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News & Press: Regulatory

Assisted Living Forum October 10, 2017 Update

Monday, October 16, 2017   (0 Comments)
Posted by: Forbes McIntosh
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Provided are highlights of the Department of Health Services (DHS) Assisted Living Forum held this past Tuesday.

  • Person Centered Care (Publication Forthcoming)
    • DQA-BAL, Alfred Johnson, reminded providers about the ultimate purpose of the services we provide, i.e. "person centered care." As providers the goal is to assist residents \ clients in pursuing the type of quality of life they define. Mr. Johnson stated he wanted to challenge the attendees and in turn challenge their staff - to focus on residents' person-centered care. Providers should remember there are already regulations that identify the authority, purposes and scope. DQA-BAL is about to publish a publication on this issue, which will speak to promoting quality, healthcare, community and activities. Mr. Johnson said that DQA-BAL is looking to partner with you.
CBRF Training Updates - UW Green Bay
  • UWGB representatives stated they are hoping to go forward with the new training in 2018.
  • UWGB is seeking further input from the profession on the changes \ curriculum. In July participant feedback was 5 percent, which led to increased efforts to obtain feedback. From July thru September participant feedback is now 8 percent. The goal is to achieve 10% by January 1, 2018. From the feedback received thus far: 98 percent identified the instructor as "great" and they have received 99 percent positive feedback. UWGB representatives always follow up with instructor when negative feedback received. Providers should always feel free to contact UWGB representatives with feedback.
  • A slide presentation was provided, which we hope to include in the next Friday Update.
Division of Quality Assurance & Bureau of Assisted Living Publications 
  • Physician Orders & Medications (DHS Publication)
    • In assisted living facilities and adult day care settings, regulations or standards may indicate that a written order is required from a physician before staff can administer medications. According to DQA, there have been questions regarding what constitutes a written physician order. There have also been barriers to obtaining a written physician order, which can cause harm to residents. This publication provides technical assistance related to what survey staff looks for in regards to a written physician order.
  • Hot Water Temperatures in Adult Family Homes (DHS Publication)
    • DQA staff are reminding residential providers that Department of Health Services (DHS) Wisconsin Administrative Code stipulates that resident exposure to hot water is a potential environmental danger and can lead to a citation. The publication included on the agenda applies specifically to Adult Family Homes and provides an overview of the issue, possible citation and how providers can remedy the situation. Questions and discussion ensued about resident rights if the client complains and requests the water temperature be increased - provider liability and possible citation was at the heart of the discussion - and no solution was provided.
  • Revised Licensing, Certification & Registration Process for Assisted Living Facilities (DHS Publication)
    • DQA-BAL conducted a systems analysis of the initial application process for CBRFs, AFHs, RCACs and adult day care center providers. This has led to DQA-BAL determining that revisions of the application materials and processes were needed. DQA-BAL provided an overview of the publication that was effective July 17, 2017, which is provided above.
  • Background Checks. 
    • DQA-BAL provided an update on assisted living provider background checks. Four years ago DQA-BAL had cited approximately 400-500 providers for failure to complete facility staff background checks. So far this year that number of citation is down to 157 (113 AFHs, 39 CBRFs and 5 RCACs). While there is much less compared to where the profession was, DQA-BAL still striving to get that number down.
Emergency Preparedness in Assisted Living 
  • The problems and challenges that have occurred around the country in connection to recent hurricanes and fires has highlighted the issue of provider emergency preparedness.
  • Federal government is coming out with new regulations on emergency preparedness on November 15, 2017. While these new regulations do not apply to assisted living, DQA-BAL is encouraging providers to review and feel free to adopt its own policies.
  • There are DHS-DQA-BAL Emergency Preparedness Regulations for Assisted Living, which are covered in a February 2016 publication that providers should review.
(Self) Reporting Requirements for Assisted Living Facilities
  • DQA-BAL is working on a draft publication to help providers with the self-reporting process. A draft document \ form was handed around for review. While providers are not required to fill this document out when self-reporting, the department believes it is a helpful guide. In essence the document when filled out will provide the department with an understanding of not only the incident, but what was done after the incident and what steps were taken. The goal is to obtain adequate information to satisfy DQA-BAL so that a follow-up visit may not be necessary.
Other Issues DQA-BAL Issues Raised
  • Elopement. A facility had raised the question of elopement to DQA-BAL. The question was when to notify the department and contact local authorities. The example was a resident taking a walk, was expected to be back to the facility by a certain time, but the resident decided to take a different route that in the example led to their being 10 minutes late. The question is when should the provider notify? There did not appear to be a clear answer in this, only that DQA-BAL would not have cited under the example and strives to be reasonable when assessing.
  • When to Self Report. Question was raised as to when to self report when a resident complains of pain or illness, but when they are released from the hospital or clinic there is no treatment nor diagnosis identified by the physician or medical professional. DQA-BAL stated that if there is no treatment or diagnosis providers should not have to self report. However, DQA-BAL when reviewing records will be asking why a resident is in the hospital or urgent care so often?
Transitions in Care
  • Slide presentation was provided. A copy was requested but not received at time of publication. When obtained it will be included in the next Friday Update.

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