SS 108-21 Revised Scope Statement

DEPARTMENT OF HEALTH SERVICES Office of Legal Counsel F-02315 (06/2018)

STATE OF WISCONSIN

STATEMENT OF SCOPE WISCONSIN DEPARTMENT OF HEALTH SERVICES

CHAPTER:         DHS 88

RELATING TO:       Licensed Adult Family Homes

RULE TYPE:         Permanent

SCOPE TYPE:   Revised. This statement of scope modifies SS 092-19, which was approved by the Governor on August 29, 2019, published in the Administrative Register on September 3, 2019, and approved by the Secretary of the Department of Health Services (” the Department”) on September 16, 2019. This revised statement of scope seeks to update policies proposed to be included in the rule.

FINDINGS OF EMERGENCY:   Not applicable

SUMMARY

1.

Description of rule objective/s

Licensed Adult Family Homes (“AFHs”) provide care, treatment, or services to three or four adults that are above the level of room and board, including up to seven hours per week of nursing care per resident. Currently, there are 2,015 AFHs in Wisconsin. Chapter DHS 88 establishes licensing standards for the operation of these AFHs. The Department proposes to update ch. DHS 88 for the purpose of strengthening provisions related to the health, safety and rights of residents. The rule was created on June 1, 1995 and has not been substantially revised since that time.

2.

Existing policies relevant to the rule

AFHs have traditionally cared for elders with minor health problems or individuals with mild intellectual disabilities. Over the past several years, a new type of AFH has emerged that provides care to residents who have significant medical needs, intellectual disabilities, mental illness, or who are a part of the correctional system. These residents require complex care and highly trained staff to meet their needs. Chapter DHS 88 must be updated to address these needs and ensure adequate protection of AFH residents.

3.

Policies proposed to be included in the rule

Pursuant to s. 50.02 (2) (am), Stats., the Department proposes to update ch. DHS 88 to accomplish the following:

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Focus on resident outcomes and quality of life and care.

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Support reasonable and flexible regulatory processes.

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Improve readability and organization of the rule.

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Address increasing acuity care levels of residents living in AFHs.

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Establish thresholds for admission and retention of residents with a long term illness or disability that is relatively stable and predictable and other related program requirements. 

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Improve assessment and care planning.

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Include use of temporary service plans, developed and implemented on admission, to address immediate needs of residents.

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Update training standards to enhance the ability of staff to meet the increasing care needs of residents in AFHs, including the provision of personal care.

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Develop evidenced-based program standards, staffing requirements, training and environmental safeguards for facilities that admit and provide care to residents with dementia.

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Establish minimum staff training requirements regarding medication administration, standard precautions, changes of condition, challenging behaviors, abuse, neglect and misappropriation, fire safety and first aid and choking.

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Clarify medication administration requirements and the monitoring of psychotropic medication.

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Clarify nurse delegation responsibilities to a non-licensed caregiver to address acuity and allow the facility to provide appropriate care in a time of limited nurse availability.

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Promote the use of nationally recognized standards of practice.

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Provide or arrange for services to meet the needs of residents in the areas of personal care, supervision, leisure time activities, community activities, family and social contacts, communication skills, health monitoring, and behavior management.

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Update provisions relating to reporting, investigating, and documenting allegations of caregiver misconduct to include resident protection.

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Establish an infection control program based on current standards of practice to prevent the development and transmission of communicable disease and infection. The infection control program will include orientation and ongoing education for all staff, trainees and volunteers.

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Modernize environmental accessibility requirements to meet the needs of residents with physical and intellectual disabilities.

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Establish standards that require facilities to develop, implement and maintain a quality assurance and quality improvement program.

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Establish a relocation planning process that includes notification to the department and adequate time for the resident to choose and visit the admitting facility prior to moving.

Policies were developed at the direction of an interdivisional committee in the Department formed to study and make recommendations regarding the delivery of Long Term Care services in Wisconsin. The revised Statement of Scope adds policies related to establishing thresholds for admission and retention of residents with a long term illness or disability; program, staffing, training and environmental standards to provide care to residents with dementia; quality assurance and quality improvement program and a relocation planning process.

4.

Analysis of policy alternative

The Department has determined that oversight of AFHs is not adequate to ensure a minimum standard of care for vulnerable residents, and to protect the health, safety, and rights residents. There are no reasonable alternatives to updating the rule.

5.

Statutory authority for the rule

a.

Explanation of authority to promulgate the proposed rule

The Department is authorized to establish requirements for certification, certification application procedures and forms, standards for operation, and procedures for monitoring, inspection, decertification and appeal of decertification for adult family homes. The rules must be designed to protect and promote the health, safety and welfare of the disabled adults receiving care and maintenance in certified adult family homes. The Department is also authorized to promulgate rules that establish minimum requirements for licensure, licensure application procedures and forms, standards for operation and procedures for monitoring, inspection, revocation and appeal of revocation.

b.

Statute/s that authorize/s the promulgation of the proposed rule

Section 50.02 (2) (am), Stats., reads:

The department shall promulgate all of the following rules with respect to adult family homes:

1. For the purposes of s. 50.032, defining the term “permanent basis" and establishing minimum requirements for certification, certification application procedures and forms, standards for operation and procedures for monitoring, inspection, decertification and appeal of decertification. The rules shall be designed to protect and promote the health, safety and welfare of the disabled adults receiving care and maintenance in certified adult family homes.