27
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:
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????
[email protected] web site Address::
http://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/CBC/Pages/index.aspx
