ASSISTED LIVING: RESPITE CARE IN ASSISTED LIVING

Assisted living facilities can legally provide short-term respite care in assisted-living licensed rooms. There is no additional application or approval process necessary for an assisted living to offer respite care.

Respite stays are an excellent way for residents and their families to “try on” assisted living and learn how a resident settles into this type of care setting. Per WAC 388-78A-2202, respite clients cannot legally stay beyond 30 calendar days; the facility cannot use respite as a placement pending the resident’s admission to the assisted living facility.

Prior to admitting a respite client, the assisted living facility must obtain sufficient information about the person to meet the client’s needs. At a minimum, that information includes:

• The resident’s legal name
• The name, phone number, and address of the resident’s representative (if applicable)
• The name and address of the location where the resident normally lives, with the name of the contact person and their phone number
• The name, address, and phone number of the resident’s attending physician
• Medical and social history, as well as mental and physical assessment data
• Physician’s orders for diet, medication, and routine care

Respite residents also must have a negotiated service agreement (NSA), developed with the resident and, where appropriate, their representative. The NSA must focus on maintaining or improving the individual’s health and functional status during their stay.

The assisted living facility may use their internal assessment and NSA systems used for all assisted living residents to fulfill the requirements of these sections. Alternately, respite care assessments and service plans completed by case managers working for Area Agencies on Aging can be used.

WAC 388-78A-2206 calls out the idea that respite residents warrant assessment for symptoms of tuberculosis and, if results show symptoms, testing should take place. Likewise, the facility must follow appropriate infection control processes for any respite resident showing signs of other infectious diseases.

It is recommended that the facility have policies and procedures highlighting respite resident admission, services, and discharge. A separate admission agreement for respite residents is recommended. All respite residents have access to DSHS and ombuds representatives, and their records can be audited during inspections.

For questions about assisted living regulations, contact Vicki McNealley via email or call 1-800-562-6170 extension 107.

SKILLED NURSING: WHAT IS SUBSTANTIAL COMPLIANCE?

For a skilled nursing facility (SNF), or what CMS calls a nursing home (NH), the NH reform regulation establishes several expectations. The first is that all NHs must remain in substantial compliance with Medicare/Medicaid program requirements, as well as individual state laws. The regulation emphasizes the need for facility continued/sustained, rather than cyclical or yo-yo compliance. 

The CMS enforcement process mandates that facilities establish policies and procedures to remedy deficient practices and to ensure that correction is lasting; specifically, facilities are expected to take the initiative and responsibility for continuously monitoring their own performance to sustain compliance. Measures such as the requirements for an acceptable plan of correction emphasize the ability to attain and maintain compliance leading to improved quality of care. 

According to CMS, the second expectation is that all deficiencies will be addressed promptly. This includes both the Life Safety Code (LSC) and Health Survey deficiencies. The minimum standard for NH program certification and participation is substantial compliance. The federal regulation goes on to note that the state agency and the CMS regional office will take steps to bring about NH compliance quickly by using remedies such as civil money penalties, temporary managers, directed plans of correction, in-service training, denial of payment for new admissions, and State monitoring. CMS’s third expectation is that residents will receive the care and services they need to meet their highest practicable level of functioning.

To better understand what substantial compliance is, it is important to understand “noncompliance.” By CMS definition, noncompliance means any deficiency that causes a facility to not be in substantial compliance. While that may seem obvious, it is often confusing. Substantial compliance means the facility always maintains a level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm. 

Another important concept is that NHs must follow the requirements in 42 CFR Part 483, Subpart B to receive payment under Medicare or Medicaid. For the state agency (SA) to certify a NH, the facility must be in substantial compliance with the full survey. The full survey consists of both the LSC survey and the standard Health Survey. Compliance is determined as of the latest correction date on the approved Plan of Correction (PoC), unless correction occurred between the latest correction date on the PoC and the date of the first onsite revisit, or correction occurred sooner than the latest correction date on the PoC. If during the re-visit survey, the facility is found to remain out of compliance for one or more citations at a level greater than a scope and severity A, B, or C, the facility remains on the same track (timeline) of non-compliance from the original survey citation (health and/or LSC). 

If during a course of non-compliance, a facility has intervening complaint investigations that result in additional citations, the facility remains on the same track/timeline of non-compliance. For a facility to achieve substantial compliance, all citations from the original 2567 and any intervening citations (from failed follow up survey or complaint investigations, whether from health survey or LSC) must be found in substantial compliance. In looking at the CMS scope and severity grid, this means no citations above a level A, B or C. In the absence of an immediate jeopardy, the CMS regional office or State Medicaid Agency will terminate the NH’s Medicare and/or Medicaid provider agreements that are in effect no later than six months from the date of the survey that determined noncompliance if noncompliance still exists. If you have any questions, please email Elena Madrid, Executive Vice President for Regulatory Affairs or call at (800) 562-6170, extension 105.