Oregon Department of Human Services, Aging and People with Disabilities and Developmental Disabilities

Rule Rule 411-054-0026
Notice to Potential Residents

The facility must provide the following documents to potential residents before move-in:
(1) UNIFORM DISCLOSURE STATEMENT. This is a Department-designated form (form APD 9098A) to provide to each individual who requests information about the facility.
(2) RESIDENCY AGREEMENT. This is an agreement prepared by the facility. The residency agreement must be reviewed by the Department before distribution and must include the following:
(a) Terms of occupancy, including policy on the possession of firearms and ammunition.
(b) Payment provisions including the basic rental rate and what it includes, cost of additional services, billing method, payment system and due dates, deposits, and non-refundable fees, if applicable.
(c) The method for evaluating a resident’s service needs and assessing the costs for the services provided.
(d) Policy for increases, additions, or changes to the rate structure. The disclosure must address the minimum requirement of 30 days prior written notice of any facility-wide increases or changes and the requirement for immediate written notice for individual resident rate changes that occur as a result of changes in the service plan.
(e) Refund and proration conditions.
(f) A description of the scope of resident services available according to OAR 411-054-0030 (Resident Services).
(g) A description of the service planning process.
(h) Additional available services.
(i) The philosophy of how health care and ADL services are provided to the resident.
(j) Resident rights and responsibilities.
(k) The facility’s system for packaging medications including the option for residents to choose a pharmacy that meets the requirements of ORS 443.437 (Choice of prescription and nonprescription drugs and supplies).
(l) Criteria, actions, circumstances, or conditions that may result in a move-out notification or intra-facility move consistent with OAR 411-054-0080 (Involuntary Move-out Criteria).
(m) Resident rights pertaining to notification of involuntary move-out.
(n) Notice that the Department has the authority to examine resident records as part of the evaluation of the facility.
(o) The facility’s staffing plan.
(p) Additional elements as listed in 411-054-0027 (Resident Rights and Protections)(2).
(3) CONSUMER SUMMARY. The facility must develop a Consumer Summary Statement specific to the facility. This form is separate from the residency agreement. For a model consumer summary that may be used as an example, please see the Department form (form APD 9098CS).
(a) Similar to the residency agreement, this summary statement must be provided to a potential resident before move-in. The consumer summary must include the following:
(A) A summary of the services provided by the facility.
(B) A summary of the services and types of care the facility does not provide.
(C) A statement that, if the facility is not capable of meeting the resident’s needs for care and services, the facility may require the resident to move to another facility or care setting, in accordance with OAR 411-054-0080 (Involuntary Move-out Criteria).
(D) A statement explaining that, if a resident leaves the facility to receive acute medical, psychiatric, nursing or other specialized care, the facility will evaluate the facility’s ability to meet the resident’s care needs before the resident is permitted to return to the facility, in accordance with OAR 411-054-0080 (Involuntary Move-out Criteria)(6).
(E) An explanation of the resident’s right to appeal should the facility either require the resident to leave the facility, or not permit the resident to return following treatment as described in paragraph (D). Appeal rights are explained in OAR 411-054-0080 (Involuntary Move-out Criteria)(7).
(F) A statement as to whether the facility will arrange or coordinate hospice care for a resident upon request.
(b) The information in the summary statement outlined in subsection (a) above must:
(A) Be in writing.
(B) Be written in plain English.
(C) Be explained to the individual or the person acting on behalf of the individual in a manner the individual or representative understands.
(D) Be provided separately from all other disclosure documents, such as the Uniform Disclosure Statement (APD form 9098A), and the facility’s Residency Agreement.
(E) Be signed by the individual or the person acting on behalf of the individual, acknowledging that the individual or representative understands the content and implications of the information.
(4) All disclosure information and residency agreements must be written in compliance with these rules.
(a) The facility may not include any provision in the residency agreement, summary statement or disclosure information that is in conflict with these rules and may not ask or require a resident to waive any of the resident’s rights or the facility’s liability for negligence.
(b) The facility must retain a copy of the original and any subsequent signed and dated residency agreements and must provide copies to the resident or to the resident’s designated representative.
(c) The facility must give residents 30 days prior written notice of any additions or changes to the residency agreement. Changes to the residency agreement must be faxed, emailed, or mailed to the Department before distribution.

Last accessed
Jun. 8, 2021