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Assisted Living Forum Summary from Jan 9, 2017

Wednesday, January 10, 2018   (0 Comments)
Posted by: Sarah Bass
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On Tuesday, January 9, 2018 the Assisted Living Forum was conducted via Adobe Connect. If you are not currently connected to the AL Forum listserve that gives updates and announcements of these meetings, please go to to find out more and to sign up for the email list. The following are highlights and summary of what was discussed at the last meeting.


Alfred Johnson started the meeting off giving staff change announcements. The Bureau currently has a couple of positions it is actively recruiting for and some that have been filled with new hires coming on board. Johnson also updated the forum on some new publications including the publication “Reporting for Assisted Living Facilities” which will provide guidance on self-reporting. As of Assisted Living Forum, this document has not been published – but will be posted hopefully soon.


Also discussed is the recent announcement of DQA’s ongoing compliance of the Home and Community Based Setting Rule. This publication was posted January 2, 2018 with an effective date of January 1, 2018. The publication is called DQA Implementation of Home and Community-Based Services Settings Rule in Assisted Living Facilities and can be found at A very helpful tool in this document is the HCBS Setting Rule Crosswalk for CBRFs, AFHs, and RCACs which points out the various DHS code references as well as the rules not covered in DHS code but are in the HCBS rule.


The first guest speaker was Henry Kosarzycki, Director of Office of Plan Review and Inspection, who spoke on the difference between the building and the assisted living licensing process. Kosarzycki referenced the web page “Construction/Remodeling Plan Review for Health Care Facilities” found at

Kosarzycki emphasized the importance of looking at the facility as the resident’s home and that it should be a safe home not only for the resident but for the staff as well. You have full responsibility to make sure that happens, so when there are projects that need to be done, Kosarzycki suggested that is not a bad idea to get a little legal representation before you do it yourself. Instead of just doing something yourself – get piece of mind with a licensed architect or contractor to make sure the liability doesn’t entirely fall on you.


He also emphasized setting up a pre-design meeting with your local officials and DHS (the Bureau of Assisted Living and the Office of Plan Review and Inspection) for any remodeling and construction of CBRFs. View the Memorandum of Agreement Diagram for more information on the scope of health care plan reviews done by the OPRI.


The second guest speaker was Thomas Haupt from the Wisconsin Division of Public Health, influenza surveillance Coordinator and Research Scientist who spoke on reporting, prevention, and control of acute respiratory illness outbreaks in long-term care facilities.

This year it has been already a moderate to severe influenza season even though we are still several weeks away from the peak of the flu season. All assisted living facilities are required to report influenza outbreaks.


Wisconsin average 100 hospitalizations daily – and it is expected to increase over the next weeks. The department is seeing children affected – but most with patients over 65 years old. Almost all hospitalizations are over 65 years old. For comparison Haupt gave some past statistics: In the 2016-2017 flu season there were only 18 outbreaks reported in LTC by January. In January 2018 there have been 56 outbreaks reported so far in LTC. 17 of those outbreaks were in Assisted Living facilities.


An outbreak is based on symptomology – at least 3 people who have similar symptoms within 72 hours constitutes an outbreak. Providers need to report outbreaks to local public health department and then that information gets passed up to statewide departments. Outbreak locations are not released to the general public, so there should be no concerns with sharing that information. Haupt warned by not reporting you could make it harder on yourself.


He also encouraged providers to get the flu shot to all their residents and staff as soon as it becomes available. Haupt gave an example of an assisted living facility that had 9 out of 19 residents have symptoms of influenza. In this example in AL example no one had been vaccinated at the facility and it was only October.


Haupt referenced the DPH Memo released in October of 2017 “Reporting, prevention and Control of Acute Respiratory Illness Outbreaks in Long-Term Care Facilities” available to download at for more details on reporting and follow up including anti-viral treatments to all residents if symptoms of the flu are present in your facility.


The major take-away from this presentation is that we should all try to bridge the gap between local public health and assisted living facilities to bring awareness to the importance of prevention and reporting. For any questions please contact Thomas Haupt at or 608-266-5326.


Lastly, Cindy O’Connell presented on the Home and Community Based Services rule and DQA’s role in the ongoing compliance. Referencing the publication stated above (www.dhs.wisconsin/publications/p01826.pdf)

O’Connell went through some of the highlights of the publication and answered questions asked by the forum participants. She stated that 1555 assisted living providers were deemed DQA compliant in regard to the HCBS requirements and have received letters. There were 84 non-compliant letters sent – the majority were from facilities that didn’t respond to the initial questionnaires or from facilities that refused to comply.


If you haven’t received a letter it may still be coming – it depends on where you stand on the compliant work load. If you are a newer to your facility and are unclear on where you stand with HCBS compliance you can contact Cindy O’Connell at DHS to see where you are in the process. DQA will be conducting catch up lists for self-assessments for those facilities who have not been contacted yet. Providers can request a compliance review using the form available at


O’Connell reminded that where the HCBS rule cannot be implemented – it should be documented in the ISP, but it cannot be based on diagnosis. To be acceptable it has to be on capabilities and desire of the resident. Anything is a deviation of that rule will need to be approved by the care team, guardian, MCO, IRIS, Provider etc. Providers can not get a waiver for any of the HCBS rules. She also stated that the licensing decision is separate from HCBS compliance; BAL will issue license’s even if you may not be HCBS compliant.


The last part of the AL Forum the meeting was split into the 4 regulatory categories. Each of the breakouts discussed one of the top ten citations for that category (AFH, CBRF, RCAC, ADC). Additional and specific questions about the HCBS rule were also answered in these breakouts. 

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