DHS 105.17(1n)(a)1.1. Evaluate every personal care worker and RN supervisor employed by or under contract with the provider periodically according to the provider's policy for quality of performance and adherence to the provider's policies and this chapter and s.
DHS 107.112. Evaluations shall be followed up with appropriate action.
DHS 105.17(1n)(a)2.
2. Provide orientation and on-going instruction for RN supervisors and personal care workers. Personal care workers shall receive orientation before providing services to a client. The titles of the persons responsible for conducting orientation and training shall be specified in the plan. The plan shall include a system for providing instruction when an evaluation of the RN's or personal care worker's performance or competency indicates additional instruction may be needed. Orientation shall include training on all of the following:
DHS 105.17(1n)(a)2.b.
b. Information concerning specific job duties. Training shall be provided for each skill the personal care worker is assigned and shall include a successful demonstration of each skill by the personal care worker to the qualified trainer, under the supervision of the RN supervisor, prior to providing the service to a client independently. Only an RN may train others on a delegated act, as defined in s.
N 6.02 (5), and s.
N 6.03. The RN or qualified trainer shall document the personal care worker's successful demonstration of each skill and maintain the information in their personnel file.
DHS 105.17(1n)(a)2.c.
c. The functions of personnel employed by the provider and how they interrelate and communicate with each other in providing services.
DHS 105.17(1n)(a)2.e.
e. Epidemiology, modes of transmission and prevention of infections and the need for routine use of current infection control measures as recommended by the U.S. centers for disease control and prevention.
DHS 105.17(1n)(a)3.
3. Comply with the caregiver background check requirements under s.
50.065, Stats., and ch.
DHS 12, including the disclosure requirements under s.
50.065 (2m), Stats., and s.
DHS 12.115. The provider shall also comply with the caregiver misconduct reporting and investigation requirements under ch.
DHS 13.
DHS 105.17(1n)(b)
(b) Employ trained personal care workers as described under sub.
(3), or train or arrange and pay for training of employed or subcontracted personal care workers as necessary. No employee or subcontractor may be assigned any duty for which he or she is not trained.
DHS 105.17(1n)(d)1.1. Supervise the provision of personal care services. Except as provided in subd.
2., services for all clients shall be supervised by an RN according to the requirements set forth in s.
DHS 107.112 (3) (a) and
(c). The visit to the client's home by an RN shall be conducted at a time when the personal care worker will be directly observed providing personal care services to the client in the client's home. The RN shall document the results of the visit including the observation of the personal care worker and maintain the information in their personnel file or other designated agency file. When observation of the personal care worker by the RN reveals a failure to follow the client's care plan, the personal care provider shall provide counseling, education or retraining to ensure the personal care worker is adequately trained to complete their job responsibilities.
DHS 105.17(1n)(d)2.
2. Clients who are not Medicaid recipients may choose to waive the requirements contained in s.
DHS 107.112 (3) (c) for the supervisory review of the personal care worker, including a visit to the client's home every 60 days, through a written agreement between the client or the client's legal representative and the personal care agency. The agreement shall specify the requirements being waived by the client or the client's legal representative and the benefits of the requirement and probable consequences of the requirement not applying to the client. The agreement shall be included in the service agreement required s.
DHS 105.17 (1w) (c).
DHS 105.17(1n)(e)
(e) Employ or contract with personal care workers to provide personal care services.
DHS 105.17(1n)(f)
(f) In the case of personal care workers who are not employees of the personal care provider, specify all required training, qualifications and services to be performed in a written personal care provider contract between the personal care provider and personal care workers, and maintain a copy of that contract on file.
DHS 105.17(1n)(fm)
(fm) Document performance of personal care services by personal care workers by maintaining time sheets of personal care workers which document the types and duration of services provided, by funding source.
DHS 105.17(1r)(a)
(a) The personal care provider shall develop and implement written policies for control of communicable diseases that take into consideration control procedures incorporated by reference in ch.
DHS 145 and that ensure that employees with symptoms or signs of communicable disease or infected skin lesions are not permitted to work unless authorized to do so by a physician or physician assistant or advanced practice nurse.
DHS 105.17(1r)(b)1.1. The personal care provider shall ensure that each new employee, before having direct contact with clients, is certified in writing by a physician, physician assistant or registered nurse as having been screened for tuberculosis, and clinically apparent communicable disease that may be transmitted to a client during the normal performance of the employee's duties. The screening shall occur within 90 days before the employee has direct client contact.
DHS 105.17(1r)(b)2.
2. The personal care provider shall ensure that each continuing employee having direct contact with clients is periodically screened for clinically apparent communicable disease by a physician, physician assistant, or registered nurse based on the likelihood of their exposure to a communicable disease, including tuberculosis. The exposure to a communicable disease may have occurred in the community or in another location.
DHS 105.17(1r)(c)
(c) The personal care provider shall monitor employees' adherence to evidence-based standards of practice as recommended by the U.S. centers for disease control and prevention, or other evidence-based standards of practice, related to protective measures. When monitoring reveals a failure to follow evidence-based standards of practice, the provider shall provide counseling, education, or retraining to ensure staff is adequately trained to complete their job responsibilities.
DHS 105.17(1r)(d)
(d) The personal care provider shall provide equipment and supplies necessary for all staff having direct care contact with the client to minimize the risk of infection.
DHS 105.17(1w)
(1w)
Client services. The personal care provider shall do all of the following:
DHS 105.17(1w)(a)
(a) Acceptance. Assess a prospective client's appropriateness to be served by the provider without delay, unless the reason for the delay is justifiable and documented, and accept a client only if there is reasonable expectation that the client's needs can be met by the provider. If the provider accepts the applicant as a client, the provider shall promptly provide services to the individual. If the provider does not accept an applicant as a client, the provider shall inform the applicant of other personal care providers in the area or how to obtain a list of those providers.
DHS 105.17(1w)(b)
(b) Information to provide to the client. The provider shall provide, in writing, prior to or at the time of accepting an applicant as a client, each client or the client's legal representative all of the following:
DHS 105.17(1w)(b)1.
1. The provider's rules and the client's responsibilities under the provider's rules.
DHS 105.17(1w)(b)2.
2. The procedures indicating the complaint or grievance process which shall include a statement on how the client can make a complaint to the department.
DHS 105.17(1w)(b)3.
3. A statement of client's rights which shall include all of the following:
DHS 105.17(1w)(b)3.a.
a. To be fully informed of these rights and of all of the provider's rules governing client responsibilities.
DHS 105.17 Note
Note: For clients who are Medicaid recipients, personal care services are not subject to recipient cost sharing, per s.
49.45 (18) (b) 11., Stats., and the provider is prohibited from charging the recipient for services in addition to or in lieu of obtaining Medicaid payment, per s.
946.91 (5), Stats.
DHS 105.17(1w)(b)3.d.
d. To participate in the planning of services, including referral to a health care institution or other provider and to refuse to participate in experimental research.
DHS 105.17(1w)(b)3.dm.
dm. To have access to information about the client's health condition to the extent required by law.
DHS 105.17 Note
Note: Section
146.83, Stats., and federal HIPAA regulations [
45 CFR s. 164.524] generally require health care providers to make health care records available for inspection by the patient.
DHS 105.17(1w)(b)3.f.
f. To confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the provider, except in the case of transfer to another provider or to a health facility, or as otherwise permitted by law.
DHS 105.17(1w)(b)3.g.
g. To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs.
DHS 105.17(1w)(b)3.h.
h. To be taught the service required so that the client can, to the extent possible, help himself or herself.
DHS 105.17(1w)(b)3.i.
i. To have a person designated by the client taught the service required, so that, to the extent possible, the person designated can understand and help the client.
DHS 105.17(1w)(b)3.k.
k. To complain about the care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.
DHS 105.17(1w)(b)3.L.
L. To have the client's legal representative exercise the client's rights when the legal representative is legally authorized to do so.
DHS 105.17(1w)(c)
(c) Service agreement. Before services are provided, the personal care provider shall inform the client, orally and in writing, of the extent to which payment may be expected from other sources, the charges for services that will not be covered by other sources and charges that the individual may have to pay.
DHS 105.17 Note
Note: For clients who are Medicaid recipients, personal care services are not subject to recipient cost sharing, per s.
49.45 (18) (b) 11., Stats., and the provider is prohibited from charging the recipient for services in addition to or in lieu of obtaining Medicaid payment, per s.
946.91 (5), Stats.
DHS 105.17(1w)(d)
(d) Client records. Maintain all of the following records, if required in this section or s.
DHS 107.112, for each client:
DHS 105.17(1w)(d)1.
1. The nursing assessment, physician prescription, plan of care, personal care worker's assignment and record of all assignments, and record of registered nurse supervisory visits.
DHS 105.17(1w)(d)2.
2. The record of all visits by the personal care worker, including observations and assigned activities completed and not completed.
DHS 105.17(1w)(d)3.
3. Written acknowledgement of receipt by the client of the client's rights and responsibilities, provider rules and policies, and the department statement on how to register a complaint.
DHS 105.17(1w)(e)
(e) Client's preference for services. Give full consideration to a client's preferences for service arrangements and choice of personal care workers.
DHS 105.17(1w)(f)1.1. A personal care provider may discharge a client only for one or more of the reasons listed in subd.
2.,
3., or
6. and only after discussing the reasons for the discharge with the client or the client's legal representative and the client's attending physician, when the physician has ordered personal care services, and providing written notice to the client or client's legal representative within the timelines specified in this paragraph.
DHS 105.17(1w)(f)2.
2. The personal care provider shall provide written notice to the client or the client's legal representative at least 10 working days in advance of the discharge if the reason for the discharge is either of the following:
DHS 105.17(1w)(f)2.a.
a. The provider is unable to provide the personal care services required by the client due to either a change in the client's conditions that is not an emergency, or the provider's documented inability to staff the case.
DHS 105.17(1w)(f)3.
3. The personal care provider shall provide written notice to the client or the client's legal representative at the time of the discharge if the reason for the discharge is the result of any of the following:
DHS 105.17(1w)(f)3.a.
a. The safety of the personal care worker or nurse supervisor is compromised, as documented by provider staff.
DHS 105.17(1w)(f)3.b.
b. The attending physician orders the discharge of the client for emergency medical reasons.
DHS 105.17(1w)(f)3.c.
c. The client no longer needs personal care service as determined by the attending physician.
DHS 105.17(1w)(f)4.
4. A copy of the written notice of discharge shall be placed in the client's medical record.
DHS 105.17(1w)(f)5.
5. The personal care provider shall include all of the following in the written notice of discharge required under this paragraph:
DHS 105.17(1w)(f)5.b.
b. The assistance the personal care provider is able to provide in arranging for continuity of all necessary personal care services.
DHS 105.17(1w)(f)5.c.
c. A notice of the client's right to file a complaint with the department if the client believes the discharge does not comply with any of the provisions of this section and the department's toll-free complaint telephone number and the address and telephone number of the department's division of quality assurance.
DHS 105.17 Note
Note: A complaint may be filed by writing the Bureau of Health Services, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or by calling the department's toll-free complaint line at 1-800-642-6552 or by filing a complaint at
http://dhs.wisconsin.gov/bqaconsumer/HealthCareComplaints.htm.
DHS 105.17(1w)(f)6.
6. No written notification is necessary for discharge for any of the following reasons:
DHS 105.17(1w)(f)6.b.
b. The client changes place of residence to a location in an area not served by the provider.
DHS 105.17(1w)(f)6.c.
c. The client or the client's legal representative notifies the provider in writing to terminate services.
DHS 105.17(1w)(f)7.
7. The personal care provider shall complete a written discharge summary within 30 calendar days following discharge of a client or voluntary termination of services by the client or the client's legal representative. The discharge summary shall include a description of the care provided and the reason for discharge. The personal care provider shall place a copy of the discharge summary in the former client's medical record. Upon request, the personal care provider shall provide a copy of the discharge summary to the former client, the client's legal representative, the attending physician, or advanced practice nurse prescriber.
DHS 105.17 Note
Note: A complaint may be filed by writing the Bureau of Health Services, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or by calling the department's toll-free complaint line at 1-800-642-6552 or by filing a complaint at
http://dhs.wisconsin.gov/bqaconsumer/HealthCareComplaints.htm.
DHS 105.17(1w)(h)
(h) Client grievances and complaints. Provide and document a grievance mechanism to resolve clients' complaints about personal care services, including a personal care provider's decision not to hire a client's choice of a personal care worker. The procedure shall set forth a procedure for clients to register complaints with the department.
DHS 105.17(2)
(2)
Qualifications and duties of the registered nurse supervisor. DHS 105.17(2)(a)(a)
Qualifications. A personal care provider shall employ or contract with an RN supervisor who shall have all of the following qualifications:
DHS 105.17(2)(a)2.
2. Training and experience in the provision of personal care services or in a related program.
DHS 105.17(2)(a)3.
3. At least one year of supervisory or administrative experience in personal care services or in a related program.
DHS 105.17(2)(b)
(b)
Duties. The RN supervisor shall perform all of the following duties:
DHS 105.17(2)(b)1.
1. Assess and evaluate the need for services according to the standards of practice contained in s.
N 6.03 (1) (a) and
(d), and make referrals to other services as appropriate. Documentation shall be signed and dated by the RN supervisor who conducted the assessment and evaluation, attesting to its accuracy and truthfulness.
DHS 105.17(2)(b)2.
2. Secure written orders from the client's physician. These orders are to be renewed once every 3 months unless the physician specifies that orders covering a period of time up to one year are appropriate, or when the client's needs change, whichever occurs first. Physician orders for personal care services are not required for clients who are not Medicaid recipients unless the personal care service is a delegated act. This provision does not mitigate the RN supervisor's responsibility to follow the standards contained in ch.
N 6.
DHS 105.17(2)(b)3.
3. Develop a plan of care for the client, giving full consideration to the client's preferences for service arrangements and choice of personal care workers, interpret the plan to the personal care worker, include a copy of the plan in the client's health record, and review the plan at least every 60 days and update it as necessary.
DHS 105.17(2)(b)3m.
3m. Promptly notify a client's physician or other appropriate medical personnel and legal representative, if any, of any significant changes observed or reported in the client's condition.
DHS 105.17(2)(b)4.
4. Develop appropriate time and service reporting mechanisms for personal care workers and instruct the workers on their use.
