Staff assignments shall include sufficient time necessary to permit staff to assist tenants with unscheduled care needs.
(c) Emergency assistance.
A residential care apartment complex shall ensure that tenant health and safety are protected in the event of an emergency and shall have the capacity to provide emergency assistance 24 hours a day. A residential care apartment complex shall have a written emergency plan which describes staff responsibilities and procedures to be followed in the event of fire, sudden serious illness, accident, severe weather or other emergency and is developed in cooperation with local fire and emergency services.
Residential care apartment complex services shall be provided by qualified staff, consistent with the requirements under sub. (4)
Services shall be provided in the type, amount and frequency identified in the service agreements.
Services to meet both scheduled and unscheduled care needs shall be provided in a timely manner.
Services shall be appropriate to the needs, abilities and preferences of tenants as identified in the comprehensive assessment, service agreement and risk agreement.
Services shall be provided in a manner which respects tenant privacy, enhances tenant self-reliance and supports tenant autonomy in decision-making, including the right to accept risk.
Meals and snacks served to tenants shall be prepared, stored and served in a safe and sanitary manner.
Residential care apartment complex services shall be provided by staff who are trained in the services that they provide and are capable of doing their assigned work. Any service provider employed by or under contract to a residential care apartment complex shall meet applicable federal or state standards for that service or profession.
Nursing services and supervision of delegated nursing services shall be provided consistent with the standards contained in the Wisconsin nurse practice act. Medication administration and medication management shall be performed by or, as a delegated task, under the supervision of a nurse or pharmacist.
DHS 89.23 Note
Note: The nurse practice act is published as “Wisconsin Statutes and Administrative Code Relating to the Practice of Nursing" and is available from the Department of Safety and Professional Services, Board of Nursing, P.O. Box 8935, Madison, WI 53708.
Personal and supportive services shall be provided by staff who have documented training or experience in needs and techniques for assistance with tenant care and activities of daily living, such as bathing, grooming, skin care, transfer, ambulation, exercise, meal preparation and eating assistance, dressing, and use of adaptive aids and equipment.
Each residential care apartment complex shall have a designated service manager who shall be responsible for day-to-day operation of, including ensuring that the services provided are sufficient to meet tenant needs and are provided by qualified persons; that staff are appropriately trained and supervised; that facility policies and procedures are followed; and that the health, safety and autonomy of the tenants are protected. The service manager shall be capable of managing a multi-disciplinary staff to provide services specified in the service agreements.
A person shall be designated to be in charge of the facility whenever there is not a service manager present. The person in charge shall be competent to supervise staff of the residential care apartment complex. The person in charge shall be available to the residential care apartment complex and shall be identified to and easily reachable by all tenants and staff. In this subdivision “available" means accessible and able to ensure that services are provided to tenants as required under sub. (1)
. The person in charge is available if he or she is either present in the facility or present, awake and on duty in an attached or adjacent residential, health care or other similar facility and able to be physically present in the facility on short notice.
(c) Freedom from abuse, neglect and exploitation.
A residential care apartment complex shall ensure that tenants are free from abuse, neglect or financial exploitation by the facility or its staff. A residential care apartment complex shall not employ an individual who has been convicted of a crime that is substantially related to the circumstances of the job or for whom there is a substantiated finding of abuse or neglect or misappropriation of property in the department's registry for nurse aides, home health aides and hospice aides. The facility shall conduct a criminal records check with the Wisconsin department of justice and shall check with the department's registry for nurse aides, home health aides and hospice aides when hiring a service manager, service providers and other persons to work in the facility or have contact with tenants.
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)
DHS 89.25 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.
DHS 89.26 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.