing to the Sponsor within the next twenty-four (24) hours from the making of said decision. In addition, the Department shall notify the Sponsor of his/her right to appeal the decision made based upon the regulation set forth to such purposes by the Secretary of the Department of Housing and shall take all the foreseeable
necessary measures to ensure the well being of these residents. Section 13. - Duties of the Ombudsman for Elderly Residents a) The Ombudsman shall have the primary duty to attend the claims of the housing projects within the conceptual framework of assisted living residents, and their relatives or representatives, with diligence. When addressing the claims, the Ombudsman shall provide said persons with pertinent juridical and government information that allows the claimant to make an informed decision regarding the steps to be taken to remedy the situation.
When addressing the claim and deeming that same is warranted pursuant to this Act, the Ombudsman shall perform a thorough investigation of the situation and issue a report in that regard. Then, same shall take the appropriate steps in the pertinent public agency or organism that shall result in the prompt solution for, and due attention to, the problem subject of the claim. b) In the exercise of his/her powers, the Ombudsman shall have free access to the residences set forth in this Act, and may review the files of each resident with the informed consent of same. Moreover, the Ombudsman shall interview the personnel of the residence, the external providers of the residence, the latter having the inescapable duty to provide all data or documentation that throws light over the submitted claim. c) The Ombudsman shall set forth the necessary mechanisms for the receipt and processing of claims and for the performance of investigations, as well as informing the results of same to the Director of the Office for the Affairs of the Elderly. d) The Ombudsman shall exercise all the powers conferred upon
same pursuant to Act No. 308 of October 3, 1999, to comply with the duties imposed by this Act. e) When complying with the duties set forth herein, the Ombudsman shall acquire knowledge of the particular services offered in the residences within the conceptual framework of assisted living and act according to same. f) The Ombudsman shall carry out an amount randomly periodic visits that represent the amount of residences to verify that they are in compliance with this Act. The results of same shall be detailed in a report to be submitted to the Office and the Department. In addition, said report shall be made accessible to the residences concerned.
Section 14. - Penalties All housing projects or residences established within the conceptual framework of this Act that incurs in a violation or non-compliance against the provisions set forth in this Act and the duties demanded in same shall risk that the Department of Housing may determine that the suspension of their certification, the permanent repeal of their certification, or the denial of the renewal of same is warranted.
Furthermore, any person who operates or manages a housing project or residence within the conceptual framework of assisted living created pursuant to this Act without the due certification shall incur in a misdemeanor, and if found guilty, shall be punished with a penalty not to exceed five thousand $(5,000)$ dollars or a jail term of up to six (6) months, or both penalties, ad the discretion of the Court.
Any person in Puerto Rico who is dedicated to or disposed toward running residences within the conceptual framework of assisted living for the elderly created pursuant to this Act, knowing that said residence or housing
project does not have a certification for its operations shall incur in a misdemeanor, and if convicted, shall be punished with a fine not to exceed five thousand $(5,000)$ dollars or a jail term of up to six (6) months, or both penalties, at the discretion of the Court.
Any violation against the aforementioned shall constitute reasonable cause to deny, renew, modify or repeal a certification for dedication to the purposes mentioned previously in this Act. Regardless of the existence or use of any other remedy, at the request of the Office or the Department, the Secretary of Justice of Puerto Rico shall request an injunction or any other remedy to restrain the accused person from operating or managing a housing project or residence within the conceptual framework of assisted living without due certification.
Section 15. - Exemptions Any residence established within the conceptual framework of assisted living shall be exempted from payments on the percentage of municipal licenses, the payment of movable and immovable property taxes, and income tax for the first two (2) years of operation pursuant to this Act.
The aforementioned exemption shall be subject only to the Department of Housing, jointly with the Office for the Affairs of the Elderly, certifying before the Secretary of the Treasury that same is in strict compliance with the requirements imposed by this Act.
However, in the case of the tax exemptions on property and municipal license taxes, for purposes of developing the creation and establishment of housing projects established within the conceptual framework of assisted living or contributing toward those in operation, the municipalities whose fiscal capability allows shall exercise their discretion to grant to said residences exemptions from the payment of property and municipal license
taxes. The procedures set forth by law shall be followed for the approval of these exemptions.
At the end of the aforementioned term of two (2) years, the Legislature shall evaluate said exemption and shall determine its continuation or its termination.
Section 16. - Establishment of the Model Project The Department of Housing shall establish a Model Project within the conceptual framework of assisted living to begin the forthcoming implementation of this new regulatory scheme set forth in this Act, and to execute the concept of assisted living, as conceived herein. Regarding the administration of said Model Project, same shall correspond to the entity previously chosen by the Department and the Office.
Said Model Project shall be in operation for a term of two (2) years, at the end of which the Legislature shall pass judgment over the results obtained and shall extend said term, if by so doing the exposure and proliferation of Assisted Living Establishments is thereby developed. The evaluation term of two (2) years shall commence to take effect when said project obtains the certification as set forth in Section 5 of this Act and begins its operations.
Section 17. - Collaboration Agreements For this Law to be effective, the necessary collaboration of innumerable agencies, municipalities and public and private instrumentalities is required. Therefore, both the Department of Housing and the Office for the Affairs of the Elderly are hereby empowered to set forth collaboration agreements with the Department of Health, the Department of the Family, the Health Services Administration (ASES, in Spanish), and any other deemed necessary for the implementation of this Act.
Section 18. - Separability If any disposition set forth in this Act or the application of same to any person or circumstances were declared null, said nullity shall not affect the remaining dispositions or applications of the Law.
Section 19. - Applicability of the Establishments for the Aged Act The Establishments for the Aged Act shall not apply in any manner to residences within the conceptual framework of assisted living.
Section 20. - Regulation and Forms The Department of Housing is hereby empowered to create by means of regulation any necessary dispositions for the implementation of this Act within one hundred eighty (180) days after the approval of this Act, and pursuant to Act No. 170 of August 12, 1988, as amended, known as the "Uniform Administrative Procedures Act of the Commonwealth of Puerto Rico." In addition, it shall create all the necessary forms for its implementation within one hundred eighty (180) days after the approval of this Act.
Likewise, same shall set forth procedures to validate or accept any federal or state assistance such as Medicaid, the Nutritional Assistance Program, the Temporary Assistance for Needy Families (TANF) Program, Social Security or Section 8, among others, that may be received by elderly persons interested in living in the housing projects set forth pursuant to this Act as payment or partial payment of the rent established by means of the Residency Agreement.
Section 21. - Funds for the implementation of this Act The Department of Housing shall request federal funds through the federal Department of Housing in order to comply with the provisions herein. However, the Department of Housing may use funds identified and
appropriated in the General Fund of the Commonwealth of Puerto Rico, subject to the availability of such resources.
In addition, it I hereby authorized to receive and administer funds originating from legislative appropriations and transfers, delegations, contributions and donations of any sort received from agencies, municipal governments and the Government of the United States of America, as well as those originating from persons and other private entities for the implementation of this Act.
Section 22. - Effectiveness This Act shall take effect immediately after its approval. However, both the Department and the Office shall have six (6) months to set forth the necessary
regulations, as well as the due forms and collaboration agreements for the implementation of this Act.
I hereby certify to the Secretary of State that the following Act No. 244 (H.B. 1763) (Conference) of the $5^{ ext {th }}$ Session of the $14^{ ext {th }}$ Legislature of Puerto Rico:
AN ACT to set forth the "Act for the Creation of Assisted Living Housing Projects for the Elderly in Puerto Rico;" to declare as Public Policy of the Commonwealth of Puerto Rico the furthering of the creation and maintenance of housing projects that incorporate the structural and conceptual framework of Assisted Living; to establish a model Assisted Living project; and to establish the special regulatory scheme for this housing concept, establish rights and responsibilities for its implementation, and penalties for noncompliance with this Act, and for other purposes, has been translated from Spanish to English and that the English version is correct.
In San Juan, Puerto Rico, today $23^{ ext {rd }}$ of August of 2004.
Elba Rosa Rodríguez-Fuentes Director