Ohio’s Proposed Recovery Housing Rules: What Providers Need to Be Paying Attention To

Ohio recovery housing providers may be facing significant changes.

The Ohio Department of Behavioral Health (DBH) is assuming a larger role in recovery housing oversight and has proposed a comprehensive set of rules governing certification and operation of recovery housing residences.

I was recently invited to participate in a DBH listening session in Columbus regarding the proposed rules. In preparation, I did what I tend to do when new regulations come out: I went through them line by line and asked a different question than simply, “What does the rule say?”

What would this actually mean for a provider trying to operate a recovery house every day?

That exercise identified some significant issues that recovery housing providers should be paying attention to now.

Recovery Housing or Residential Facility?

The biggest issue I see is not any single provision. It is the cumulative effect of the rules.

Recovery housing can look very different from one provider to another. Some residences have employees onsite. Others are intentionally peer run environments where adults work, attend meetings, manage their own medications, participate in the community, and support one another in recovery.

Several of the proposed requirements appear to assume a much more formal staffing model.

That matters because requirements that may sound reasonable individually can produce very different consequences when applied together.

A Resident With a Wheelchair Could Change the Staffing Model of an Entire House

The proposed rules define certain residents who require a wheelchair as non-ambulatory.

That designation matters.

It can trigger additional building and fire safety requirements including combined smoke and fire alarm systems. It can affect where the resident's bedroom may be located. Most significantly, the proposed staffing provisions can require qualified staff to be physically present whenever a non-ambulatory resident is in the residence, including overnight.

Think about what that means operationally.

A peer-run home may function safely without overnight staff. A prospective resident who uses a wheelchair may be completely independent, work full time, manage personal care, manage medications, and need no assistance from the provider.

Admitting that one resident could nevertheless create an ongoing onsite staffing obligation for the residence.

That deserves serious consideration, particularly because regulations intended to protect people with disabilities should not inadvertently create a financial incentive for providers not to serve them.

One As-Needed Medication Could Also Have Major Staffing Consequences

The medication provisions deserve particular attention.

Under the proposed staffing language, a resident prescribed an as-needed (PRN) medication can trigger a requirement for qualified staff to be physically present when that resident is in the home.

That could potentially include medications that independent adults routinely manage themselves.

Consider a resident with a rescue inhaler.

Or an EpiPen.

Or prescription migraine medication.

The presence of a single independently managed as-needed prescription should not unintentionally convert a peer run house into an onsite staffed residence.

This is one of several areas where the proposed rules need greater distinction between independent medication management and residents who actually require medication assistance.

The Medication Requirements Go Much Further

The proposed rules also address staff monitoring of the self-administration of medication.

Staff performing that function would receive training from a registered nurse, physician, or another approved entity regarding medication use, intended effects, potential side effects, medication type and dosage, and safe monitoring procedures.

Most notably, the proposed language extends that training to all medications, psychotropic and otherwise, used by residents in the residence.

Now picture a recovery house where residents take antidepressants, blood pressure medication, insulin, seizure medication, an antibiotic, an inhaler, cholesterol medication, and migraine medication.

Then a new resident arrives with a different prescription.

For a nonclinical housing provider, the operational questions become significant very quickly.

Do Independent Adults Really Need a Medication Administration Record?

The proposed resident record requirements also include medication administration records documenting prescription medications, dosage, frequency, and when medications are taken.

That raises a simple real world question.

What happens when a resident takes medication at work?

What about at a recovery meeting? At a family member's home? While traveling?

Recovery housing residents are adults living in the community. Many independently possess and administer their medications.

There is an important difference between ensuring medications are safely stored and requiring independent adults to participate in a clinical style medication documentation system.

That distinction should remain clear.

Nine Residents Could Trigger Significant Fire System Requirements

Physical building requirements are another area providers should review carefully.

Under the proposed rules, a residence with nine or more ambulatory residents triggers combined smoke detector and fire alarm system requirements, along with additional associated requirements.

That creates a meaningful threshold.

A residence operating with eight ambulatory residents could face substantially different requirements simply by adding a ninth.

Separate heightened requirements apply when a residence serves one or more nonambulatory residents.

Providers need to understand these thresholds before making decisions about capacity, renovations, or future properties.

Nighttime Fire Drills Raise Another Practical Question

The proposed rules require evacuation drills quarterly on each shift and at varying times during the day and night.

But many recovery homes do not have shifts.

They have residents.

Those residents may work during the day and sleep in their homes at night.

Fire preparedness is unquestionably important. The question is whether an institutional shift based drill structure is the right way to accomplish it in a peer-run residential setting.

What Happens When Someone Uses Alcohol or Drugs?

This may be one of the most consequential policy questions.

The proposed resident rights provisions generally provide for 30 days written notice before termination of residency, with an exception involving documented danger.

But recovery housing exists to maintain an alcohol and drug free environment.

Imagine eight people living together in early recovery. One resident returns to the house intoxicated. The person is not violent and does not threaten anyone.

Does the residence really have to allow that person to remain for another 30 days?

A recurrence of use does not necessarily have to mean automatic discharge. Good recovery housing can have thoughtful recurrence policies that provide options such as assessment, treatment, detoxification, increased recovery support, or transfer to another appropriate setting.

But a residence also needs the ability to enforce the recovery environment residents agreed to live in.

Providers should be able to establish clear recurrence of use policies, explain them before admission, and respond immediately when alcohol or drug use occurs.

Criminal Background Requirements Could Affect the Recovery Workforce

The proposed background assessment requirements also deserve careful review.

Recovery housing is unusual because lived experience is often an asset.

People who have experienced addiction, incarceration, treatment, and successful reentry may become some of the strongest peer leaders and recovery professionals in our communities.

Proposed requirements involving offender databases and disclosure of sealed convictions therefore have implications beyond ordinary employment screening.

A regulatory system designed for recovery should recognize that rehabilitation is not merely possible. It is the entire premise of the work.

Safety related exclusions can be appropriate. But they should be targeted to actual risks rather than unnecessarily preventing rehabilitated people from working in the recovery community.

The Details Matter

There are many additional operational questions in the proposed rules involving staff definitions, CPR and first aid training, continuing education, inspections, utility reporting, medication disposal, resident records, recovery supports, laundry, property standards, background databases, and other day to day requirements.

For providers operating multiple residences, even relatively small requirements can become significant when multiplied across every property and every staff member.

That is why regulatory review cannot stop with reading the rule.

Someone has to ask:

What policy will we need?

What documentation will we need?

Who will be responsible for it?

Will we need additional staff?

Will we need to modify the property?

What will this cost?

Does another requirement conflict with this one?

And perhaps most importantly:

What happens when we apply this rule to an actual resident on an ordinary Tuesday night?

That is where regulatory language becomes operational reality.

What Recovery Housing Providers Should Be Doing Now

The rules are proposed, which means this is the time for providers to understand them and identify unintended consequences.

Providers should begin evaluating their residences against the proposed requirements now, particularly their current staffing models, resident capacity, fire systems, accessibility, medication practices, resident agreements, recurrence of use policies, personnel practices, training, and recordkeeping.

Providers should also document anticipated costs and operational barriers. Concrete examples are often much more useful to policymakers than simply saying a requirement is burdensome.

If a proposed requirement would require an additional employee, say so.

If it would require modifying a house, estimate the impact.

If a requirement would make it harder to accept a resident with a disability, explain exactly why.

If it conflicts with how your recovery model actually works, describe that model.

This Is the Work I Love Doing

Regulatory changes rarely arrive with an implementation manual explaining what they mean for your organization.

That gap is where I tend to work.

Through Hope Harbor Solutions, I help behavioral health providers and mission driven organizations take complicated accreditation, certification, regulatory, and funding requirements and turn them into something operational.

Sometimes that means interpreting new requirements. Sometimes it means building the policies, processes, tools, documentation, or implementation plan needed to comply. And sometimes it means identifying a problem before a proposed rule becomes an operational problem.

If your organization is trying to understand how Ohio's proposed recovery housing rules could affect your residences, I would be happy to talk through your specific model and help identify what would need to change.

Hope Harbor Solutions
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