SURVEY AND REGULATORY UPDATE
ASSISTED LIVING: RESIDENT MOVE-IN PROCESS
The process of moving a new resident into an assisted living community can be daunting for the resident, their family members, staff, and the facility leadership. This process can be nuanced for facilities that accept assisted living (AL) residents as well as nonresident individuals (often termed “independent living” or IL). This article outlines the regulatory expectations and best practice regarding moving in both AL and IL residents.

Preadmission Assessment
The assisted living resident will need to be assessed prior to moving in. The minimum assessment topics are listed in WAC 388-78A-2060 and the assessment must be completed by a qualified assessor. This assessment determines whether the potential resident’s needs can be met in the facility; it is best to discuss any concerns amongst the leadership team before moving forward with the move-in process.

IL residents should not receive a preadmission assessment, unless they have requested the assessment for the purposes of determining the need for services in a licensed care setting.

Admission Agreement
Per RCW 70.129.030, the facility must provide the resident, in writing and in a language the resident or representative understands, the following:
  • Services, items, and activities customarily available
  • Charges for those services, items, and activities
  • Services, items, and activities not covered by the facility’s per diem rate or Medicaid
  • Individual resident rights as outlined in RCW 70.129.140(2), in addition to a statement that the resident may file a complaint with the state agency concerning alleged resident abuse, neglect, and misappropriation of resident property
  • A description of the manner of protecting personal funds as found in RCW 70.129.040
  • Reasons a resident may be transferred or discharged, as outlined in RCW 70.129.110.

If the facility serves both privately paying residents and residents whose care is paid for fully or partially by the Medicaid program, it is recommended that different admission agreements are used based on the resident’s payment source. This separation prompts the provider to ensure that services covered by the Medicaid program do not include additional charges. If a privately-paying resident transitions to Medicaid, ensure s/he reviews and signs a new Medicaid admission agreement.

IL residents are under the landlord-tenant act and should receive a different admission agreement that highlights the services they will receive under that law. If an IL resident transitions to AL, an assisted living admission agreement should be reviewed and signed; the IL resident at that point would be treated as a new move-in for the purposes of the assisted living regulations.

Disclosure
Per WAC 388-78A-2710 and -2720 prospective AL residents must receive a copy of the facility’s disclosure of services document on the DSHS-approved disclosure form. This form discloses the specific care and services provided in the facility. Signature and date of receipt suffices as proof this disclosure was shared with the resident or representative.

Prospective IL residents must receive a disclosure statement as well. DSHS does not offer a sample IL resident disclosure form; WAC 388-78A-2035 highlights that this disclosure must notify the IL resident that the following does not apply to them:
  • Resident rights statute (RCW 70.129)
  • Assisted living regulations
  • Jurisdiction of the long-term care ombuds

Written Notice of Rights, Rules, and Regulations
The same section of RCW 70.129 states that the facility must notify the resident both orally and in writing in a language the resident understands of the rights, rules, and regulations governing resident conduct and responsibilities. Acknowledgement of receiving this information must be documented and stored in the resident’s record. Many facilities/companies capture this information in a resident handbook, which the resident can reference later as needed.

IL residents might receive a different handbook or document that covers only the facility “house rules” and excludes rules and regulations that pertain specifically to AL residents.

Policies and Procedures
The following policies and procedures will highlight which type of resident (AL, IL, or both) need to receive copies. This is not an exhaustive list. Per WAC 388-78A-2600, all facility policies must be made available to AL residents and their representatives upon request.
  • AL – facility’s policy on accepting Medicaid as a payment source. Per RCW 70.129.180 this notice must be provided separate from other documents, in 14-font or larger, and provided orally and in writing in a language the resident understands
  • BOTH (suggested for IL) – CPR, honoring a resident’s advance directive(s) and/or signed POLST form
  • AL – how the facility accounts for residents who leave the building
  • BOTH (suggested for IL) – how a resident can file a grievance, and steps the facility takes to resolve grievances
  • BOTH – management of pets
  • BOTH – smoking, including location and safety
  • BOTH – cannabis, including if allowed, and limitations to its use
  • BOTH – valuables, including encouragement to store safely in the resident’s apartment or not bring to the facility

Other policies to consider include firearms/weapons, overnight guests, visitation/ essential support persons, and any infection control requirements. Some or all of these policies might be included in the resident handbook.
 
Other Documents
Other documents can prove helpful, and may pertain to AL, IL, or both. These include but are not limited to:
  • Photo and/or video release; current picture (for health record and/or MAR)
  • Preferred pharmacy agreement
  • Incontinence products company agreement
  • Authorization to release medical information
  • Copies of powers of attorney, advance directives, and/or POLST form if these exist
  • Signed doctor’s medication and diet orders
  • Medical history
  • Face sheet
  • Activities/life enrichment information
  • Allergies

The process of moving in can be overwhelming for all involved. Consider a checklist to ensure nothing is missed. Breaking down document reviews and signing of forms might be best completed in “bite size” pieces where questions can be asked and answered to ensure the resident and/or representative understand all the documents.

If you have questions about assisted living regulations, please email Vicki McNealley, or call her at (800) 562-6170, extension 107.
SKILLED NURSING: CMS FOCUS ON INFECTION CONTROL AND TRAINING
On June 29, the Centers for Medicare and Medicaid Services released QSO Memo 22-19-NH. The Memo revealed revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide. This new guidance will become effective, and surveyors will begin surveying to the criteria on October 24, 2022. This new guidance focuses on several training topics, one of which is infection control.

CMS guidance to surveyors in Training Requirements §483.95(e) F945 states that all facilities must develop, implement, and permanently maintain an effective training program for all staff, which includes training on the standards, policies, and procedures for the infection prevention and control program as described in F880, that is appropriate and effective, and as determined by staff need. For the purposes of this training requirement, staff includes all facility staff (direct and indirect care functions), contracted staff, and volunteers (training topics as appropriate to role).

The guidance from CMS goes on to state that changes to the facility’s resident population, community infection risk, national standards, staff turnover, the facility’s physical environment, or facility assessment may necessitate ongoing revisions to the facility’s training program for infection prevention and control.

All training should support current scope and standards of practice through curricula which detail learning objectives, performance standards, evaluation criteria, and addresses potential risks to residents, staff, and volunteers if procedures are not followed. Facilities are expected to have a process in place to track staff participation in and understanding of the required training.

According to CMS, the infection control training must, at a minimum, include the following areas (Please refer to F880 for a detailed description of these topics):
  • The facility’s surveillance system designed to identify possible communicable diseases or infections before they can spread to other persons in the facility.
  • When and to whom possible incidents of communicable disease or infections in the facility should be reported.
  • How and when to use standard precautions, including proper hand hygiene practices and environmental cleaning and disinfection practices.
  • How and when to use transmission-based precautions for a resident, including but not limited to, the type and its duration of use depending upon the infectious agent or organism involved.                                                            
  • Occupational health policies, including the circumstances under which the facility must enforce work restrictions and when to self-report illness or exposures to potentially infectious materials.
  • Proper infection prevention and control practices when performing resident care activities as it pertains to staff roles, responsibilities, and situations. 

If you have questions, please email Elena Madrid or call her at (800) 562-6170, extension 105.
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