RURAL MEDICAL CENTERS
Licensing procedure and requirements.
Inspections and investigations.
Penalties and remedies.
Departmental powers and duties.
Use of name or advertising prohibited.
Right of injunction.
Ch. 50 Cross-reference
See s. 46.011
for definitions applicable to chs. 46
CARE AND SERVICE RESIDENTIAL FACILITIES
As used in this subchapter:
"Adult family home" means one of the following:
A private residence to which all of the following apply:
Care and maintenance above the level of room and board but not including nursing care are provided in the private residence by the care provider whose primary domicile is this residence for 3 or 4 adults, or more adults if all of the adults are siblings, each of whom has a developmental disability, as defined in s. 51.01 (5)
, or, if the residence is licensed as a foster home, care and maintenance are provided to children, the combined total of adults and children so served being no more than 4, or more adults or children if all of the adults or all of the children are siblings, or, if the residence is licensed as a treatment foster home, care and maintenance are provided to children, the combined total of adults and children so served being no more than 4.
The private residence was licensed under s. 48.62
as a foster home or treatment foster home for the care of the adults specified in subd. 1.
at least 12 months before any of the adults attained 18 years of age.
A place that meets the definition under sub. (1g)
, except sub. (1g) (e)
, and except that only 3 or 4 unrelated adults reside there.
"Assisted living facility" means a place where 5 or more adults reside that consists of independent apartments, each of which has an individual lockable entrance and exit, a kitchen, including a stove, and individual bathroom, sleeping and living areas, and that provides, to a person who resides in the place, not more than 28 hours per week of services that are supportive, personal and nursing services. "Assisted living facility" does not include a nursing home or a community-based residential facility, but may be physically part of a structure that is a nursing home or community-based residential facility.
"Community-based residential facility" means a place where 5 or more unrelated adults reside in which care, treatment or services above the level of room and board but not including nursing care are provided to persons residing in the facility as a primary function of the facility. "Community-based residential facility" does not include any of the following:
A convent or facility owned or operated by members of a religious order exclusively for the reception and care or treatment of members of that order.
A facility or private home that provides care, treatment and services only for victims of domestic abuse, as defined in s. 46.95 (1) (a)
, and their children.
A place that provides lodging for individuals and in which all of the following conditions are met:
Each lodged individual is able to exit the place under emergency conditions without the assistance of another individual.
No lodged individual receives from the owner, manager or operator of the place or the owner's, manager's or operator's agent or employe any of the following:
Personal care, supervision or treatment, or management, control or supervision of prescription medications.
Care or services other than board, information, referral, advocacy or job guidance; location and coordination of social services by an agency that is not affiliated with the owner, manager or operator, for which arrangements were made for an individual before he or she lodged in the place; or, in the case of an emergency, arrangement for the provision of health care or social services by an agency that is not affiliated with the owner, manager or operator.
"Facility" means a nursing home or community-based residential facility. If notice is required to be served on a facility or a facility is required to perform any act, "facility" means the person licensed or required to be licensed under s. 50.03 (1)
"Nurse's assistant" means a person who performs routine patient care duties delegated by a registered nurse or licensed practical nurse who supervises the person, for the direct health care of a patient or resident. "Nurse's assistant" does not mean a person who is licensed, permitted, certified or registered under ch. 441
or a person whose duties primarily involve skills that are different than those taught in instructional programs for nurse's assistants.
"Nursing home" means a place which provides 24-hour services including board and room to 3 or more unrelated residents who because of their mental or physical condition require nursing care or personal care in excess of 7 hours a week. "Nursing home" does not include any of the following:
A convent or facility owned or operated exclusively by and for members of a religious order that provides reception and care or treatment of an individual.
"Operator" means any person licensed or required to be licensed under s. 50.03 (1)
"Personal care" means assistance with the activities of daily living, such as eating, dressing, bathing and ambulation.
"Plan of correction" means a nursing home's response to alleged deficiencies cited by the department on forms provided by the department.
"Primary function" means the basic or essential care, treatment or services provided to residents of a facility.
"Recuperative care" means care anticipated to be provided in a nursing home for a period of 90 days or less for a resident whose physician has certified that he or she is convalescing or recuperating from an illness or medical treatment.
"Resident" means a person cared for or treated in any nursing home or community-based residential facility, irrespective of how admitted.
"Respite care" means care anticipated to be provided in a nursing home for a period of 28 days or less for the purpose of temporarily relieving a family member or other caregiver from his or her daily caregiving duties.
"Short-term care" means recuperative care or respite care provided in a nursing home.
"Violation" means a failure to comply with any provision of this subchapter or administrative rule promulgated thereunder. An alleged deficiency in a nursing home reported in writing to the department by any of its authorized representatives shall not be deemed to be a violation until the department determines it is a violation by serving notice under s. 50.04 (4)
. If the facility contests the department determination, the facility shall be afforded the due process procedures in this subchapter.
Up to 7 hours of nursing care may be provided by a community based residential facility under sub. (1g) . Hacker v. DHSS, 197 W (2d) 441, 541 NW (2d) 766 ( 1995).
Department; powers and duties. 50.02(1)
The department may provide uniform, statewide licensing, inspection and regulation of community-based residential facilities and nursing homes as provided in this subchapter. The department shall certify, inspect and otherwise regulate adult family homes, as specified under s. 50.032
and shall license adult family homes, as specified under s. 50.033
. Nothing in this subchapter may be construed to limit the authority of the department of commerce or of municipalities to set standards of building safety and hygiene, but any local orders of municipalities shall be consistent with uniform, statewide regulation of community-based residential facilities. The department may not prohibit any nursing home from distributing over-the-counter drugs from bulk supply. The department may consult with nursing homes as needed and may provide specialized consultations when requested by any nursing home, separate from its inspection process, to scrutinize any particular questions the nursing home raises. The department shall, by rule, define "specialized consultation".
The department, by rule, shall develop, establish and enforce regulations and standards for the care, treatment, health, safety, rights, welfare and comfort of residents in community-based residential facilities and nursing homes and for the construction, general hygiene, maintenance and operation of those facilities which, in the light of advancing knowledge, will promote safe and adequate accommodation, care and treatment of residents in those facilities; and promulgate and enforce rules consistent with this section. Such standards and rules shall provide that intermediate care facilities, which have 16 or fewer beds may, if exempted from meeting certain physical plant, staffing and other requirements of the federal regulations, be exempted from meeting the corresponding provisions of the department's standards and rules. The department shall consult with the department of commerce when developing exemptions relating to physical plant requirements.
The department shall promulgate all of the following rules with respect to adult family homes:
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.
For the purposes of s. 50.033
, establishing minimum requirements for licensure, licensure application procedures and forms, standards for operation and procedures for monitoring, inspection, revocation and appeal of revocation.
The department shall conduct plan reviews of all capital construction and remodeling of nursing homes to ensure that the plans comply with building code requirements under ch. 101
and with life safety code and physical plant requirements under s. 49.498
, this chapter or under rules promulgated under this chapter.
The department shall promulgate rules that establish a fee schedule for its services under subd. 1.
in conducting the plan reviews. The schedule established under these rules shall set fees for nursing home plan reviews in amounts that are less than the sum of the amounts required on September 30, 1995, for fees under this paragraph and for fees for examination of nursing home plans under s. 101.19 (1) (a)
, 1993 stats.
If a nursing home is certified as a provider of services under s. 49.45 (2) (a) 11.
and is named in a verified complaint filed with the department stating that staffing requirements imposed on the nursing home are not being met, the department shall, in order to verify the staffing requirements, randomly inspect payroll records at the nursing home that indicate the actual hours worked by personnel and the number of personnel on duty. The department may not limit its inspection to schedules of work assignments prepared by the nursing home.
(3) Considerations in establishing standards and regulations. 50.02(3)(a)(a)
The department shall establish several levels and types of community-based residential facilities and nursing homes as provided in par. (b)
, including a category or categories designed to enable facilities to qualify for federal funds.
In setting standards and regulations, the department shall consider the residents' needs and abilities, the increased cost in relation to proposed benefits to be received, the services to be provided by the facility, the relationship between the physical structure and the objectives of the program conducted in the facility and the primary functions of the facility. Recognizing that size and structure will influence the ability of community-based residential facilities to provide a homelike environment, the legislature encourages the department to develop rules which facilitate in particular the development of: small facilities, small living units in larger facilities, individual residential units, independent living to the extent possible, and integration of residents into the community.
The department shall promulgate rules to establish a procedure for waiver of and variance from standards developed under this section. The department may limit the duration of the waiver or variance.
The department shall promulgate rules to establish a procedure for the admission, evaluation and care of short-term care nursing home residents. These rules shall specify that the nursing home or community-based residential facility shall be required to provide to the department as documentation of this admission, evaluation and care only that amount of information commensurate with the length of stay and the medical needs, if any, of the particular resident.
(4) Reports to the board on aging and long-term care.
The department shall submit at least one report quarterly to the board on aging and long-term care regarding enforcement actions, consultation, staff training programs, new procedures and policies, complaint investigation and consumer participation in enforcement under this subchapter and changes that may be needed under this subchapter. The department shall submit at least one report annually to the board on aging and long-term care regarding implementation of rules under sub. (3) (d)
History: 1971 c. 125
; 1973 c. 122
; 1975 c. 119
; 1975 c. 413
; 1977 c. 29
; 1981 c. 20
; 1983 a. 542
; 1985 a. 29
; 1987 a. 161
; 1989 a. 336
; 1991 a. 250
; 1993 a. 16
; 1995 a. 27
, 9116 (5)
; 1995 a. 98
Municipal ordinance which required registration of nursing homes was in direct conflict with (1) and, therefore, invalid. Volunteers of America v. Village of Brown Deer, 97 W (2d) 619, 294 NW (2d) 44 (Ct. App. 1980).
The state has given the department preemptive authority over community-based residential facilities and nursing homes. 68 Atty. Gen. 45.
The department may conduct plan reviews of all capital construction and remodeling of community-based residential facilities. The department shall promulgate rules that establish a fee schedule for its services in conducting the plan reviews.
History: 1977 c. 29
; 1977 c. 170
; 1993 a. 16
Licensing, powers and duties. 50.03(1)
Penalty for unlicensed operation.
No person may conduct, maintain, operate or permit to be maintained or operated a community-based residential facility or nursing home unless it is licensed by the department. Any person who violates this subsection may, upon a first conviction, be fined not more than $500 for each day of unlicensed operation or imprisoned not more than 6 months or both. Any person convicted of a subsequent offense under this subsection may be fined not more than $5,000 for each day of unlicensed operation or imprisoned not more than one year in the county jail or both.
(1m) Distinct part or separate licensure for institutions for mental diseases.
Upon application to the department, the department may approve licensure of the operation of a nursing home or a distinct part of a nursing home as an institution for mental diseases, as defined under 42 CFR 435.1009
. Conditions and procedures for application for, approval of, operation under and renewal of licensure under this subsection shall be established in rules promulgated by the department.
The department shall make or cause to be made such inspections and investigations as it deems necessary.
With approval of the department, the county board of any county having a population of 500,000 or more may, in an effort to assure compliance with this section, establish a program for the inspection of facilities licensed under this section within its jurisdiction. If a county agency deems such action necessary after inspection, the county agency may, after notifying the department, withdraw from the facility any persons receiving county support for care in a facility which fails to comply with the standards established by this section or rules promulgated under this section.
The department shall conduct both announced and unannounced inspections. Inspections of records not directly related to resident health, welfare or safety shall be made between the hours of 8 a.m. and 5 p.m. unless specifically authorized by the secretary. Any employe of the department who intentionally gives or causes to be given advance notice of an unannounced inspection to any unauthorized person is subject to disciplinary action ranging from a 5-day suspension without pay to termination of employment.