No resident may be involuntarily transferred or discharged under par. (a) 2.
for nonpayment of charges if the resident meets both of the following conditions:
He or she is in need of ongoing care and treatment and has not been accepted for ongoing care and treatment by another facility or through community support services; and
The funding of the resident's care in the nursing home under s. 49.45 (6m)
, Stats., is reduced or terminated because either the resident requires a level or type of care which is not provided by the nursing home or the nursing home is found to be an institution for mental diseases as defined under 42 CFR 435.1009
DHS 132.53(3)(a)(a) Notice.
The facility shall provide a resident, the resident's physician and, if known, an immediate family member or legal counsel, guardian, relative or other responsible person at least 30 days notice of transfer or discharge under sub. (2) (a) 2.
, and the reasons for the transfer or discharge, unless the continued presence of the resident endangers the health, safety or welfare of the resident or other residents. The notice shall also contain the name, address and telephone number of the board on aging and long-term care. For a resident with developmental disability or mental illness, the notice shall contain the mailing address and telephone number of the protection and advocacy agency designated under s. 51.62 (2) (a)
Unless circumstances posing a danger to the health, safety or welfare of a resident require otherwise, at least 7 days before the planning conference required by subd. 2.
, the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident's physician, shall be given a notice containing the time and place of the conference, a statement informing the resident that any persons of the resident's choice may attend the conference, and the procedure for submitting a complaint to the department.
Unless the resident is receiving respite care or unless precluded by circumstances posing a danger to the health, safety, or welfare of a resident, prior to any involuntary transfer or discharge under sub. (2) (a) 2.
, a planning conference shall be held at least 14 days before transfer or discharge with the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident's physician, to review the need for relocation, assess the effect of relocation on the resident, discuss alternative placements and develop a relocation plan which includes at least those activities listed in subd. 3.
The opportunity for the resident to make at least one visit to the potential alternative placement, if any, including a meeting with that facility's admissions staff, unless medically contraindicated or waived by the resident;
Assistance in moving the resident and the resident's belongings and funds to the new facility or quarters; and
A resident who is transferred or discharged at the resident's request shall be advised of the assistance required by subd. 3.
and shall be provided with that assistance upon request.
Upon transfer or discharge of a resident, the documents required by s. DHS 132.45 (5) (L)
and (6) (h)
shall be prepared and provided to the facility admitting the resident, along with any other information about the resident needed by the admitting facility.
DHS 132.53(4)(a)(a) Requirement.
Each facility shall have in effect a transfer agreement with one or more hospitals under which inpatient hospital care or other hospital services are available promptly to the facility's residents when needed. Each intermediate care facility shall also have in effect a transfer agreement with one or more skilled care facilities.
(b) Transfer of residents.
A hospital and a facility shall be considered to have a transfer agreement in effect if there is a written agreement between them or, when the 2 institutions are under common control, if there is a written statement by the person or body which controls them, which gives reasonable assurance that:
Transfer of residents will take place between the hospital and the facility ensuring timely admission, whenever such transfer is medically appropriate as determined by the attending physician; and
There shall be interchange of medical and other information necessary for the care and treatment of individuals transferred between the institutions, or for determining whether such individuals can be adequately cared for somewhere other than in either of the institutions.
Before a resident of a facility is transferred to a hospital or for therapeutic leave, the facility shall provide written information to the resident and an immediate family member or legal counsel concerning the provisions of the approved state medicaid plan about the period of time, if any, during which the resident is permitted to return and resume residence in the nursing facility.
At the time of a resident's transfer to a hospital or for therapeutic leave, the facility shall provide written notice to the resident and an immediate family member or legal counsel of the duration of the period, if any, specified under subd. 1.
DHS 132.53 Note
The "approved state medicaid plan" referred to s. 49.498 (4) (d)
1a, Stats., and subd. 1. states that the department shall have a bedhold policy. The bedhold policy is found in s. DHS 107.09 (4) (j)
DHS 132.53(5)(a)(a) Bedhold.
A resident who is on leave or temporarily discharged, as to a hospital for surgery or treatment, and has expressed an intention to return to the facility under the terms of the admission statement for bedhold, shall not be denied readmission unless, at the time readmission is requested, a condition of sub. (2) (b)
has been satisfied.
The facility shall hold a resident's bed under par. (a)
until the resident returns, until the resident waives his or her right to have the bed held, or up to 15 days following the temporary leave or discharge, whichever is earlier.
Every facility shall post in a prominent place a notice that a resident has a right to appeal a transfer or discharge decision. The notice shall explain how to appeal that decision and shall contain the address and telephone number of the nearest bureau of quality assurance regional office. The notice shall also contain the name, address and telephone number of the state board on aging and long-term care or, if the resident is developmentally disabled or has a mental illness, the mailing address and telephone number of the protection and advocacy agency designated under s. 51.62 (2) (a)
A copy of the notice of a resident's right to appeal a transfer or discharge decision shall be placed in each resident's admission folder.
Every notice of transfer or discharge under sub. (3) (a)
to a resident, relative, guardian or other responsible party shall include a notice of the resident's right to appeal that decision.
If a resident wishes to appeal a transfer or discharge decision, the resident shall send a letter to the nearest regional office of the department's bureau of quality assurance within 7 days after receiving a notice of transfer or discharge from the facility, with a copy to the facility administrator, asking for a review of the decision.
The resident's written appeal shall indicate why the transfer or discharge should not take place.
Within 5 days after receiving a copy of the resident's written appeal, the facility shall provide written justification to the department's bureau of quality assurance for the transfer or discharge of the resident from the facility.
If the resident files a written appeal within 7 days after receiving notice of transfer or of discharge from the facility, the resident may not be transferred or discharged from the facility until the department's bureau of quality assurance has completed its review of the decision and notified both the resident and the facility of its decision.
The department's bureau of quality assurance shall complete its review of the facility's decision and notify both the resident and the facility in writing of its decision within 14 days after receiving written justification for the transfer or discharge of the resident from the facility.
A resident or a facility may appeal the decision of the department's bureau of quality assurance in writing to the department of administration's division of hearings and appeals within 5 days after receipt of the decision.
DHS 132.53 Note
Note: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, Wisconsin 53707.
The appeal procedures in this paragraph do not apply if the continued presence of the resident poses a danger to the health, safety or welfare of the resident or other residents.
DHS 132.53 Note
Note: The bureau of quality assurance was renamed the division of quality assurance.
DHS 132.53 History
Cr. Register, July, 1982, No. 319
, eff. 8-1-82; cr. (2) (b) 8. and 9., am. (2) (c), (3) (b) 2. and (c), Register, January, 1987, No. 373
, eff. 2-1-87; renum. (2) (c) to be (2) (c) 1. and am., cr. (2) (c) 2., Register, February, 1989, No. 398
, eff. 3-1-89; am. (2) (c) 2. b., Register, October, 1989, No. 406
, eff. 11-1-89; r. and recr. (1) to (3), cr. (4) (d) and (6), Register, June, 1991, No. 426
, eff. 7-1-91; CR 06-053
: am. (2) (b) 1., r. (4) (c), Register August 2007 No. 620
, eff. 9-1-07.
Transfer within the facility.
Prior to any transfer of a resident between rooms or beds within a facility, the resident or guardian, if any, and any other person designated by the resident shall be given reasonable notice and an explanation of the reasons for transfer. Transfer of a resident between rooms or beds within a facility may be made only for medical reasons or for the resident's welfare or the welfare of other residents or as permitted under s. DHS 132.31 (1) (p) 1.
DHS 132.54 History
Cr. Register, July, 1982, No. 319
, eff. 8-1-82; am. Register, January, 1987, No. 373
, eff. 2-1-87.
Unless it is in conflict with the plan of care, each resident shall receive care based upon individual needs.
(b) Decubiti prevention.
Nursing personnel shall employ appropriate nursing management techniques to promote the maintenance of skin integrity and to prevent development of decubiti (bedsores). These techniques may include periodic position change, massage therapy and regular monitoring of skin integrity.
Nursing personnel shall provide care designed to maintain current functioning and to improve the resident's ability to carry out activities of daily living, including assistance with maintaining good body alignment and proper positioning to prevent deformities.
Each resident shall be encouraged to be up and out of bed as much as possible, unless otherwise ordered by a physician.
Any significant changes in the condition of any resident shall be reported to the nurse in charge or on call, who shall take appropriate action including the notice provided for in sub. (3)
The nursing home shall provide appropriate assessment and treatment of pain for each resident suspected of or experiencing pain based on accepted standards of practice that includes all of the following:
An initial assessment of pain intensity that shall include: the resident's self-report of pain, unless the resident is unable to communicate; quality and characteristics of the pain, including the onset, duration and location of pain; what measures increase or decrease the pain; the resident's pain relief goal; and the effect of the pain on the resident's daily life and functioning.
Regular and periodic reassessment of the pain after the initial assessment, including quarterly reviews, whenever the resident's medical condition changes, and at any time pain is suspected, including prompt reassessment when a change in pain is self-reported, suspected or observed.
The delivery and evaluation of pain treatment interventions to assist the resident to be as free of pain as possible.
Consideration and implementation, as appropriate, of nonpharmacological interventions to control pain.
(d) Rehabilitative measures.
Residents shall be assisted in carrying out rehabilitative measures initiated by a rehabilitative therapist or ordered by a physician, including assistance with adjusting to any disabilities and using any prosthetic devices.
(b) Adaptive devices.
Adaptive self-help devices, including dentures if available, shall be provided to residents, and residents shall be trained in their use to contribute to independence in eating.
(d) Food and fluid intake and diet acceptance.
A resident's food and fluid intake and acceptance of diet shall be observed, and significant deviations from normal eating patterns shall be reported to the nurse and either the resident's physician or dietitian as appropriate.
DHS 132.60 Note
For other dietary requirements, see s. DHS 132.63
(3) Notification of changes in condition or status of resident. DHS 132.60(3)(a)(a) Changes in condition.
A resident's physician, guardian, if any, and any other responsible person designated in writing by the resident or guardian to be notified shall be notified promptly of any significant accident, injury, or adverse change in the resident's condition.
(b) Changes in status.
A resident's guardian and any other person designated in writing by the resident or guardian shall be notified promptly of any significant non-medical change in the resident's status, including financial situation, any plan to discharge the resident, or any plan to transfer the resident within the facility or to another facility.
DHS 132.60(5)(a)1.1. `Restriction.'
Medications, treatments and rehabilitative therapies shall be administered as ordered by an authorized prescriber subject to the resident's right to refuse them. No medication, treatment or changes in medication or treatment may be administered to a resident or a daycare client without an authorized prescriber's written order which shall be filed in the resident's or daycare client's clinical record.
2. `Oral orders.'
Oral orders shall be immediately written, signed and dated by the nurse, pharmacist or therapist on the prescriber's order sheet, and shall be countersigned by the prescriber and filed in the resident's clinical record within 10 days of the order.
DHS 132.60(5)(d)1.1. `Personnel who may administer medications.'
In a nursing home, medication may be administered only by a nurse, a practitioner, as defined in s. 450.01 (17)
, Stats., or a person who has completed training in a drug administration course approved by the department.
2. `Responsibility for administration.'
Policies and procedures designed to provide safe and accurate acquisition, receipt, dispensing and administration of medications shall be developed by the facility and shall be followed by personnel assigned to prepare and administer medications and to record their administration. The same person shall prepare, administer, and immediately record in the resident's clinical record the administration of medications, except when a single unit dose package distribution system is used.
5. `Errors and reactions.'
Medication errors and suspected or apparent drug reactions shall be reported to the nurse in charge or on call as soon as discovered and an entry made in the resident's clinical record. The nurse shall take appropriate action.
DHS 132.60 Note
See s. DHS 132.65
, pharmaceutical services, for additional requirements.
DHS 132.60(6)(b)(b) Orders required.
Physical or chemical restraints shall be applied or administered only on the written order of a physician which shall indicate the resident's name, the reason for restraint, and the period during which the restraint is to be applied.
(e) Type of restraints.
Physical restraints shall be of a type which can be removed promptly in an emergency, and shall be the least restrictive type appropriate to the resident.
(f) Periodic care.
Nursing personnel shall check a physically restrained resident as necessary, but at least every 2 hours, to see that the resident's personal needs are met and to change the resident's position.
DHS 132.60(8)(a)(a) Development and content of care plans.
Except in the case of a person admitted for short-term care, within 4 weeks following admission a written care plan shall be developed, based on the resident's history and assessments from all appropriate disciplines and the physician's evaluation and orders, as required by s. DHS 132.52
DHS 132.60 Note
For requirements upon admission, see s. DHS 132.52
. For requirements for short-term care residents, see s. DHS 132.70 (2)