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Contact Information 1335 Dublin Rd. Phone: (614) 481-1950
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The RCF Rules Effective April 1, 2007 This coming year, 2008, will be the first full year under the new, revised RCF rules. Thus far, we have received 3 official interpretations on areas in the new rules, and answers to many questions, although additional questions will likely continue. The newly required disclosure form is now available and can be found on ODH’s website: www.odh.state.oh.us under forms, residential care facilities/assisted living. The Department has also stated they will ultimately be listing the “special interpretations” they have provided in this same area. I would like to just highlight some major areas of change and important points on them. At the end of my materials, we have copied lists of questions that have been answered by ODH on the new rules by rule number. Disclosure
Training
Limitations on Care
Staffing
Answered Questions on the Revised RCF Rules 3701-17-52, Residential care facility licensure Where is the disclosure form? When will it have to be submitted to Health? The disclosure form required by 3701-17-52, can be found on ODH’s website, www.odh.state.oh.us under forms, residential care facilities. The form, if you advertise or meet the number thresholds established by ODH, will need to be submitted with your license renewal. Additionally, it will have to be available to prospective residents and their sponsors along with ODH surveyors and ombudsmen. As of December 1st the form must be “available”, but you can wait to send it to ODH with your license renewal. What if we reach the number threshold mid-year? Do we send the form in at that time or wait till the subsequent license renewal period? You would need to send it in to ODH, if you have not previously sent one in with a license renewal. . How do we determine “late stage cognitive impairment with significant on-going daily assistance needs” or “cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents or both”? Without a definition in rules for either of these populations, communities should select cognitive and functional assessment tools and establish scores or standards on those tools to consistently identify these populations (Example: MMSE (Mini Mental State Exam) or Clock Drawing Test). In the case of cognitive impairment, remember it is a combination of late-stage impairment and significant on-going daily assistance needs. In the case of increased emotional needs, they should be significant and not sporadic and in the case of behaviors, they need to be behaviors that cause problems. Mental illness is defined in rules and provides a basis for determining this population. The definition of mental illness has 3 parts and in order for an individual to be classified based on this definition, they need to fall into two of the listed categories. (diagnosis, disability, duration) Do all communities need to complete the form even if they do not serve any special populations, advertise themselves as offering “special” care, or fall short of any number thresholds? No. You do not need to do the form if it is obvious you do not fall under the scepter of Rule 52, special populations. In determining number or percentage, do we count individuals with more than one of the special needs identified, multiple times? Do we total all 3 special needs diagnoses together in determining number and/or percentage? We received an “official” interpretation from Health on this question. Essentially, individuals with multiple diagnoses in the special needs populations identified by Health are only counted once and all 3 special populations are totaled to determine numbers and/ or percentages. What if there are secondary diagnoses falling in the outlined special populations by ODH, do they count? The secondary diagnoses would count in your “calculations” to determine whether you needed to provide ODH with the disclosure form, unless the individual has already been counted based on their primary diagnosis. If our population is intermixed and we fall under 52, do we have to provide all residents on admission a copy of the disclosure form and policy and procedures, even if they have no indication of special needs? It is our understanding, the form will have to be distributed to all prospective residents to special care units. In communities where special populations are intermingled, it will only need to be distributed to all prospective residents with diagnoses of dementia and cognitive impairment needs and those with diagnoses of mental illness. Rule 53, Inspections and Investigations Do the new rules require a written plan of correction? Facilities with serious or ongoing, uncorrected violations will be told to submit a written plan of correction at the discretion of the Department. Written plans of correction will not be required for all citations, nor will a written plan of correction always determine a follow-up survey. Rule 54, Personnel requirements If we provide skilled cares beyond the 3 exempted (medication administration, special diets, dressing changes) using our own qualified staff, do the new nursing requirements kick-in? Yes. If, however, skilled cares are provided by a home health agency, etc., under contract to the individual resident and not the facility, then the new requirements do not apply. Do we have to have a certified activity professional if we serve special populations? No, however, if you have to provide a disclosure form, then the person who plans activities for those populations must have training in appropriate activities for those individuals. Do we have to have a staff or consultant physician or psychologist if we serve special populations? Not necessarily. However, if you have to provide a disclosure form, then the private physicians of these individuals need to be familiar with their special diagnoses and treatment. If not, then a staff or consultant physician or psychologist familiar with these special needs, would need to be employed or contracted with. Rule 55, Qualifications and Health of Personnel Are the required 8 hours of continuing education annually for all personal care staff pro-rated by date of hire? What about the specialized annual training (4 hours) if you serve special populations, is it prorated also? Yes to both questions. Do STNAs have to have the required 8 hours of continuing education annually? What about nursing students? What if someone is only part-time? Yes, to all 3 questions. STNAs, nursing students and part-time staff are all required to have the 8 hours of documented continuing education annually. Does residents’ rights training or fire prevention training count toward the required 8 hours? The Department has taken the position that residents’ rights or fire prevention training does not count toward the newly required 8 hours of training for all personal care staff. Does specialized required training in dementia or mental illness count toward the required 8 hours annually for all personal care staff? Yes. Specialized training (initial and annual) does count toward the required hours for all personal care staff. “Initial” training is a “one-time” training and does not have to be repeated for the same staff member. Is specialized training only mandated, if we are required to do the disclosure form? No. Specialized training is required for any staff serving individuals with the needs identified in rules (late-stage, etc.) regardless of whether you meet ODH’s requirement to complete the disclosure form. In determining this need, remember to refer to your definition of “late-stage cognitive impairments with significant on-going daily assistance needs or emotional or behavioral issues affecting the individual or others.” The rules do not require this training for any or all residents with a diagnosis of dementia. Who is encompassed in the term “staff” as it refers to requirements for specialized training? The Department has provided another “official” interpretation on this issue. The rule uses the word “staff” which applies to everyone, however, the Department has clarified they mean staff who provided direct care and services to special population residents. It would include nurses in addition to personal care staff and possibly activity directors, therapists, dietitians and social workers employed by the RCF depending on their job descriptions. It would not apply to kitchen, housekeeping, janitorial or administrative staff unless their jobs routinely included the provision of personal care or services. In terms of licensed professionals, continuing education taken to maintain licensure can be used to meet the requirements of this rule, provided it is on topic. Additionally, when a licensed professional, who is an employee provides continuing education to other members of the staff, the individual may count the training towards the continuing education requirements of this rule. This rule only covers staff employed by the facility. Temporary agency staff, employed by someone else, would not be covered under this rule. Can videos, on-line or other types of training be used for the initial and subsequently required specialized training? The initial specialized training must be conducted by a qualified instructor who is present. Subsequent specialized training may be done through the use of videos, or on-line instruction, however, a qualified instructor must be present at a minimum at the end to answer questions and facilitate discussion. What is meant by a qualified instructor? A qualified instructor is someone with the knowledge, ability and background to provide training in a particular area. It does not necessarily mean a “degreed” individual. Rule 57, Resident Agreement Do individuals with Stage III or Stage IV pressure ulcers have to be transferred? Yes, unless they are on hospice. Residents on hospice are exempted from the limitations listed in OAC 3701-17-57 (B). How do we determine Stage III or Stage IV pressure ulcers for the purposes of this rule? The regulations do not specify a standard to be applied, however, whatever standard a facility uses, it should be widely recognized and accepted. For example, the National Pressure Ulcer Advisory Panel (NPUAP) staging terms and definitions for assessment of pressure ulcers could be used to determine admission and discharge criteria for this rule. Rule 59.1 Part-time Intermittent Skilled Nursing Care Must we have a hospice agreement as outlined in rules for all of our residents on hospice? No. The hospice agreement is required when the individual exceeds the allowed 120 days of part-time intermittent skilled care. It should be done as a resident on hospice approaches this maximum. What if someone is taken off hospice? What happens in terms of their skilled days and the hospice exemption? Would they have to be transferred? Unfortunately, the preliminary response from Health is that the individual would have to be transferred as they would have exceeded the allowed 120 days of part-time intermittent skilled care and the hospice exemption would no longer be valid. Rule 60, Dietary Services Can we just prepare special diets, not supervise them? Special diets other than complex therapeutic can be prepared and not supervised. If a community elects to only prepare special diets, it must prepare and provide them in accordance with the instructions of a physician or dietitian and adjust them as instructed by a dietitian or the resident’s attending physician. Can we elect to only supervise special diets other than complex therapeutic? Yes, if your resident agreement clearly states you only supervise special diets that are not complex therapeutic. What diet does “thickened liquids” fall under? Thickened liquids would be a special diet, falling under (1) Texture modifications, including chopped, ground and pureed. It would not be a “complex therapeutic diet”, but a “special diet”. By contrast, a “dysphagia” diet ordered by a physician for a resident is a complex therapeutic diet. Rule 61, Laundry services; activities; resident finances; pets. Do banking hours in the community refer to the RCF community or the broader community, for residents for whom we manage funds? The Department has stated that “community” in this context means the banking hours in the community beyond the facility. At a minimum they want residents to be able to access some funds on the weekend, not receive banking statements, etc. It would suffice for purposes of this rule to have some “cash” available at some location in the facility on the weekend. As long as receipts are given, individual’s accounts can be adjusted during the next facility banking hours. This requirement only applies if you manage residents’ funds. Rule 63, Building, plumbing and fire safety requirements. Does the requirement to not prop open any door, refer to all doors in the facility? Yes. Also, wheelchairs, carts, etc. can not be left for long periods of time or stored in hallways. What do varied times and conditions mean in terms of fire drills? The Department interprets “varied times” as at least 1 hour apart and “varied conditions” to mean during shift changes, meals, or bath time, etc. What about verification of fire drills from the appropriate monitoring station or fire department during evening drills, when just a coded announcement is made? This Department replied with another “official interpretation” on this question. In cases where a facility’s system is capable of running silently in the building while still transmitting a signal to the monitoring station or fire department verification of the receipt of signal should be concurrently documented as in all other drills. However, when a system is not capable of running silently in the building, yet transmitting a signal to the appropriate monitoring station or fire department, a coded announcement between the hours of 9 pm and 6 am can still be used, but within 24 hours of the coded announcement drill, the audible alarm must be sounded and receipt of signal verified. In such cases, you would want to alert your staff and residents that the subsequent fire alarm signal was just for testing purposes. Rule 64, Space Requirements Must soap and toilet tissue be provided free of charge for all residents for their private bathrooms? The Department has clarified that a facility may charge for toilet tissue and soap, if a resident does not bring their own, if it is so stated in the resident agreement. However, the facility must always have a free “back-up” supply for use in resident bathrooms in the event they run out. On inspection, all bathrooms must always have a supply of toilet tissue and soap. Rule 65, Building maintenance, equipment and supplies. Do facilities have to provide the required apartment furnishings and supplies as detailed in rule, free of charge, if a resident does not bring their own? No, if their resident agreement clearly states that a resident can bring their own furnishings or the required furnishings will be provided by the facility for a specific charge. Do RCFs have to have all their exits lead to hard surface that leads to a public way? No. If you build or convert to an RCF license after 4/1/07, then all exits must lead to a hard surface to a public way.
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Phone: (614) 481-1950 ~ Fax: (614) 481-1954 ~ Email: oala@ohioassistedliving.org
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