BP BHEAD INT S [atlas:bill]

AN ACT Relating to improving long-term care; amending RCW 70.129.030; adding a new section to chapter 18.20 RCW; adding a new section to chapter 70.128 RCW; creating a new section; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that many residents of long-term care facilities are exceptionally vulnerable and their health and well-being are heavily dependent on their caregivers. The legislature further finds that the quality of staff in long-term care facilities is often the key to good care. The need for well-trained staff and well-managed facilities is growing as the state's population ages and the acuity of the health care problems of residents increases. In order to better protect and care for residents, the legislature directs that the minimum training standards for licensees serving residents with special needs, such as mental illness, dementia, or a developmental disability, be increased, and that licensees receive additional appropriate training, and that the training delivery system be improved.

NEW SECTION. Sec. 2. A new section is added to chapter 18.20 RCW to read as follows:

(1) The department of social and health services shall design and develop, in coordination with the department of health and the nursing care quality assurance commission, proposed revisions to the training standards for administrators and resident caregiving staff. The departments and the commission shall submit to the appropriate committees of the house of representatives and the senate by December 1, 1998, specific recommendations for enhancement of the training standards and delivery system, including necessary statutory changes and funding requirements. The proposed enhancements shall be consistent with this section, shall take into account and not duplicate other training requirements applicable to facilities and staff, and shall be developed with the input of facility and resident representatives, health care professionals, and other vested interest groups. The enhanced training standards and delivery system shall be relevant to the needs of residents served by the facility and shall be sufficient to ensure that administrators and caregiving staff have the skills and knowledge necessary to provide high quality, appropriate care. Following the action of the 1999 legislature, the departments and commission shall adopt appropriate rules to implement the enhanced training standards and improved training delivery system.

(2) The proposed training standards shall include enhanced minimum standards for all administrators and caregiving staff and specialized training standards for administrators and staff serving residents with special needs. Residents with special needs include, but are not limited to, residents with a diagnosis of mental illness, dementia, or developmental disability.

(3) The proposed training standards shall consist of modules, with competency testing for each module. At least one module of not less than five hours in the minimum standards shall be dedicated to residents' rights under chapter 70.129 RCW. The proposed standards shall include an appropriate mixture of coursework and practical or clinical training. The competency tests shall include a demonstration of skills when appropriate for the subject, and shall be sufficiently detailed and rigorous to provide evidence of the individual's competence.

(4) Prospective administrators and caregiving staff with professional health care or social services licenses, as determined by the department by rule, shall be exempted from part or all of the minimum training, except for the module regarding residents' rights, provided that they successfully pass competency testing by the department. For purpose of this section, "prospective" means individuals who become licensed to operate a facility, or are employed by or for a facility, after the effective date of the rules adopted under chapter . . ., Laws of 1998 (this act). Current administrators and caregiving staff who have successfully completed previous department-required minimum training standards are exempted from portions of the department's enhanced minimum training standards that duplicate the previous standards. Current administrators and caregiving staff shall also be exempted from the enhanced minimum training standards, except for the module regarding residents' rights, if they successfully pass competency testing by the department. The department shall exempt prospective and current administrators and caregiving staff from part or all of the specialized training standards if they successfully pass additional competency testing by the department. To the extent consistent with state and federal law, a certificate of completion of modules of the training, or the entire training, shall be transferable between different health care settings.

(5) The proposed training standards shall provide that all prospective administrators, unless exempted, must successfully pass the enhanced minimum training standards prior to receiving a license or providing care to residents. Prospective caregiving staff shall complete a portion of the enhanced minimum training standards on key areas of resident care before providing care to residents. The remainder of the minimum training standards shall be completed by prospective caregiving staff within four months of employment. Until the minimum training is successfully completed, caregiving staff hired after the effective date of the enhanced training standards shall provide care only under the direct supervision of an individual who has successfully completed department-required minimum training. All current administrators and caregiving staff, to the extent not exempted, shall successfully complete the enhanced minimum training standards within four months of the effective date of the revised standards.

(6) After the effective date of the specialized training standards, prospective administrators who will be serving residents with special care needs, including residents with a diagnosis of developmental disability, dementia, or mental illness, shall successfully complete the specialized training regarding these residents prior to receiving a license or providing care to residents with special care needs. After the effective date of the specialized standards, prospective caregiving staff who will be serving residents with special care needs shall complete a portion of the specialized training on key areas of such care before providing care to residents with special care needs. The remainder of the specialized training shall be completed within four months of employment. Until the specialized training is successfully completed, caregiving staff hired after the effective date of the specialized standards shall provide care to residents with special needs only under the direct supervision of an individual who has successfully completed department-required specialized training. All current administrators and caregiving staff who serve residents with special care needs shall successfully complete the specialized training within four months of the effective date of the specialized standards.

(7) For facilities with a small percentage of residents with special care needs, the department may by rule determine that only the administrators and caregiving staff who interact with these residents are required to complete the specialized training.

(8) The minimum and specialized training may be conducted by persons and entities approved by the department. The December 1, 1998, recommendations of the department of social and health services, the department of health, and the nursing care quality assurance commission to the legislature shall include recommendations regarding a revised training delivery system, which may include, but is not limited to, training through the department, community colleges, area agencies on aging, regional support networks, other persons or entities with expertise on long-term care or special care needs, and by long-term care facilities if the facility does not have a history of significant noncompliance with federal or state laws concerning the care of vulnerable adults or children. No person, entity, or facility may conduct training until they also meet relevant standards set by the department to ensure high quality training.

(9) The department of social and health services, the department of health, and the nursing care quality assurance commission, with input from interested persons, shall use their best efforts to design the training modules and competency testing to teach and test appropriate skill areas. The commission shall accept some or all of the successfully competed modules towards meeting the requirements for a nursing assistant certificate under chapter 18.88A RCW.

(10) The department of social and health services shall establish payment rates to cover the reasonable costs of the enhanced minimum training and specialized standards for facilities with a contract to accept state-funded residents. The payment rates shall compensate facilities on a pro rata basis, based upon the facility's ratio of state-funded residents to private-pay residents. Compensation by the department of social and health services shall include the reasonable cost of tuition for the training and the reasonable cost for administrators and caregiving staff while they attend required training. To the extent possible, the department of social and health services shall seek federal reimbursement for these training-related costs. Facilities that admit only private-pay residents shall not have training costs paid for by the state.

NEW SECTION. Sec. 3. A new section is added to chapter 70.128 RCW to read as follows:

(1) The department of social and health services shall design and develop, in coordination with the department of health and the nursing care quality assurance commission, proposed revisions to the training standards for providers and resident managers and resident caregiving staff. The departments and the commission shall submit to the appropriate committees of the house of representatives and the senate by December 1, 1998, specific recommendations for enhancement of the training standards and delivery system, including necessary statutory changes and funding requirements. The proposed enhancements shall be consistent with this section, shall take into account and not duplicate other training requirements applicable to facilities and staff, and shall be developed with the input of facility and resident representatives, health care professionals, and other vested interest groups. The enhanced training standards and delivery system shall be relevant to the needs of residents served by the facility and shall be sufficient to ensure that providers and resident managers and caregiving staff have the skills and knowledge necessary to provide high quality, appropriate care. Following the action of the 1999 legislature, the departments and commission shall adopt appropriate rules to implement the enhanced training standards and improved training delivery system.

(2) The proposed training standards shall include enhanced minimum standards for all providers and resident managers and caregiving staff and specialized training standards for providers and resident managers and staff serving residents with special needs. Residents with special needs include, but are not limited to, residents with a diagnosis of mental illness, dementia, or developmental disability.

(4) Prospective providers and resident managers and caregiving staff with professional health care or social services licenses, as determined by the department by rule, shall be exempted from part or all of the minimum training, except for the module regarding residents' rights, provided that they successfully pass competency testing by the department. For purpose of this section, "prospective" means individuals who become licensed to operate a facility, or are employed by or for a facility, after the effective date of the rules adopted under chapter . . ., Laws of 1998 (this act). Current providers and resident managers and caregiving staff who have successfully completed previous department-required minimum training standards are exempted from portions of the department's enhanced minimum training standards that duplicate the previous standards. Current providers and resident managers and caregiving staff shall also be exempted from the enhanced minimum training standards, except for the module regarding residents' rights, if they successfully pass competency testing by the department. The department shall exempt prospective and current providers and resident managers and caregiving staff from part or all of the specialized training standards if they successfully pass additional competency testing by the department. To the extent consistent with state and federal law, a certificate of completion of modules of the training, or the entire training, shall be transferable between different health care settings.

(5) The proposed training standards shall provide that all prospective providers and resident managers, unless exempted, must successfully pass the enhanced minimum training standards prior to receiving a license or providing care to residents. Prospective caregiving staff shall complete a portion of the enhanced minimum training standards on key areas of resident care before providing care to residents. The remainder of the minimum training standards shall be completed by prospective caregiving staff within four months of employment. Until the minimum training is successfully completed, caregiving staff hired after the effective date of the enhanced training standards shall provide care only under the direct supervision of an individual who has successfully completed department-required minimum training. All current providers and resident managers and caregiving staff, to the extent not exempted, shall successfully complete the enhanced minimum training standards within four months of the effective date of the revised standards.

(6) After the effective date of the specialized training standards, prospective providers and resident managers who will be serving residents with special care needs, including residents with a diagnosis of developmental disability, dementia, or mental illness, shall successfully complete the specialized training regarding these residents prior to receiving a license or providing care to residents with special care needs. After the effective date of the specialized standards, prospective caregiving staff who will be serving residents with special care needs shall complete a portion of the specialized training on key areas of such care before providing care to residents with special care needs. The remainder of the specialized training shall be completed within four months of employment. Until the specialized training is successfully completed, caregiving staff hired after the effective date of the specialized standards shall provide care to residents with special needs only under the direct supervision of an individual who has successfully completed department-required specialized training. All current providers and resident managers and caregiving staff who serve residents with special care needs shall successfully complete the specialized training within four months of the effective date of the specialized standards.

(7) For facilities with a small percentage of residents with special care needs, the department may by rule determine that only the providers and resident managers and caregiving staff who interact with these residents are required to complete the specialized training.

(10) The department of social and health services shall establish payment rates to cover the reasonable costs of the enhanced minimum training and specialized standards for facilities with a contract to accept state-funded residents. The payment rates shall compensate facilities on a pro rata basis, based upon the facility's ratio of state-funded residents to private-pay residents. Compensation by the department of social and health services shall include the reasonable cost of tuition for the training and the reasonable cost for providers and resident managers and caregiving staff while they attend required training. To the extent possible, the department of social and health services shall seek federal reimbursement for these training-related costs. Facilities that admit only private-pay residents shall not have training costs paid for by the state.

Sec. 4. RCW 70.129.030 and 1997 c 386 s 31 are each amended to read as follows:

(1) The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. The notification must be made prior to or upon admission. Receipt of the information must be acknowledged in writing.

(2) The resident or his or her legal representative has the right:

(a) Upon an oral or written request, to access all records pertaining to himself or herself including clinical records within twenty-four hours; and

(b) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or portions of them upon request and two working days' advance notice to the facility.

(3) The facility shall only admit or retain individuals whose needs it can safely and appropriately serve in the facility with appropriate available staff or through the provision of reasonable accommodations required by state or federal law. Except in cases of genuine emergency, the facility shall not admit an individual before obtaining a thorough assessment of the resident's needs and preferences. The assessment shall contain, unless unavailable despite the best efforts of the facility, potential resident, and other interested parties, the following minimum information: Recent medical history; necessary and prohibited medications; a medical professional's diagnosis; significant know behaviors or symptoms that may cause concern or require special care; mental illness, except where protected by confidentiality laws; level of personal care needs; activities and service preferences; and preferences regarding other issues important to the potential resident, such as food and daily routine.

(4) The facility must inform each resident in writing in a language the resident or his or her representative understands before((~~, or at the time of~~)) admission, and at least once every twenty-four months thereafter of: (a) Services, items, and activities customarily available in the facility or arranged for by the facility; (b) charges for those services, items, and activities including charges for services, items, and activities not covered by the facility's per diem rate or applicable public benefit programs; and (c) the rules of facility operations required under RCW 70.129.140(2). Each resident and his or her representative must be informed in writing in advance of changes in the availability or the charges for services, items, or activities, or of changes in the facility's rules. Except in emergencies, thirty days' advance notice must be given prior to the change. However, for facilities licensed for six or fewer residents, if there has been a substantial and continuing change in the resident's condition necessitating substantially greater or lesser services, items, or activities, then the charges for those services, items, or activities may be changed upon fourteen days' advance written notice.

((~~(4)~~)) (5) The facility must furnish a written description of residents rights that includes:

(a) A description of the manner of protecting personal funds, under RCW 70.129.040;

(b) A posting of names, addresses, and telephone numbers of the state survey and certification agency, the state licensure office, the state ombudsmen program, and the protection and advocacy systems; and

(c) A statement that the resident may file a complaint with the appropriate state licensing agency concerning alleged resident abuse, neglect, and misappropriation of resident property in the facility.

((~~(5)~~)) (6) Notification of changes.

(a) A facility must immediately consult with the resident's physician, and if known, make reasonable efforts to notify the resident's legal representative or an interested family member when there is:

(i) An accident involving the resident which requires or has the potential for requiring physician intervention;

(ii) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications).

(b) The facility must promptly notify the resident or the resident's representative shall make reasonable efforts to notify an interested family member, if known, when there is:

(i) A change in room or roommate assignment; or

(ii) A decision to transfer or discharge the resident from the facility.

(c) The facility must record and update the address and phone number of the resident's representative or interested family member, upon receipt of notice from them.

NEW SECTION. Sec. 5. (1) Section 4 of this act takes effect July 1, 1998.

(2) Sections 2 and 3 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and take effect immediately.