Trending and Best Practices in Assisted Living Programs

Trending and Best Practices in Assisted Living Programs Jana Illingworth Health Facilities Surveyor Adult Services Bureaus Iowa Department of Inspections and Appeals

Background Checks-67. 19 � Must be completed prior to date of hire � Valid for 30 days � If initial check results in a “hit”, evaluation by DHS must be completed.

Evaluations-69. 22 � Cognitive, Functional, and Health � Prior to admission, within 30 days, annually, and/or significant change � Cognitive-when the tool indicates moderate cognitive impairment and risk, GDS will be used for all subsequent cognitive evaluations

Service Plans-69. 26 � Develop based on evaluations � Prior to signing of OA, within 30 days of admission (if personal and/or health related care), with significant change, and at least annually. � If no significant change and after nurse review, can add minor discretionary changes without evaluations and signatures. � If significant change relates to recurring or chronic condition, a previous evaluation and service plan can be utilized without new signatures.

Service Plans � Contain: tenant needs and preferences, services and care, service providers � Planned and spontaneous activities for those who are unable, including tenants with dementia (GDS 4 or higher)

Service Plans � Wound care and treatment � Hospice Services � Behavioral issues and interventions � Exit Seeking and interventions � Falls and interventions � General lack of specificity with cares

Physician Orders 67. 5(6) d. � Medications should be administered as prescribed by the tenant’s physician, advanced registered nurse practitioner, or physician assistant. � Transcription errors from the order to the MAR � PRN medication given for reason other than the order indicated � Failure to document medications as given � Failure to document desired effect of PRN

Medication-Infection Control � Failure to wash hands/sanitizer � Failure to wear and remove gloves

Tenant on Tenant Aggression � Identify and implement interventions ◦ Beyond medication change or doctor visit ◦ Other interventions for staff to follow ◦ Look at level of care

Sexuality � Basic Human Need � Independence � Choices � Privacy, dignity, respect � Policies to facilitate safe sexual expression

Notification to the Department � DHS vs DIA � Thefts-medication, money, belongings � Falls with Fractures � Mistreatment

Notification to the Department � Elopement-March 2017 -March 2018 *Data collected from DIA Facility Self Reporting System

Door Alarms in ALP/D 69. 32 (2) � An operating alarm system shall be connected to each exit door in a dementia-specific program. � Safety and Autonomy � Options ◦ Dually certify the Program when current certification expires ◦ Install alarms on all exit doors ◦ September 1, 2018

Determination of Dependent Adult � Determination ◦ Evaluations ◦ Service Plans ◦ ACU is made in the office

Waiver of Criteria for Retention � 67. 7 (1) Time-limited waiver. Upon receipt of a Program’s request for waiver of the criteria for retention of a tenant, the Department may grant a waiver for a timelimited basis. A waiver of the criteria for retention of a tenant is limited to a period of six months or less.

Involuntary Discharge from the Program � 30 days notice in writing � Reason for discharge � LTCO contact information � Copy to the LTCO � Internal appeals process (not with the Department)

Best Practices � Implementation of interventions for tenants with dementia and behavioral issuesaggression, agitation, exit seeking, redirection and activities-staff training of such interventions � Identify level of care issues and assistance with seamless discharge process � Investment in staff to encourage retention and tenure

Best Practices � Cameras in hallways and common areas � Attendance at meals

Contact Info Linda Kellen, Bureau Chief (515) 281 -7624 linda. kellen@dia. iowa. gov Catie Campbell, Program Coordinator (A-L) (515) 2813759 catie. campbell@dia. iowa. gov Deb Dixon, Program Coordinator (M-Z) (515) 281 -4081 deb. dixon@dia. iowa. gov Tamara Brockob, Administrative Assistant (515) 281 -5721 tamara. brockob@dia. iowa. gov

References Iowa Administrative Code (IAC) (2016). 48167. 5(6)d. , 67. 19, 69. 22, 69. 26. Office of the State Long-Term Care Ombudsman. Disability Rights Iowa (2016) Sexual Expression Policy Development, A Guide for Long-Term Care Facilities & Assisted Living Programs, (p. 3)