State of Wisconsin Assisted Living News

Focus 2010 Conference

Save the Date!

November 18, 2010

FOCUS 2010 Conference "Striving for Excellence in Challenging Times"

November 17, 2010

FOCUS 2010 Special Session "Infection Prevention and Control"

For more information go to the DHS website at http://dhs.wisconsin.gov/rl_dsl/Training/focus10.htm

The New DHS 83 Rule and Trainings

The new DHS 83 will be effective April 1, 2009. Yes, April Fool's Day.

BAL has just announced that the only training they are able to provide CBRFs will be an on-line webcast. Once launched (we expect by mid-March) this webcast will be available 24/7 from your office computer. Due to budget constraints, they do not intend to provide live training in the five BAL regions.

WALA is planning both basic and detailed DHS 83 training in the regions around the state. More details will become available later as we finalize our plans. (Note: The name will be DHS 83 reflecting the newly named Department of Health Services.)

From March 2009 Newsletter

Preliminary Summary of the States Biennial 2009-2011 Budget.

2009 Bill - LRB 1173: diversions under a community integration program of Medical Assistance-eligible persons from imminent entry into nursing homes.

DHS Memos and ListServ Information

DQA Memo 08-025 - Guidelines for Managing MRSA (Methicillin-Resistant Staphylococcus Aureus) - This memo provides guidance for managing MRSA when presnet in residents of assisted living facilities, including Community-Based Residential Facilities (CBRFs), Adult Family Homes (AFHs) and Residential Care Apartment Complexes (RCACs). This memo will specifically address MRSA as the most commonly encountered multidrug- resistant organism encountered in assisted living. For more information and to review the memo, go to The DHS Website.

 

DHS has now two ListServ's to keep providers more abreast of Assisted Living information. The first is to receive memos and other information from DHS. Sign up here.

The second is to receive Assisted Living Forum handouts and information. See handout regarding how to set this ListServ up for your email.

Training Available on Emergency Response for Healthcare- Basic Level

The State Expert Panel on Long-Term Care Facilities in collaboration with the Hospital Preparedness Program of the Wisconsin Division of Public Health and Lakeshore Technical College is providing your facility and your staff with unlimited access to a Certificate Course in "Emergency Response for Healthcare - Basic Level". This Certificate Course provides your staff with an opportunity to learn about basic emergency preparedness through an on-line course that they can complete on their own time-frame. For more information go here.

Survey Guides Now On Internet

The BAL has begun making survey guides available on the Internet and will no longer be providing a paper copy at the start of a survey, unless a provider does not have Internet access and requests a copy. However, surveyors will continue to distribute a contact page listing the website address, surveyor's name, surveyor's supervisor and contact information for both. [Survey guides.]

DHS Proposes Facility Fee Increase in the 09-11 Biennial Budget

Note the fee increases below. Please let WALA know your opinion about this proposed increase by calling 608/288-0246 or emailing at info@ewala.org.

 

Provider Current Fee Proposed Fee
(27% increase)
Community Based Residential Facility (CBRF) $306.00 $389.00
CBRF Beds $39.60 $50.25
Adult Family Homes $135.00 $171.00
Residential Care Apartment Complex (RCAC) $350.00 $445.00
RCAC Apartments $6.00 $7.60
Adult Day Care $100.00 $127.00

 

*Note: All fees are biennial except of RCACs, which are annual

Biennial Budget Summary and Intro to the Assisted Living Medication Management Initiative Website

Please visit and view DQA memo/08-024 Summary of Wisconsin's Assisted Living Medication Management Initiative Workgroup Activities and Introduction of the Assisted Living Medication Management Initiative Website

*This is a major resource and initiative. WALA strongly encourages you to review these documents.*

Ethics of Disaster Preparedness

The State Expert Panel on the Ethics of Disaster Preparedness has produced a series of six brochures to help health care organizations and their staff to have a greater awareness of the ethical issues that will arise during a disaster and also more realistic expectations of what to expect from the healthcare system in a disaster. [More on this topic.]

BAL announces "Starting Up an AFH" Webcast

"Starting Up an AFH" Webcast is now available onnline.

This webcast is now mandatory for all new facilities wanted to be licensed AFHs in Wisconsin. You must watch the webcast and turn in a certification of completion with your application to BAL.

DQA Background Check Reminder

It is a Mandatory Requirement to Submit Four - Year Renewal of Licensee Background Check regardless of when a DQA regulated entity last submitted an application for licensure, certification or registration, if an entity wishes the license approval to continue, the license holder or legal representative submit the completed forms for the required four-year renewal process. Failure to comply with any provision of background information gathering requirements subjects entities to certain sanctions, including denial, revocation, non-renewal, or suspension of regulatory approval.

All license holders/legal representatives must have complied with the requirements by June 30, 2008, however only half of all license holders/legal representatives have complied. Those who have not may get citied if this compliance is not taken care of immediately.

Access the DQA Regulated Entity Background Check Process web page to obtain the necessary forms for the Existing License Holder Four-Year Renewal Background Check Process. See DQA Memo 08-015 for more information.

Volunteer Ombudsman Program is ending

From Letter received by Heather Bruemmer, Executive Director/State Ombudsman, State of Wisconsin Board on Aging and Long Term Care:

It is with no small measure of disappointment that the Board on Aging and Long Term Care (BOALTC) announces that the Volunteer Ombudsman Program for Assisted Living will be ending July 31st, 2008.

In early 2007, the Volunteer Ombudsman Program began a project to expand services into the Assisted Living arena, enlisting Volunteer Ombudsmen to make visit in Community Based Residential Facilities (CBRF). This expansion included the hiring of an additional Volunteer Coordinator in a project position for 18 months to recruit, screen and place up to 36 CBRF Volunteer Ombudsmen into selected individual facilities.

The 18 months has come to an end and due to the lack of continuing funding, we are not able to continue this project position. The project has realized many accomplishments and has seen the same success as the Volunteer Program's nursing home counterpart. As an agency, the BOALTC will be conducting legislative advocacy to ensure that the achievements of this project are not lost. The BOALTC will be seeking authorization and funding to renew the Volunteer Ombudsman Program - Assisted Living in the future. I encourage you to contact your legislator to advocate for the program's importance and continuance.

DFHS is now officially DHS (Department of Health Services)

The Wisconsin Department of Health and Family Services (DHFS) is now officially known as the Wisconsin Department of Health Services (DHS). Other Important Changes include:

IRIS - a new alternative to Managed Care

This new program is called IRIS, which stands for "Include, Respect, I Self-Direct." Consumers who are eligible for publicly funded long-term care on or after July 1, 2008 in counties where Family Care is operating will now have another choice when deciding which program will best meet their needs. Please see Memo DLTC Info Memo Series 2008-06

Medication Waste

A difficult issue for facilities is the disposal of medications. Some can be considered as hazardous as lead or mercury. The Division of Quality Assurance has issued three memos (06-022, 07-008, and 08-003) which give facilities some sort of direction in the disposal process.

Although DQA has issued memos meant to help facilities, they do not specify a method of disposal. In addition to these memos, facilities should follow guidelines issued by the Department of Natural Resources, the Environmental Protection Agency, and other governmental agencies. Memos are located online.

Medication Stability in Food

The Division of Quality Assurance issued memo 07-012 regarding the involuntary administration of psychotropic medications. It maintains that the mixing of medications with food can be considered involuntary administration. It is because of this memo that a lot of discussion regarding the affects of mixing medications with food has arisen. Some medications cannot be given with food.

Crushed medication is sometimes mixed with applesauce or other foods and is then set aside. These foods may have low pH which will possibly begin to break down the medication, affecting its stability and effectiveness. If possible, avoid mixing medication with food, setting it aside, or storing it for later use. If medication is mixed with food, it should be administered immediately.

Integrated Evacuation Planning for Long Term Care Facilities

The State of Wisconsin expert panel on Healthcare Facilities Evacuation Planning has adopted a policy on the "Evacuation of Healthcare Facilities." LTC organizations helped in the development of the policy, and helped to identify a need to network, educate, and support such organizations. The city of Madison and the Metro Area Medical Response System have established a strategy to support long term area facilities within Dane County by offering training and technical assistance with development of comprehensive emergency management plans and evacuation procedures.

Melissa Waller, a consultant with Pre-Emergency Planning, LLC, will serve as the Dane County Long Term Care Disaster Preparedness Liaison. Her assistance will include training sessions, one-on-one or site visits, phone consultations, and resource networking to support the planning process with each facility. Training sessions will be offered to all LTC facilities in Dane County.

Statewide Waiver of Certain Sections of Wisconsin Administration Code Chapter HFS 88, Relating to the Provision of Information to an Aging and Disability Resource Center and Referral to a Resource Center - DQA Memo 08-019

With the passage of the State's budget, Adult Family Homes (AFHs) in counties with a resource center certified by the Secretary of the Department of Health and Family Services are no longer obligated to meet the requirements in Wis. Admin. Code HFS 10.73(3) and (4). The purpose of this statewide waiver is to notify facilities of the elimination of the statutory requirement to (a) provide information about the services of an aging and disability resource center and available screening for family care benefit eligibility, and (b) the requirement to make referrals to an aging and disability resource center.

Recent FDA Medication Recalls and Compliance- DQA Memo 08-020

The Centers for Medicare and Medicaid Services (CMS) has become aware, during facility surveys nationally, of instances where facilities have not been in compliance with various Food and Drug Administration (FDA) recalls. Recent recalls have included heparin products and Digitex (r). These recalls were due to adverse effects occurring in patients, including deaths. Therefore, facility removal of the recalled products is imperative for patient safety. The FDA information on recalled products and lot numbers may be accessed at the FDA web site.

Pharmacy providers and distributors and health care providers should be monitoring their supplies, including, for example, crash carts and storage cabinets, and removing recalled products in order to assure that recalled products are not available for patient/resident use.

In response to the recent finding nationally, CMS has asked the state survey agencies to do the following:

For further information, please contact Doug Englebert at (608) 266-5388.

List of Communicable Diseases Updated

Effective March 1, 2008, Wisconsin's list of Reportable Communicable Diseases changed. Revisions to Appendix A of Administrative Rule HFS 145 were adopted by the Department of Health and Family Services and published in the Wisconsin Administrative register on January 31, 2008. For a complete list and the implications of these changes, contact WALA.

Kevin Coughlin Wins Prestigious Award

Kevin Coughlin, Director of the Bureau of Assisted Living, was one of nine winners of Governing Magazine's Public Official of the Year. I met the writer, Penelope Lemov, at the awards dinner on November 6 in Washington DC at the legendary Willard Hotel, and she was impressed with Kevin, as you can see from her story. When I chatted with Elder Witt, the Deputy Publisher & General Manager of Governing Magazine, she emphasized that the award is for innovative collaborators.

Kevin Coughlin: Common-Sense Compliance

by PENELOPE LEMOV | photograph by MICHAEL KIENITZ

Photo of Kevin Coughlin"Kevin Coughlin wasn't a stranger to assisted-living systems when he took over the assisted-living program in Wisconsin in 2003 - he'd spent seven years managing a private facility before going to work for the state. But like Bratton (WALA note - another winner), he had a talent for asking the right questions. Why were all the state's assisted-living facilities being regulated the same way, when some clearly needed more attention and some could function with less? Coughlin's decision to rationalize the regulatory process led to myriad improvements across the state - and made Wisconsin a national model for meeting the growing demand for assisted living.

Kevin Coughlin didn't set out to turn Wisconsin's assisted-living system upside down. He just wanted to inject its regulatory process with a dose of common sense. But Coughlin's rational approach has, in fact, been both revolutionary and successful: He has managed to shift the old "gotcha" relationship between regulator and provider to a collaborative process that has translated into safer homes for the frail and elderly residents in the state's 2,700 assisted-living facilities."

Visit this page for more on Kevin or read the the full story on all the award winners.

Legislative Update

Wisconsin Senate Replaces Senate Majority Leader the Day After Budget Passes - The day after the Wisconsin Legislature passed the State Budget, Senate Democrats who control the majority voted to elect a new leader. Senator Russell Decker (D-Weston) was elected to replace Senator Judy Robson (D-Beloit) as the Wisconsin Senate Majority Leader. The change has been treated by the press as being controversial. Senate Majority Leader Russell Decker last week announced the following changes to the Senate Committees:

Wisconsin Budget: Provisions Impacting Long-Term Care - As reported two weeks ago, the Wisconsin Legislature passed the 2007-09 Biennial Budget and Governor Doyle signed the proposal, with limited vetoes, into law. A 15-page comprehensive review of the final budget is available at WALA. Below is a shorter summary impacting long-term care providers. If you would like more detail on any of these provisions, please contact WALA lobbyist Forbes McIntosh at: mcintosh@broydrick.com.