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.
The tenant's preference concerning how the situation is to be handled and the possible consequences of acting on that preference.
What the facility will and will not do to meet the tenant's needs and comply with the tenant's preference relative to the identified course of action.
Alternatives offered to reduce the risk or mitigate the consequences relating to the situation or condition.
The agreed-upon course of action, including responsibilities of both the tenant and the facility.
The tenant's understanding and acceptance of responsibility for the outcome from the agreed-upon course of action.
(b) Unmet needs.
Any needs identified in the comprehensive assessment which will not be provided for by the facility, either directly or under contract.
(c) Notice regarding enforcement in registered facilities.
For registered facilities only, notice that the department does not routinely inspect registered facilities or verify their compliance with this chapter and does not enforce contractual obligations under the service or risk agreements.
(3) No waiver of rules or rights.
A risk agreement may not waive any provision of this chapter or any other right of the tenant.
(4) Obligation to negotiate in good faith.
Neither the tenant nor the facility shall refuse to accept reasonable risk or insist that the other party accept unreasonable risk.
(5) Signed and dated.
The risk agreement shall be signed and dated by both an authorized representative of the residential care apartment complex and by the tenant or the tenant's guardian and agents designated under an activated power of attorney for health care under ch. 155, Stats.
, and durable power of attorney under ch. 244, Stats.
, if any.
The risk agreement shall be updated when the tenant's condition or service needs change in a way that may affect risk, as indicated by a review and update of the comprehensive assessment, by a change in the service agreement or at the request of the tenant or facility.
DHS 89.28 History
Cr. Register, February, 1997, No. 494
, eff. 3-1-97; am. Register, November, 1998, No. 515
, eff. 12-1-98; correction in (5) made under s. 13.92 (4) (b) 7.
, Stats., Register July 2011 No. 667
Admission and retention of tenants. DHS 89.29(1)(1)
No residential care apartment complex may admit any of the following persons, unless the person being admitted shares an apartment with a competent spouse or other person who has legal responsibility for the individual:
A person who has a court determination of incompetence and is subject to guardianship under ch. 54, Stats.
A person who has an activated power of attorney for health care under ch. 155, Stats.
A person who has been found by a physician or psychologist to be incapable of recognizing danger, summoning assistance, expressing need or making care decisions
DHS 89.29 Note
Note: This requirement is included because tenants need to be competent to understand and express their needs and preferences, enter into a service agreement and understand and accept risk.
(1m) Family care information and referral.
If the secretary of the department has certified that a resource center, as defined in s. DHS 10.13 (42)
, is available for the residential care apartment complex under s. DHS 10.71
, the residential care apartment complex shall provide information to prospective residents and refer residents and prospective residents to the aging and disability resource center as required under s. 50.034 (5m)
, Stats., and s. DHS 10.73
A residential care apartment complex may retain a tenant whose service needs can be met by the facility or can be met with services made available by another provider.