Agenda

Regulatory/Department Updates: HCBS

Compliance Tips:

Compliance Trend Report

Hot Topics: Dr. Paula Carder; Portland State

Manager’s Corner: Ana Potter

Regulatory/Department Updates-1

Home and Community-Based Services (HCBS), updates

Bob Weir

Chris Angel

Individually-Based Limitations to the Rules

Sometimes called: IBL’s, IBLR’s, Limitations, or Federally: Modifications to the conditions

Regulatory/Department Updates-1

HCBS: New Freedoms, Rights, Protections

Lockable unit doors for privacy

Decorating and Furnishing within residency agreement

Choice of Roommate

Access to Food

Access to Visitors

Ability to control own schedule (inside and outside

Freedom from restraint (new)

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

What are they?

A Limitation is a defined process for proposing a limit to one or more of the HCBS freedoms, rights, and protections of an individual for their own or others health and safety.

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

When are they effective?

411-004-0040 Individually-Based Limitations (Amended 12/28/2016)

This rule will begin being implemented January 1, 2017. The requirements in this rule must be in place no later than February 28, 2018.

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

What does the rule mean?

The intent of the rule is to provide a rolling time period for identifying, proposing, and documenting any necessary Limitation.

Beginning in July 2017:

Private Pay – Next scheduled plan review Medicaid – Next annual Medicaid review

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

What else should I know? Limitations are like restraints, they are a last resort

option after all alternatives have been tried and did not work.

Cannot be proposed for the convenience of the provider

Must be for a significant risk to health or safety

Must be consented to by the individual or legal representative

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

What if the person does not have the ability to consent?

We are working with stakeholders on a new Bill/Statute (currently Legislative Concept 2180)

This would give authority to use substitute decision makers for the purpose of Limitations only.

If unsuccessful passing new legislation - seeking guardianship will be our only legal alternative.

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

How do I stay informed?

HCBS Website (Google HCBS Oregon)

Association events and communication

Administrator Alerts

in person training

Possible mailings

Regulatory/Department Updates-1

Individually-Based Limitations to the Rules

Questions? Please email us

HCBS email:

HCBS.Oregon@state.or.us

Compliance Tips Cadet Heaters

Compliance Trend ReportTop Ten Citations: 11/1/2016-01/9/2017

1: 260 Service Plan (15)

2: 270 Change of Condition(23)

3: C310 Systems: Medications (12)

4: 280 Resident Health Services (10)

5: 303 Treatment Orders (9)

6: 282 RN Delegation (7)

7: 1518 Individual door locks(7)

8: C 231 Abuse reporting (6)

9: C 252 Resident Move in

10: C 330 Psychoactive meds (6)

999: Technical assistance (25)

Hot Topics-1

Dr. Paula Carder: Institute on Aging, Portland State University

Why is PSU asking me questions?

Contracted by DHS, funded by Oregon legislature

Encouragement from OHCA and LeadingAge

To inform providers, policymakers, and consumers about:

Residents – who lives in CBC settings?

Staff – who works in CBC settings?

Community features, policies, rates and fees

To document and understand changes over time

How is the study conducted?

Questionnaires mailed January 2017

Phone calls to those that don’t respond in 3 weeks

Questions developed by PSU and DHS with input from OHCA and LeadingAge

Information collected by PSU is confidential

Final report due to DHS May 2017

What have we learned?

About residents

About staff

About communities

Who lives in CBC settings?

1% 6%

12%

29%

52%

18-49 50-64 65-74 75-84 85 and over

Oregon CBC settings have a capacity for 25,094 residents

70% female; 91% White, non-Hispanic

Most moved in from home

More MC residents moved in from an AL or RC

Resident needs over time

When Residents leave, where do they go?

45

%

13

%

12

%

5% 6%

3%

47

%

9%

6%

6% 7% 8%

68

%

7%

6%

4%

4%

1%

D IED NURSING FACILITY

MEMORY CARE HOME HOME OF CHILD OR

OTHER RELATIVE

INDEPENDENT LIVING

AL RC MC

Length of stay over time

% of Communities that employ specified staff types

77%

58%

52%

19%

12%

2%

78%

45%

51%

27%

9%7%

77%

60%

49%

29%

22%

4%

PersonalCare

ActivitiesStaff

RN CNA/CMA LPN SocialWorker

AL RC MC

% of certified/licensed staff

8%AL direct care staff

were certified

72%AL with full-time

RN

11%RC direct care staff

were certified

62%RC with full-time

RN

10%MC direct care staff

were certified

58%MC with full-time

RN

Use of Fall Risk Assessment Tools

63%

56%

73%

64%

27%

21%

12%

21%

8%

20%

15%

14%

2%

3%

0%

2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

AL

RC

MC

Total

Standard practice with every resident Case-by-case basis No Don't know

Summary Collecting information helps DHS, as the licensing

agency, understand who lives and works in CBC settings, and how things change over time

Study findings will be most reliable and impactful if more communities complete the questionnaire

Final reports: https://www.pdx.edu/ioa/oregon-community-based-care-project

THANK YOU!

Manager’s Corner

Ana Potter, Residential and Assisted Living Manager

Thanks so much!

Next News hour:

April 27th 2017

9:00 am

Questions????

CBCTeam@state.or.usCBC web site Address::

http://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/CBC/Pages/index.aspx