DHS 89.23 Note
Substantiated findings of client abuse or neglect or misappropriation of client property are recorded in the department's registry which can be accessed 24 hours a day by calling (608) 266-5545. See ch. DHS 12
for required background checks including a criminal record check.
All facility staff shall have training in safety procedures, including fire safety, first aid, universal precautions and the facility's emergency plan, and in the facility's policies and procedures relating to tenant rights.
Staff providing residential care apartment complex services to tenants shall have documented training or experience in the following areas:
Physical, functional and psychological characteristics associated with aging or likely to be present in the tenant population and their implications for service needs.
The purpose and philosophy of assisted living, including respect for tenant privacy, autonomy and independence.
Assigned duties and responsibilities, including the needs and abilities of individual tenants for whom staff will be providing care.
A residential care apartment complex shall document that the requirements for provider qualifications have been met.
(6) Written staffing plan.
A residential care apartment complex shall maintain an up-to-date, written staffing plan which describes how the facility is staffed to provide services that are sufficient to meet tenant needs and that are provided by qualified staff. The facility shall inform current and prospective tenants and their representatives about the existence and availability of the staffing plan and shall provide copies of the plan upon request.
Limit on hours of service provided.
A residential care apartment complex shall provide not more than 28 hours per week of supportive, personal and nursing services to each tenant. There is no limit on the type or amount of other services, activities or amenities which the facility provides.
DHS 89.24 Note
Note: Some individuals may initially need little or no service but, over time, may need more services up to the full 28 hours per week.
(2) Amount of service provided to individual tenants. DHS 89.24(2)(a)(a) Services provided by the residential care apartment complex.
The amount of supportive, personal and nursing service which a facility provides to a tenant, either directly or under contract, shall be determined by the tenant's needs and preferences, as documented in the service agreement. A residential care apartment complex shall not limit the hours of service it makes available for an individual tenant to less than 28 hours per week if needed by the tenant.
(b) Services from providers other than the residential care apartment complex. DHS 89.24(2)(b)1.1.
A tenant may contract for additional services not included in the service agreement from providers of the tenant's choice, so long as the tenant informs the facility, complies with applicable facility policies and procedures and agrees to have the arrangements reflected in the risk agreement. Except as limited by a facility under subd. 3.
, there is no restriction on the amount or type of service which a tenant may receive from providers other than the facility.
A residential care apartment complex may approve the provider of supportive, personal or nursing services for any particular tenant and require that providers of these services comply with established facility standards and policies.
A residential care apartment complex may only limit the amount of supportive, personal and nursing service a tenant purchases from outside providers when the total amount of supportive, personal and nursing services that the tenant receives from all paid providers exceeds 28 hours per week. A facility may not limit the amount of hospice care a tenant receives or the amount of unpaid services provided by the tenants family or friends. A facility may not limit the amount of recuperative care which a tenant receives, provided the recuperative care will not raise the total service level above 28 hours per week for more than 90 days.
DHS 89.24(3)(a)(a) Purpose.
A residential care apartment complex shall compute hours of service provided to an individual tenant when necessary for the purpose of determining whether the 28 hour per week limit on services under sub. (1)
has been reached and making related decisions about the appropriateness of continued residency in the facility. The computation may be initiated by the facility or at the request of the tenant, the tenant's family or other representative, or the department. Facilities are not required to continually document the amount of time spent in providing services to each tenant.
DHS 89.24 Note
Note: This requirement is intended solely for the purpose of determining whether a person can appropriately reside in a residential care apartment complex. It is not intended for the purposes of documenting or billing for services provided or for determining facility staffing levels.
Only staff time that is directly attributable to providing or arranging supportive, personal and nursing services to a tenant shall count toward the 28-hour per week limit on services. Hours of service include time devoted to nursing assessment, documentation and consultation, stand-by assistance for activities of daily living and any other services directly attributable to an individual tenant.
Congregate services such as meals served in a common dining room, housekeeping in common areas of the facility, laundry and social and recreational activities which would be typically available in a hotel or in unlicensed housing for the elderly shall not be counted toward the 28-hour per week limit on services.
Time spent in meeting a tenant's unscheduled care needs shall be included in the 28 hours.
Services arranged directly by an individual tenant from a provider other than the residential care apartment complex shall not count toward the limit on the amount of services provided by a facility under sub. (1)
Schedule of fees for services. DHS 89.25(1)
Residential care apartment complexes shall have a written schedule of fees for services which includes all of the following:
Separately identified charges for rent, meals and services. The schedule of fees for services shall clearly identify those services which are included in any base service rate or rates and those for which there will be separate charges.
The amount of any application fee, entrance fee or security deposit.
The facility's refund policy regarding application and entrance fees, security deposits and monthly rent, meal and service charges in the event of death or termination of the contract between the tenant and the facility.
The schedule of fees for services shall be presented in language and a format that make it possible for tenants to readily identify the cost of the components of the service agreement and to be able to make informed choices about the services they receive.
A copy of the schedule of fees for services shall be given to each prospective tenant and to the prospective tenant's family or designated representative, where appropriate, along with public information materials on assisted living if provided by the department. Copies of revised fee schedules shall be provided to current tenants and their families or representatives, where appropriate, at least 30 days in advance of an increase in fees.
Comprehensive assessment. DHS 89.26(1)(1)
A comprehensive assessment shall be performed prior to admission for each person seeking admission as a basis for developing the service agreement under s. DHS 89.27
and the risk agreement under s. DHS 89.28
The comprehensive assessment shall identify and evaluate the following factors relating to the person's need and preference for services:
Medications and ability to self-administer medications.
Situations or conditions which could put the tenant at risk of harm or injury.
Type, amount and timing of services desired by the tenant.
Frequency of monitoring which the resident's condition requires.
A comprehensive assessment shall be performed with the active participation of the prospective tenant. That person's family or designated representative shall also participate in the assessment, if desired by the person.
Persons performing the comprehensive assessment shall have expertise in areas related to the tenant's health and service needs. Portions of the comprehensive assessment relating to physical health, medications and ability to self-administer medications shall be performed by a physician or a registered nurse.
A comprehensive assessment shall be performed or arranged for by:
The residential care apartment complex for tenants whose bills are paid for from private resources or by third party payers.
The county department or aging unit designated to administer the medicaid waiver for those tenants whose services are paid for under s. 46.27 (11)
(4) Annual review.
A tenant's capabilities, needs and preferences identified in the comprehensive assessment shall be reviewed at least annually to determine whether there have been changes that would necessitate a change in the service or risk agreement. The review may be initiated by the facility, the county department designated under sub. (3) (c) 2.
, or at the request of or on the behalf of the tenant.
A residential care apartment complex shall enter into a mutually agreed-upon written service agreement with each of its tenants consistent with the comprehensive assessment under s. DHS 89.26
A service agreement shall identify all of the following:
The type, amount and frequency of the services to be provided to the tenant, including services which will be available to meet unscheduled care needs.
Any additional services which are available for purchase by the tenant.
The activities and social connections the tenant will be assisted in maintaining.
The charge for the services covered by the service agreement, both individually and in total, and the time and amount of any fee increase that will occur during the period covered by the service agreement. Facilities shall remind tenants of any fee increase by written notice 30 days in advance of the effective date.
Any supplemental fees for services not covered in the service agreement or other agreement between the facility and the tenant.
Types of additional services which the facility would make available or which the facility would assist in arranging for a tenant during acute episodes, following release from the hospital or during other periods when the tenant may experience temporary needs.
Policies and procedures regarding services which the tenant arranges to receive from providers other than the residential care apartment complex.
2. `Termination or transfer.'
Grounds for termination of the contract between the tenant and the facility or relocation of the tenant to another residence and the procedure for tenant participation in decisions regarding termination and relocation. Conditions for termination contained in the service agreement shall not be contrary to the requirements relating to contract termination contained in s. DHS 89.29 (3)
3. `Tenant's rights.'
The residential care apartment complex's policies relating to tenant rights, including at a minimum, the rights identified in subch. III
4. `Dispute resolution.'
The facility's internal grievance procedure for resolving tenant complaints.
Only services selected and agreed to by the tenant may be included in the service agreement.
A service agreement may not waive any of the provisions of this chapter or other rights of the tenant.
The service agreement shall be presented in language and a format that make it possible for tenants to readily identify the type, amount, frequency and cost of services they receive, the qualifications of the staff providing those services and whether the services are provided directly by the facility or by subcontract.
The initial service agreement and any renewals of the service agreement shall be dated and signed by a representative of the facility; by the tenant or by the tenant's guardian, if any, and all other persons with legal authority to make health care or financial decisions for the tenant; and by the county for a tenant whose services are funded under s. 46.27 (11)
, Stats. The facility shall provide a copy of the service agreement to all parties who signed the agreement.
DHS 89.27 Note
Persons with legal authority to make health care or financial decisions for the tenant include agents designated under an activated power of attorney for health care under ch. 155
, Stats., and durable power of attorney under ch. 244
The service agreement shall be completed by the date of admission.
(4) Review and update.
The service agreement shall be reviewed when there is a change in the comprehensive assessment or at the request of the facility or at the request or on behalf of the tenant and shall be updated as mutually agreed to by all parties to the agreement.
As a protection for both the individual tenant and the residential care apartment complex, a residential care apartment complex shall enter into a signed, jointly negotiated risk agreement with each tenant by the date of occupancy.
A risk agreement shall identify and state all of the following:
Any situation or condition which is or should be known to the facility which involves a course of action taken or desired to be taken by the tenant contrary to the practice or advice of the facility and which could put the tenant at risk of harm or injury.