WSR 98-04-032

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Aging and Adult Services Administration)

[Filed January 29, 1998, 10:44 a.m.]

Supplemental Notice to WSR 97-20-114.

Preproposal statement of inquiry was filed as WSR 96-18-089.

Title of Rule: Adult family home (AFH) licensing designations, WAC 388-76-561, 388-76-590, 388-76-600, 388-76-610, and 388-76-615.

Purpose: To comply with legislative mandate for the Department of Social and Health Services to define, in rule, AFH license levels based upon the education, training, and caregiving experience of the licensed provider or staff. To comply with statute requiring providers to obtain specialty care training before admitting residents with special care needs. This supplemental notice is the result of changes made in response to public comments received concerning the original proposed rules which were filed on September 30, 1997.

Statutory Authority for Adoption: RCW 70.128.060 and 70.128.120.

Statute Being Implemented: Chapter 70.128 RCW.

Summary: Establishes AFH licensing designations based upon education, training, and caregiving experience of providers and staff. Amends "specialty" AFH standards to require specialty care training before providers may admit residents with special care needs. Amends AFH disclosure and assessment requirements to deter inappropriate admissions to adult family homes. Revises and clarifies negotiated care plan standards.

Reasons Supporting Proposal: Comply with legislative mandate. Promote quality services and protection for AFH residents. State legislation RCW 70.128.060(6) and 70.128.120(6).

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: John Gaskell, P.O. Box 45600, Olympia, WA 98504-5600, 1-800-422-3263 or (360) 438-7937.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: These rules are intended to bring adult family home regulations into compliance with RCW 70.128.060 and 70.128.120. The rules should help ensure that AFH providers admit only those residents for whom they are capable of providing care. The rule should also allow consumers to make more informed decisions when selecting an adult family home. Finally, these rules are intended to promote the development of more highly trained providers who will have the capability to serve residents with special care needs.

Proposal Changes the Following Existing Rules: Establishes adult family home licensing designations (levels). Changes current rules to require specialty care training before providers may admit and serve residents with special care needs (with exceptions, effective July 1, 1999). Requires providers to give more detailed information about an adult family home to prospective residents. Requires completion of a comprehensive assessment prior to a resident's admission to an adult family home. Provides that the comprehensive assessment must be completed by a qualified health services assessor (with exceptions, effective July 1, 1999).

A small business economic impact statement has been prepared under chapter 19.85 RCW.

What are the general goals and specific objectives of the statute that this rule implements? RCW 70.128.060(6) directs the department to license an adult family home for the maximum level of care that the home may provide. The law also instructs the department to define, in rule, license levels which are based upon the education, training, and caregiving experience of the licensed provider or staff. In the proposed rules, the various license levels defined are each called a licensing "designation." This was done in an effort to avoid confusion with the commonly used terms "payment level" and "level of care."

RCW 70.128.120(6) says that providers and resident managers must successfully complete special care training before providing special care services to a resident.

The broad goal of these statutes is the licensure and operation of adult family homes capable of providing quality personal care and special care services to diverse populations of residents with significantly different needs and capacities from one another. Chapter 70.128 RCW directs the department to develop rules and policies that adequately protect residents and that recognize and accommodate the different needs and capacities of the various populations served by the homes while promoting a homelike environment.

In requiring the development of license levels, the statute seeks to assure that providers only admit those residents for whom they are capable of providing quality care and adequate protection. The law is attempting to promote the development of standards which increase the likelihood of appropriate matches between consumers and providers. It seeks to deter inappropriate admissions to adult family homes which result in providers finding they are unable to meet resident needs which in turn can lead to negative resident outcomes and relocations.

The statute pertaining to special care training requirements is attempting to promote the development of more highly trained providers who will have the capability to serve residents with special care needs (e.g., residents with a developmental disability, a mental illness, or dementia). A primary intent of this law is to promote aging in place (i.e., the capacity for an individual to live in a setting for most or all of the individual's life without having to be relocated due to changing care needs) by assuring that providers possess or obtain the necessary skills and training to meet the increasing care needs of residents.

How were these proposed rules developed? The department initially attempted to define adult family home licensing levels during the development of comprehensive rules mandated by the 1995 legislature and which became effective in July of 1996. Rules specific to adult family home licensing levels were found to be more complex and controversial than expected. A great deal of input was given by stakeholders (e.g., advocates, providers, consumers, social and health service professionals) which represented widely varying viewpoints. The inability to achieve broad support for a licensing levels proposal threatened to delay the adoption of the remainder of the comprehensive rules.

Following discussions with stakeholders, the department decided to postpone proposing regulations for licensing levels and to address them in a separate rule-making process following adoption of the comprehensive adult family home rules.

The department resumed rule development for licensing levels in October of 1996. During October and November of that year, fourteen meetings were held throughout the state with key stakeholder groups. Among others, the department met with adult family home provider associations, advocacy groups including advocates for persons with developmental disabilities, regional area agencies on aging, community nurses and case managers serving adult family home residents, and family members of adult family home residents. Comments and recommendations that were obtained in 1995 and early 1996 were also reviewed and considered.

By December of 1996, significant progress had been made toward consensus regarding a three tiered model of adult family home licensing levels. In this hierarchical model, the first level of adult family homes would have been licensed to serve only relatively higher functioning residents with less intensive service or care needs. The second and third level adult family homes would have had higher training and skill level requirements for providers and resident managers and would have been authorized to admit and serve residents with progressively higher, more complex care needs. In addition, homes would have had to successfully operate for a certain period of time before being eligible for licensure at levels two and three.

An initial preliminary analysis projected that this proposal would have had a significant fiscal impact for the 1997-1999 biennium. With no funding available in the department's budget, it became necessary to draft a licensing levels proposal that would not require additional funds.

Work on this no fiscal impact model commenced in the spring of 1997. Comments and recommendations from the state-wide meetings held in October and November of 1996 were reviewed and analyzed again. Efforts were made to incorporate as many desirable recommendations as possible and rule out only those suggestions which were expected to have a fiscal impact.

A new draft of licensing levels rules was distributed at a meeting of key stakeholders and interested parties on August 19, 1997. Feedback from the state's two primary associations of adult family home providers reflected strong opposition to the draft rules. The department made some changes to the draft rules in response to stakeholder comments and filed proposed rules with the office of the code reviser on September 30, 1997.

Public hearings on the proposed rules were held on November 11 and 25 and were attended almost exclusively by adult family home providers. Written comments and testimony from providers continued to express strong opposition to the proposed rules. Some individuals also requested to receive a copy of the small business economic impact statement (SBEIS) required under the state's Regulatory Fairness Act. It was argued that the department should have completed the SBEIS and included it for public review and comment with the filing of proposed rules in September.

Based upon written comments received and testimony provided at the public hearings, the department has made multiple changes to the proposed rules and has filed a supplemental notice of proposed rule making. In addition, this small business economic impact statement has been included.

Are large and small businesses involved? In reviewing current licensed adult family home providers, the vast majority of those providers fit the description of a small business found in RCW 19.85.020; "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees." However, several adult family home providers own more than one home or operate other businesses, and have the purpose of making a profit. These providers are considered large businesses by the above definition, because they have fifty or more employees.

What is the impact on business? There are several categories of impact to businesses resulting from these rules. This section lists those with major impact and the expected provider costs related to resident assessments and service plans, licensure as a "RN" or "specialty" adult family home, and provider information disclosure requirements.

Cost of resident assessment and initial service plan: One major category of impact of these rules will be incurred as a result of the requirement that all prospective residents must have a full assessment and preliminary service plan developed by an approved professional prior to admission in an adult family home. The cost of one assessment and preliminary service plan development is estimated as follows:

3-5 hours for a complete assessment and development of the preliminary care plan.

1-2 hours miscellaneous, including travel, consultation, training, and preparation of materials.

The hourly cost is estimated to be $45.00 per hour, including salary, benefits, and administrative costs to support the assessor. Included in the range of hours needed to complete the assessment is the recognition of the eventual requirement of a functional assessment for persons with dementia. This estimate leads to a cost range per assessment and preliminary care plan of from $135.00 to $315.00. These are estimates, and the department recognizes that costs may vary a great deal, depending on who conducts the assessment, their individual costs of doing business, and the resident's complexity of service needs.

The cost of this assessment may be borne directly or indirectly by numerous individuals or agencies. The agencies that may bear the cost include referral agencies, such as hospitals, insurance agencies, or other social or health care service providers. Individuals who may bear the cost are the residents or their family members, or the adult family home provider.

Some adult family home admissions will be delayed while awaiting completion of the required assessment. The duration of any such delays may affect a provider's potential revenue.

Costs of RN designation: Another category of impact will be incurred by providers who are not registered nurses but who choose to be designated as a "RN" adult family home. These providers will incur the cost of hiring a registered nurse for twenty hours per week for each home that has the designation. Again, hourly costs will vary widely across the state, but the cost may be estimated to be $30.00 per hour, including salary, benefits, and administrative costs. In this instance, administrative costs are intended to include the costs that the adult family home owner incurs in hiring and orienting the RN. This cost would be multiplied by twenty hours, totaling an estimated $600.00 per week per home. The cost impact will be less for providers who already employ a nurse or contract for nursing services.

In the event that one provider had a number of homes with this designation, the administrative costs would be minimized by economies of scale. The initial outlay for this cost will presumably be borne directly by businesses, and eventually passed along to residents, including those supported with state funds and those paying privately, through their fees.

There may also be a cost to providers who elect not to be designated as a "RN" adult family home. It is possible that the "RN" designation will provide an advantage in marketing to clients, thereby creating lost revenue for providers who face difficulty finding clients because they have chosen not to have the "RN" designation.

Costs of specialty designation: Another category of impact will be incurred by providers who have not completed specialty care training but who choose to have one or more "specialty" designations to serve persons with dementia, a developmental disability, or a mental illness. These adult family homes will incur the cost of training for individual providers, and, in the instance that they hire a resident manager, also for the costs of training that individual. Each "specialty" designation will require completion of a separate specialty care training curriculum.

Providers and resident managers will have one opportunity, if they choose, to successfully pass a challenge test for dementia and mental health specialty care. The challenge test will be designed to indicate whether or not the individual taking the test has the necessary skills and training to serve persons with dementia or a mental illness. In instances where an individual passes the challenge test, overall training costs to providers will be reduced.

There are three primary categories of cost which must be considered, and are discussed below:

The cost of paying the wages for staff who replace the staff who are attending the training; the cost of tuition; and, the cost of travel and incidentals. The Division of Developmental Disabilities (DDD) will reimburse providers for classroom time spent in specialty care training for developmental disabilities.

With respect to replacing the staff who are attending mental health and dementia specialty care training, the time commitment required for the training is eighteen hours of classroom training, and two hours of skills evaluation. The department has historically required all caregivers to attend continuing education training, which has a comparable time commitment, and applies to all caregiving staff. The continuing education training requirement is for ten hours, and must be fulfilled every year, and the specialty training will require twenty hours per year, and is required only once. According to the proposed rules, the specialty training may take the place of two years fulfillment of the continuing education requirement. This facet of the rules results in there being no additional cost to business due to replacing staff while they attend training, because they have historically incurred this cost in fulfilling the requirements of continuing education training.

The cost of tuition for dementia and mental health training will be determined by the private market, and will be set locally by the persons and agencies offering the training. This will vary considerably, depending on the nature of the specialty training, and the trainer. It will also vary depending on how the training is delivered. Specialty care training for developmental disabilities will be given at no cost to providers.

In situations where the provider is offering care to residents supported by the state, the department may assist by identifying resources to defray the cost of tuition. Also, considering that there is a preexisting requirement for the continuing education training, the cost of tuition is to some extent already being incurred.

There may also be costs incurred related to travel time, and travel related expenses, such as mileage. These will vary a great deal, depending on the location of the adult family home and its proximity to training. The aging and adult services administration (AASA) is taking steps to make dementia and mental health training available, through agreements with local trainers, in as many local areas as possible throughout the state. Training for developmental disabilities will also be made available in various regions across the state. Again, it is important to note that the adult family homes are already incurring some of these expenses as they fulfill the requirements for continuing education.

Revenue for providers currently serving residents with special care needs may be affected if those providers choose not to obtain special care training. In this instance, residents with special care needs would have to be relocated.

Costs of provider disclosure: All adult family home providers will be required to compile information about the adult family home required under the general resident rights section of the rules. The department estimates that it will initially take about five hours to compile the disclosure documents, and about three hours per year to maintain and distribute them. There will also be an initial cost to print the materials, and a continuing cost to reprint them as changes are needed. The cost for staff effort to compile and maintain the information, estimated at $8.00 per hour including wages and benefits, would total approximately $40.00 per year. The additional costs for printing and reprinting may be estimated at $40.00 per year, totaling $80.00 per year for the disclosure requirements.

The initial outlay for this cost will presumably by borne directly by businesses, and eventually passed along to residents, including those supported with state funds and those paying privately, through their fees.

Are there disproportionate impacts to large and small business? It is important to emphasize that the proposed rules are tailored to an industry that is almost solely comprised of small businesses. Therefore, all prospective providers in the industry should, for the most part, be equally impacted by these rules. The one caveat is that providers who are small businesses may experience a disproportionate impact because any costs or unearned revenue would constitute a greater proportion of their income.

How did the department mitigate the economic impacts? The rules are needed in order to accomplish the purposes listed in RCW 70.128.060(6) and 70.128.120(6) described previously. Because the rules are needed, the department cannot feasibly mitigate all impacts to business. The following steps have been taken to minimize the costs to business:

1) The rules establish clear criteria for persons choosing to apply for a specific adult family home license designation and assist prospective applicants to determine whether they will be eligible for a specific license designation. The rules will also help a prospective applicant determine whether or not becoming a provider is a desirable option and what types of residents that applicant would be suited to serve. This minimizes costs in applying for, or attempting to maintain a license for which a person is ill suited or ineligible.

2) Through the option of challenge testing, the department has attempted to mitigate costs related to specialty care training that is required to serve persons with dementia or a mental illness.

3) The department is taking steps to make specialty care training available in as many local areas as possible throughout the state.

4) When feasible, deadlines and requirements placed on businesses have been delayed. For example, the proposed rules pertaining to specialty adult family homes and resident assessments have a delayed implementation date of July, 1999.

5) The department heavily emphasizes teaching and consultation to support compliance with the rules. The department supports providers in their efforts to improve quality by initially addressing problems through training, consultation, technical assistance, and case management. The department emphasizes problem prevention through monitoring and screening potential providers, and early education of providers when deficiencies are found. The department uses a written enforcement decision tree to determine remedies for violations of rules, relying on a structured progression of remedies commensurate with the severity and scope of the violation.

6) The department will provide information to businesses that will assist them with compliance. This will be available through regional training and provider orientation focused on the new rules and related rules.

7) The preproposal and public hearing process led to the department receiving considerable feedback on business issues. To the extent possible within the law, these issues were addressed through revisions of the rules. For example, the on-site requirement to qualify for the "RN" designation was reduced from forty to twenty hours per week and provider disclosure requirements were reduced and simplified.

8) In one instance, the department decided to delay filing a proposed rule in order to allow for more study of an issue. The delayed rule was the proposed requirement that all residents and household members could be safely evacuated within five minutes of the commencement of a fire drill.

The adoption of these rules will achieve compliance with the legislative mandates found in RCW 70.128.060(6) and 70.128.120(6). The department believes that adoption of these rules will help ensure that AFH providers will admit only those residents for whom they are capable of providing care. The rules will help promote the development of more highly trained providers who will have the capability to serve residents with special care needs. The rules should also allow consumers to make more informed decisions when selecting an adult family home.

After considerable review, the department has concluded that these rules are the least burdensome alternative that will achieve the goals and objectives of the statute and that the probable benefits of these proposed rules outweigh the probable costs.

A copy of the statement may be obtained by writing to Carole Campbell, Residential Care Services, P.O. Box 45600, Olympia, WA 98504-5600, phone (800) 422-3263 or (360) 493-2631, or FAX (360) 438-7903.

RCW 34.05.328 applies to this rule adoption. Because these proposed rules are considered significant legislative rules, RCW 34.05.328 applies. To obtain a copy of the cost benefit analysis contact Carole Campbell at the address and phone number listed above.

Hearing Location: OB-2 Auditorium, 1115 Washington Street S.E., Olympia, WA 98504, on March 10, 1998, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by March 2, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Hearing Location: Spokane Community College, 1810 North Green Street, Lair Building #6 (Sasquatch Room), Spokane, WA 99207-5399, on March 17, 1998, at 9:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by March 9, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to and Identify WAC Numbers: Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by March 17, 1998.

Date of Intended Adoption: No sooner than March 18, 1998.

January 28, 1998

Edith M. Rice, Chief

Office of Legal Affairs

NEW SECTION

WAC 388-76-561 Adult family home licensing designations. (1) The department shall designate an adult family home as:

(a) A "basic" adult family home if the individual provider and resident manager have successfully completed the fundamentals of caregiving training or the modified fundamentals of caregiving training as required by WAC 388-76-660;

(b) An "experienced" adult family home if the home:

(i) Meets the criteria of (a) of this subsection; and

(ii) Has operated for the last two licensing periods without the imposition of any of the following:

(A) Civil penalties exceeding two hundred fifty dollars per visit;

(B) Cumulative civil penalties exceeding five hundred dollars;

(C) Conditions on the home's license related to resident care; or

(D) A stop placement order;

(c) A "RN" adult family home if:

(i) The individual provider is a licensed registered nurse, or the provider employs or contracts with a licensed registered nurse; and

(ii) The licensed registered nurse is on-site and on duty at least twenty hours per week or more, based upon assessed resident needs identified in the assessment required under WAC 388-76-610;

(d) A "specialty" adult family home if:

(i) The individual provider and resident manager have successfully completed specialty care training as required under WAC 388-76-590; and

(ii) The individual provider or resident manager is on-site and on duty at least twenty hours per week or more, based upon assessed resident needs identified in the assessment required under WAC 388-76-610; or

(e) A "RN-specialty" adult family home if:

(i) The individual provider is a licensed registered nurse, or the provider employs or contracts with a licensed registered nurse;

(ii) The individual provider, resident manager and any registered nurse have successfully completed specialty care training as required under WAC 388-76-590; and

(iii) The RN and individual with specialty care training are on-site and on duty at least twenty hours per week or more, based upon assessed resident needs identified in the assessment required under WAC 388-76-610.

(2) Licensed registered nurses under subsection (1)(c) and (e) of this section must also successfully complete the department's modified fundamentals of caregiving training.

(3) An adult family home designated as a "RN," "specialty," or "RN-specialty" home may also be designated as an "experienced" adult family home if it meets the criteria defined under subsection (1)(b) of this section.

(4) The department may change an adult family home's designation when:

(a) The provider submits certification of successful completion of required specialty care training to the department's licenser for that home; or

(b) Documentation is available at the home that satisfies requirements defined in this section for designation as a "RN" adult family home. Acceptable documentation shall include the RN's license and a staffing plan.

(5) The department may remove an adult family home's designation when the home no longer meets the criteria necessary to qualify for that designation.

(6) The provider shall notify the department within thirty days when the adult family home no longer meets the criteria necessary to qualify for a "RN," "specialty," or "RN-specialty" designation.

(7) The department will designate a qualifying home as an "experienced" adult family home at the time of the home's full reinspection.

(8) Failure to provide notification as required under subsection (6) of this section shall subject the provider to remedies permitted under WAC 388-76-705.

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AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-590 Specialty adult family homes. (1) ((Beginning September 1, 1996,)) An applicant or provider may apply for ((a)) one or more designations as a specialty adult family home to serve and meet the unique needs of residents with:

(a) A developmental ((disabilities)) disability as defined by subsection (3)(a) and (b) of this section;

(b) A mental ((illnesses)) illness as defined by subsection (3)(c) of this section; or

(c) Dementia.

(2) ((An adult family home is not required to have a specialty designation to serve residents identified in subsection (1) above.

(3))) For purposes of this section, the term "related condition" means a severe, chronic disability which is:

(a) Attributable to:

(i) Cerebral palsy or epilepsy; or

(ii) Any other condition, other than mental illness, found to be closely related to mental retardation which results in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation, and requires treatment or services similar to those required for these persons (i.e., autism);

(b) Manifested before the person reached age twenty-two;

(c) Likely to continue indefinitely; and

(d) Results in substantial functional limitations in three or more of the following areas of major life activities:

(i) Self-care;

(ii) Understanding and use of language;

(iii) Learning;

(iv) Mobility;

(v) Self-direction; and

(vi) Capacity for independent living.

(3) Beginning July 1, 1999, except as provided under subsection (4) of this section, an adult family home is required to have a specialty designation to admit and serve residents whose primary disability is:

(a) Mental retardation or a related condition;

(b) A developmental disability as defined by division of developmental disabilities (DDD) eligibility criteria under WAC 275-27-026 (as published in the Washington Administrative Code and in effect in January 1998);

(c) An Axis I or II diagnosed mental illness as defined by volume IV of the Diagnostic and Statistical Manual of Mental Disorders (1994 edition, copy available for review through the aging and adult services administration); or

(d) Dementia as determined by a department approved functional assessment.

(4) An adult family home must obtain a "specialty" designation before admitting and serving DDD clients or persons whose primary disability is mental retardation or a related condition if the adult family home:

(a) Is licensed after the effective date of these rules; or

(b) Does not already serve residents who are DDD clients or whose primary disability is mental retardation or a related condition.

(5) All providers may admit residents whose primary disability is a mental illness or dementia, as defined by subsection (3) of this section, until July 1, 1999.

(6) Beginning July 1, 1999, individual providers and resident managers shall have one hundred twenty days to complete specialty care training after a resident already living in the home develops a disability as defined under subsection (3) of this section.

(7) Successful completion of specialty care training shall satisfy continuing education requirements:

(a) For the current and following calendar year; or

(b) For the following two calendar years if the specialty care training is completed in the same year as required fundamentals in caregiving training or modified fundamentals in caregiving training.

(8) Providers and resident managers are exempt from attending dementia and mental health specialty care training if they successfully pass the department's challenge test for those specialties. Providers and resident managers have only one opportunity to successfully pass the challenge test then they must attend the specialty care training for which they failed to pass the challenge test.

(9) Developmental Disabilities. To be designated as a home specializing in services to residents ((with)) who are DDD clients or whose primary disability is a developmental ((disabilities)) disability as defined by subsection (3)(a) of this section, the individual provider ((or)) and resident manager, in addition to complying with all other rules in this chapter, shall:

(a) Complete the department approved ((supplemental)) specialty care training addressing the residential support needs for ((persons)) residents with developmental disabilities prior to being designated as a specialty adult family home. Training shall include, at a minimum, courses in positive behavior supports addressing behavior as a means of communication, and the division of developmental disabilities residential services guidelines;

(b) ((Each calendar year, complete a minimum of ten hours of continuing education credits that relates to providing care to persons with developmental disabilities. Training is to be obtained through regional division of developmental disabilities core training courses as offered for community service providers;

(i) The continuing education requirement listed above in subsection (3)(b) shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (3)(a); and

(c))) Demonstrate an ability to accommodate for communication barriers of residents and recognize how behaviors may be a means for communication; and

(c) Hire qualified caregivers and assure coverage of the home during periods of absence in order to meet residents' identified service needs, and have a documented staffing plan in place at all times.

(((4) A home specializing in services to residents with developmental disabilities shall provide the degree of supervision needed by residents and specified in the residents' negotiated service plans, which may be less than twenty-four hour supervision.

(5))) (10) Mental Illness. To be designated as a home specializing in services to residents ((with)) whose primary disability is a mental ((illnesses)) illness as defined by subsection (3)(c) of this section, the individual provider ((or)) and resident manager shall, in addition to complying with all other rules in this chapter:

(a) Complete the department approved ((specialized mental health)) specialty care training addressing the needs of ((persons)) residents who have a mental illness prior to being designated as a specialty adult family home;

(b) ((Each calendar year, complete a minimum of ten hours of continuing education credits that relates to mental health issues;

(i) The continuing education requirement listed above in subsection (5)(b) of this section shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (5)(a) of this section;

(c))) Have a documented crisis response plan in place, know how to access emergency mental health services, and assure all caregivers are knowledgeable and capable of implementing the plan in a crisis; and

(((d))) (c) Hire qualified caregivers and assure coverage of the home during periods of absence in order to meet residents' identified service needs, and have a documented staffing plan in place at all times.

(((6))) (11) Dementia. To be designated as a home specializing in services to residents ((with)) whose primary disability is dementia as defined by subsection (3)(d) of this section, the individual provider ((or)) and resident manager shall, in addition to complying with all other rules in this chapter:

(a) Complete the department approved specialty care training ((course)) in providing care to ((persons)) residents with dementia prior to being designated as a specialty adult family home;

(b) ((Each calendar year, complete a minimum of ten hours of continuing education credits that relate to providing care to persons with dementia;

(i) The continuing education requirement listed above in subsection (6)(b) of this section shall also qualify for the continuing education requirement in WAC 388-76-660 (2)(c);

(ii) The continuing education requirement begins the calendar year after the year in which the provider or resident manager completes the training listed above in subsection (6)(a) of this section;

(c))) Hire qualified caregivers and assure coverage of the home during periods of absence in order to meet residents' identified service needs, and have a documented staffing plan in place at all times; and

(((d) Be)) (c) Ensure the home is designed to accommodate residents with dementia in a homelike environment. The design and environment of the home shall support residents in their activities of daily living; enhance their quality of life; reduce tension, agitation, and problem behaviors; and promote their safety.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-590, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-600 General resident rights. (1) The provider shall comply with all requirements of chapter 70.129 RCW, Long-term care resident rights. The provider shall promote and protect the resident's exercise of all rights granted under that law.

(2) ((The provider shall have written policies for the services provided, house policies, financial arrangements expected, and the home's policy on refunds and deposits. Prior to admitting any resident, the provider shall provide this information to the prospective resident and his or her surrogate decision maker, if applicable.)) Prior to admitting any resident, the provider shall provide information about the adult family home to the prospective resident and his or her surrogate decision maker, if applicable. The information shall be presented orally and in writing in a language understandable to the prospective resident and at a minimum shall include:

(a) A description of services and activities provided and available in the home;

(b) House rules and policies governing resident conduct and responsibilities;

(c) Fee payment schedules expected of residents by the provider;

(d) The home's policy on refunds and deposits;

(e) The caregiving experience of the provider and resident manager and their education and training relevant to resident caregiving;

(f) The regular availability and primary responsibilities of licensed nursing staff if the home is not a "RN" or "RN-specialty" designated adult family home;

(g) A statement indicating if the provider performs or is willing to perform nurse delegation as allowed under state law;

(h) A description of what the adult family home does or will try to do to accommodate a resident's foreseeable or likely increasing care needs for the kinds of residents served by the home;

(i) The foreseeable or likely resident needs and conditions for which the adult family home cannot or will not provide care; and

(j) All information prepared and provided for resident distribution by the department.

(3) The provider shall inform the resident both orally and in writing in a manner and in a language the resident understands when there are changes in:

(a) House policies governing resident conduct and responsibilities during the resident's stay in the adult family home;

(b) Services and activities available in the adult family home;

(c) Charges for available services including charges for services not covered by the home's per diem rate or applicable public benefit programs; and

(d) Refund and deposit policies.

(4) House policies implemented by the provider shall be reasonable and may not conflict with rights granted to the resident under chapter 70.129 RCW, Long-term care resident rights or this chapter.

(5) The resident has the right to be fully informed in language that he or she can understand of his or her total health status, including, but not limited to, his or her medical condition as defined under RCW 7.70.060.

(6) The resident has the right to be fully informed in advance about recommended care and treatment and of any recommended changes in that care or treatment.

(7) The provider shall not require or ask the resident to sign any contract or agreement that waives any rights of the resident.

(8) The resident shall be free from abuse, neglect, abandonment, or financial exploitation.

(9) The provider shall comply with all applicable federal and state statutory requirements regarding nondiscrimination.

(10) The provider shall post in a place and manner clearly visible to residents and visitors the department's toll-free complaint telephone number, and the names, addresses, and telephone numbers of the state licensure office, the state ombudsman program, and the protection and advocacy systems. This posting shall include a description of the long-term care ombudsman program.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-600, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-610 Resident assessment. (1) The provider shall not admit or retain a resident unless:

(a) The adult family home can meet the resident's assessed needs;

(b) The resident's admission will not:

(i) Adversely affect the provider's ability to meet the needs of other residents in the home; or

(ii) Endanger the safety of other residents; and

(c) All residents and household members can be safely evacuated in an emergency.

(2) ((For each resident)) Prior to the resident's admission, the provider shall ((have)) obtain a current written assessment which describes the resident's:

(a) Health and medical status;

(b) Mental status;

(c) Strengths and needs;

(((c) Activities preferences; and))

(d) Functional ability in relationship to activities of daily living including: Eating, toileting, ambulating, transferring, positioning, specialized body care, personal hygiene, dressing, bathing, and management of own medication; and

(e) Preferences and choices regarding issues important to the resident (e.g., food, daily routine).

(3) ((The provider shall:

(a) Obtain sufficient assessment information to develop a negotiated service plan within fourteen days of the resident's admission; and

(b) Complete the assessment within thirty days of the resident's admission.

(4))) For purposes of this section, "health services assessor" means any person who:

(a) Has a master's degree in social services, human services, behavioral sciences or an allied field and two years social service experience working with adults who have functional or cognitive disabilities; or a bachelor's degree in social services, human services, behavioral sciences, or an allied field and three years social service experience working with adults who have functional or cognitive disabilities;

(b) Has a valid Washington state license to practice as a registered nurse and three years of clinical nursing experience; or

(c) Is a physician with a valid Washington state license to practice medicine.

(4) Prior to admitting a private pay resident, the provider shall obtain an assessment of the resident and a preliminary service plan which have been completed by a health services assessor as defined by subsection (3) of this section. The assessment shall be completed on a department approved standardized form and shall include a department approved functional assessment for dementia. The requirements of this subsection shall become effective beginning July 1, 1999.

(5) The provider may admit a private pay resident without the required assessment and service plan if the individual's health and safety are in imminent danger. "Imminent danger" means serious physical harm to a resident has occurred, or there is a serious threat to resident life, health, or safety.

(6) Prior to admitting residents receiving services paid for fully or partially by the department, the provider shall obtain a comprehensive assessment and service plan completed by department staff or department approved contractors.

(7) The provider may admit a resident receiving services paid for fully or partially by the department without the required comprehensive assessment and service plan if:

(a) The resident must relocate because of department emergency enforcement action against a residential care facility;

(b) The resident is part of an adult protective services investigation; or

(c) The resident's previous residential care facility provider abandons the resident.

(8) If a provider admits a resident as allowed under subsections (5) and (7) of this section, the required assessment and service plan must be completed within five working days of the resident's admission, unless the resident's admission is part of an adult protective services investigation.

(9) The provider shall ensure that the resident's assessment is reviewed and updated ((for accuracy)) to document the resident's ongoing needs and preferences:

(a) ((As needed; and

(b))) At least every twelve months;

(b) When there is a significant change in the resident's physical or mental condition; and

(c) At the resident's or the resident legal representative's request.

(10) The assessment review required by subsection (9) of this section shall be completed by:

(a) A health services assessor as defined by subsection (3) of this section for private pay residents beginning July 1, 1999; or

(b) Department staff or department approved contractors for residents receiving services paid for fully or partially by the department.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-610, filed 6/19/96, effective 7/20/96.]

AMENDATORY SECTION (Amending Order 3984, filed 6/19/96, effective 7/20/96 WAC 388-76-615 Negotiated ((service)) care plan. (1) Within fourteen days of the resident's admission the provider shall develop a negotiated ((service)) care plan with the resident which identifies:

(a) The care and services to be provided;

(b) Who will provide the care and services; ((and))

(c) When and how the care and services will be provided;

(d) The resident's activities preferences and how those preferences will be accommodated; and

(e) Other preferences and choices regarding issues important to the resident (e.g., food, daily routine, grooming), and what efforts will be made to accommodate those preferences and choices.

(2) For private pay residents, the provider shall build upon the assessment and preliminary service plan required under WAC 388-76-610(4) to develop the negotiated care plan.

(3) For residents receiving services paid for fully or partially by the department, the provider shall build upon the department's comprehensive assessment and service plan when developing the negotiated care plan.

(((2))) (4) The provider shall ensure that the negotiated ((service)) care plan is((:

(a) Designed to meet resident needs and preferences currently identified in the assessment; and

(b))) agreed to and signed by the resident or the resident's surrogate decision maker, if applicable.

(((3))) (5) For residents receiving services paid for fully or partially by the department, the provider shall implement the negotiated care plan after it has been agreed to and signed by the resident or the resident's surrogate decision maker. Then the provider shall give a copy of the plan to the home and community services (HCS) staff person or department authorized case manager for review and determination that the plan is designed to meet the resident's identified needs.

(6) The negotiated ((service)) care plan shall be completed with input from:

(a) The resident to the greatest extent practicable;

(b) The resident's family, if approved by the resident;

(c) The resident's surrogate decision maker, if applicable;

(d) Appropriate professionals;

(e) Other individuals the resident wants included; and

(f) The HCS staff person or authorized department case manager, if the resident is receiving services paid for fully or partially by the department.

(((4))) (7) The provider shall ensure that the resident's negotiated ((service)) care plan is reviewed and revised:

(a) ((As needed;

(b))) At least every twelve months;

(b) When there is a significant change in the resident's physical or mental condition;

(c) At the resident's request; and

(((c))) (d) If changes or additions to assessment information result in significant changes to the resident's identified needs or preferences and choices.

(8) If there are significant changes to a resident's identified needs, and the resident is receiving services paid for fully or partially by the department, the provider shall notify the HCS staff person or the authorized department case manager. No payment rate change will be approved without an assessment and authorization by the department.

[Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), 388-76-615, filed 6/19/96, effective 7/20/96.]

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