BILL REQ. #: H-1897.1
State of Washington | 62nd Legislature | 2011 Regular Session |
READ FIRST TIME 02/17/11.
AN ACT Relating to reshaping the delivery of long-term care services; amending RCW 18.20.020, 18.20.030, 18.20.330, 18.20.160, 18.52.030, 18.51.010, and 70.126.020; adding new sections to chapter 74.42 RCW; adding a new section to chapter 74.39A RCW; and creating new sections.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The legislature has a long history of
supporting seniors where they live whether it is at home or in a
licensed care facility. It is widely recognized that the consumer of
senior services and long-term care of tomorrow will have different
demands and expectations for the type and manner of supportive and
health care services that they receive. Cost efficiencies must and can
be achieved within the health care system. Through the use of care
coaches, technology-supported health and wellness programs, and by
allowing greater flexibility for the specialization and use of nursing
facility beds, costly hospitalizations and rehospitalizations can be
reduced and the entry to licensed care settings can be delayed.
Sec. 2 RCW 18.20.020 and 2006 c 242 s 1 are each amended to read
as follows:
As used in this chapter:
(1) "Boarding home" means any home or other institution, however
named, which is advertised, announced, or maintained for the express or
implied purpose of providing housing, basic services, and assuming
general responsibility for the safety and well-being of the residents,
and may also provide domiciliary care, consistent with chapter 142,
Laws of 2004, to seven or more residents after July 1, 2000. However,
a boarding home that is licensed for three to six residents prior to or
on July 1, 2000, may maintain its boarding home license as long as it
is continually licensed as a boarding home. "Boarding home" shall not
include facilities certified as group training homes pursuant to RCW
71A.22.040, nor any home, institution or section thereof which is
otherwise licensed and regulated under the provisions of state law
providing specifically for the licensing and regulation of such home,
institution or section thereof. Nor shall it include any independent
senior housing, independent living units in continuing care retirement
communities, or other similar living situations including those
subsidized by the department of housing and urban development.
(2) "Basic services" means housekeeping services, meals, nutritious
snacks, laundry, and activities.
(3) "Person" means any individual, firm, partnership, corporation,
company, association, or joint stock association, and the legal
successor thereof.
(4) "Secretary" means the secretary of social and health services.
(5) "Department" means the state department of social and health
services.
(6) "Resident's representative" means a person designated
voluntarily by a competent resident, in writing, to act in the
resident's behalf concerning the care and services provided by the
boarding home and to receive information from the boarding home, if
there is no legal representative. The resident's competence shall be
determined using the criteria in RCW 11.88.010(1)(e). The resident's
representative may not be affiliated with the licensee, boarding home,
or management company, unless the affiliated person is a family member
of the resident. The resident's representative shall not have
authority to act on behalf of the resident once the resident is no
longer competent.
(7) "Domiciliary care" means: Assistance with activities of daily
living provided by the boarding home either directly or indirectly; or
health support services, if provided directly or indirectly by the
boarding home; or ((intermittent)) nursing services, if provided
directly or indirectly by the boarding home.
(8) "General responsibility for the safety and well-being of the
resident" means the provision of the following: Prescribed general low
sodium diets; prescribed general diabetic diets; prescribed mechanical
soft foods; emergency assistance; monitoring of the resident; arranging
health care appointments with outside health care providers and
reminding residents of such appointments as necessary; coordinating
health care services with outside health care providers consistent with
RCW 18.20.380; assisting the resident to obtain and maintain glasses,
hearing aids, dentures, canes, crutches, walkers, wheelchairs, and
assistive communication devices; observation of the resident for
changes in overall functioning; blood pressure checks as scheduled;
responding appropriately when there are observable or reported changes
in the resident's physical, mental, or emotional functioning; or
medication assistance as permitted under RCW 69.41.085 and as defined
in RCW 69.41.010.
(9) "Legal representative" means a person or persons identified in
RCW 7.70.065 who may act on behalf of the resident pursuant to the
scope of their legal authority. The legal representative shall not be
affiliated with the licensee, boarding home, or management company,
unless the affiliated person is a family member of the resident.
(10) "Nonresident individual" means a person who resides in
independent senior housing, independent living units in continuing care
retirement communities, or in other similar living environments or in
an unlicensed room located within a boarding home ((and may receive)).
Nothing in this chapter prohibits nonresidents from receiving one or
more of the services listed in RCW 18.20.030(5) or requires licensure
as a boarding home when one or more of the services listed in RCW
18.20.030(5) are provided to nonresidents. A nonresident individual
may not receive domiciliary care, as defined in this chapter, directly
or indirectly by the boarding home and may not receive the items and
services listed in subsection (8) of this section, except during the
time the person is receiving adult day services as defined in this
section.
(11) "Resident" means an individual who is not related by blood or
marriage to the operator of the boarding home, and by reason of age or
disability, chooses to reside in the boarding home and receives basic
services and one or more of the services listed under general
responsibility for the safety and well-being of the resident and may
receive domiciliary care or respite care provided directly or
indirectly by the boarding home and shall be permitted to receive
hospice care through an outside service provider when arranged by the
resident or the resident's legal representative under RCW 18.20.380.
(12) "Resident applicant" means an individual who is seeking
admission to a licensed boarding home and who has completed and signed
an application for admission, or such application for admission has
been completed and signed in their behalf by their legal representative
if any, and if not, then the designated representative if any.
(13) "Adult day services" means care and services provided to a
nonresident individual by the boarding home on the boarding home
premises, for a period of time not to exceed ten continuous hours, and
does not involve an overnight stay.
Sec. 3 RCW 18.20.030 and 2004 c 142 s 17 are each amended to read
as follows:
(1) After January 1, 1958, no person shall operate or maintain a
boarding home as defined in this chapter within this state without a
license under this chapter.
(2) A boarding home license is not required for the housing, or
services, that are customarily provided under landlord tenant
agreements governed by the residential landlord-tenant act, chapter
59.18 RCW, or when housing nonresident individuals who((, without
ongoing assistance from the boarding home, initiate and arrange for
services provided by persons other than)) chose to participate in
programs or services under subsection (5) of this section, when offered
by the boarding home licensee or the licensee's contractor. This
subsection does not prohibit the licensee from furnishing written
information concerning available community resources to the nonresident
individual or the individual's family members or legal representatives.
The licensee may not require the use of any particular service
provider.
(3) Residents receiving domiciliary care, directly or indirectly by
the boarding home, are not considered nonresident individuals for the
purposes of this section.
(4) A boarding home license is required when any person other than
an outside service provider, under RCW 18.20.380, or family member:
(a) Assumes general responsibility for the safety and well-being of
a resident;
(b) Provides assistance with activities of daily living, either
directly or indirectly;
(c) Provides health support services, either directly or
indirectly; or
(d) Provides ((intermittent)) nursing services, either directly or
indirectly.
(5) A boarding home license is not required for one or more of the
following services that may, upon the request of the nonresident, be
provided to a nonresident individual: (a) Emergency assistance
provided on an intermittent or nonroutine basis ((to any nonresident
individual)); (b) systems, including technology-based monitoring
devices, employed by independent senior housing, or independent living
units in continuing care retirement communities, to respond to the
potential need for emergency services ((for nonresident individuals));
(c) ((infrequent, voluntary, and)) scheduled and nonscheduled blood
pressure checks ((for nonresident individuals)); (d) ((nurse referral))
nursing assessment services ((provided at the request of a nonresident
individual)) to determine whether referral to an outside health care
provider is recommended; (e) making and reminding the nonresident of
health care appointments ((at the request of nonresident individuals));
(f) preadmission assessment((, at the request of the nonresident
individual,)) for the purposes of transitioning to a licensed care
setting; ((or)) (g) medication assistance when performed by a nurse
licensed under chapter 18.79 RCW and may include reminding or coaching
the nonresident, opening the nonresident's medication container, using
an enabler, and prefilling insulin syringes; (h) falls risk assessment
and prevention services; (i) nutrition management and education
services; (j) dental services; (k) wellness programs; or (l) services
customarily provided under landlord tenant agreements governed by the
residential landlord-tenant act, chapter 59.18 RCW. ((The preceding
services may not include continual care or supervision of a nonresident
individual without a boarding home license.))
Sec. 4 RCW 18.20.330 and 2004 c 142 s 5 are each amended to read
as follows:
(1) Boarding homes are not required to provide ((intermittent))
nursing services. The boarding home licensee may choose to provide any
of the following ((intermittent)) nursing services through
appropriately licensed and credentialed staff, however, the facility
may or may not need to provide additional ((intermittent)) nursing
services to comply with the reasonable accommodation requirements in
federal or state law:
(a) Medication administration;
(b) Administration of health care treatments;
(c) Diabetic management;
(d) Nonroutine ostomy care;
(e) Tube feeding; ((and))
(f) Nurse delegation consistent with chapter 18.79 RCW; and
(g) Other personal and special care services as defined by the
department in rule.
(2) The licensee shall clarify on the disclosure form any
limitations, additional services, or conditions that may apply under
this section.
(3) In providing ((intermittent)) nursing services, the boarding
home shall observe the resident for changes in overall functioning and
respond appropriately when there are observable or reported changes in
the resident's physical, mental, or emotional functioning.
(4) The boarding home ((may)) must provide ((intermittent)) nursing
services ((to the extent permitted by)) consistent with the staffing
requirements described in RCW 18.20.160.
Sec. 5 RCW 18.20.160 and 2004 c 142 s 12 are each amended to read
as follows:
((No person operating a boarding home licensed under this chapter
shall admit to or retain in the boarding home any aged person requiring
nursing or medical care of a type provided by institutions licensed
under chapters 18.51, 70.41 or 71.12 RCW, except that when registered
nurses are available, and upon a doctor's order that a supervised
medication service is needed, it may be provided. Supervised
medication services, as defined by the department and consistent with
chapters 69.41 and 18.79 RCW, may include an approved program of self-medication or self-directed medication. Such medication service shall
be provided only to residents who otherwise meet all requirements for
residency in a boarding home. No boarding home shall admit or retain
a person who requires the frequent presence and frequent evaluation of
a registered nurse, excluding persons who are receiving hospice care or
persons who have a short-term illness that is expected to be resolved
within fourteen days.)) The boarding home must assure that sufficient
numbers of appropriately qualified and trained staff are available to
provide care and services consistent with this chapter.
Sec. 6 RCW 18.52.030 and 2000 c 93 s 6 are each amended to read
as follows:
Nursing homes operating within this state shall be under the
active, overall administrative charge and supervision of an on-site
full-time administrator licensed as provided in this chapter. No
person acting in any capacity, unless the holder of a nursing home
administrator's license issued under this chapter, shall be charged
with the overall responsibility to make decisions or direct actions
involved in managing the internal operation of a nursing home, except
as specifically delegated in writing by the administrator to identify
a responsible person to act on the administrator's behalf when the
administrator is absent. The administrator shall review the decisions
upon the administrator's return and amend the decisions if necessary.
The board shall define by rule the parameters for on-site full-time
administrators in nursing homes with small resident populations
((and)), nursing homes in rural areas, nursing homes with small
resident populations when the nursing home has converted some of its
licensed nursing facility bed capacity for use as assisted living or
enhanced assisted living services under chapter 74.39A RCW, or
separately licensed facilities collocated on the same campus.
Sec. 7 RCW 18.51.010 and 1983 c 236 s 1 are each amended to read
as follows:
(1) "Nursing home" means any home, place or institution which
operates or maintains facilities ((providing)) to provide one or more
of the following: Convalescent ((or)) care, chronic care, or ((both,))
postacute care for a period in excess of twenty-four consecutive hours
for three or more patients not related by blood or marriage to the
operator, who by reason of illness or infirmity, are unable properly to
care for themselves. Postacute care may include those services as
defined by the department in rule and consistent with section 10 of
this act. Convalescent and chronic care may include but not be limited
to any or all procedures commonly employed in waiting on the sick, such
as administration of medicines, preparation of special diets, giving of
bedside nursing care, application of dressings and bandages, and
carrying out of treatment prescribed by a duly licensed practitioner of
the healing arts. It may also include care of mentally incompetent
persons. It may also include community-based care in the absence of
alternative placement options. Nothing in this definition shall be
construed to include general hospitals or other places which provide
care and treatment for the acutely ill and maintain and operate
facilities for major surgery or obstetrics, or both. Nothing in this
definition shall be construed to include any boarding home, guest home,
hotel or related institution which is held forth to the public as
providing, and which is operated to give only board, room and laundry
to persons not in need of medical or nursing treatment or supervision
except in the case of temporary acute illness. The mere designation by
the operator of any place or institution as a hospital, sanitarium, or
any other similar name, which does not provide care for the acutely ill
and maintain and operate facilities for major surgery or obstetrics, or
both, shall not exclude such place or institution from the provisions
of this chapter: PROVIDED, That any nursing home providing psychiatric
treatment shall, with respect to patients receiving such treatment,
comply with the provisions of RCW 71.12.560 and 71.12.570.
(2) "Person" means any individual, firm, partnership, corporation,
company, association, or joint stock association, and the legal
successor thereof.
(3) "Secretary" means the secretary of the department of social and
health services.
(4) "Department" means the state department of social and health
services.
(5) "Community-based care" means but is not limited to the
following:
(a) Home delivered nursing services;
(b) Personal care;
(c) Day care;
(d) Nutritional services, both in-home and in a communal dining
setting;
(e) Habilitation care; and
(f) Respite care.
Sec. 8 RCW 70.126.020 and 1984 c 22 s 5 are each amended to read
as follows:
(1) Home health care shall be provided by a home health agency and
shall:
(a) Be delivered by a registered nurse, physical therapist,
occupational therapist, speech therapist, or home health aide on a
part-time or intermittent basis;
(b) Include, as applicable under the written plan, supplies and
equipment such as:
(i) Drugs and medicines that are legally obtainable only upon a
physician's written prescription, and insulin;
(ii) Rental of durable medical apparatus and medical equipment such
as wheelchairs, hospital beds, respirators, splints, trusses, braces,
or crutches needed for treatment;
(iii) Supplies normally used for hospital inpatients and dispensed
by the home health agency such as oxygen, catheters, needles, syringes,
dressings, materials used in aseptic techniques, irrigation solutions,
and intravenous fluids.
(2) The following services may be included when medically
necessary, ordered by the attending physician, and included in the
approved plan of treatment:
(a) Licensed practical nurses;
(b) Respiratory therapists;
(c) Social workers holding a master's degree;
(d) Ambulance service that is certified by the physician as
necessary in the approved plan of treatment because of the patient's
physical condition or for unexpected emergency situations.
(3) Services not included in home health care include:
(a) Nonmedical, custodial, or housekeeping services except by home
health aides as ordered in the approved plan of treatment;
(b) "Meals on Wheels" or similar food services;
(c) Nutritional guidance;
(d) Services performed by family members;
(e) Services not included in an approved plan of treatment;
(f) Supportive environmental materials such as handrails, ramps,
telephones, air conditioners, and similar appliances and devices; and
(g) Follow to home services provided by a care coach as authorized
under section 9 of this act.
NEW SECTION. Sec. 9 A new section is added to chapter 74.42 RCW
to read as follows:
Nursing homes are encouraged to collaborate with local home health
agencies for an assessment of home health needs and to determine home
health eligibility for patients being discharged. The nursing home may
provide nonmedical care management services when the patient is
eligible for home health, but refuses home health care services, the
patient has been evaluated by home health and determined to be
ineligible for services, or services provided by the home health agency
will be delayed resulting in a potential gap in service for the
patient. In addition, nursing homes may work directly with home health
agencies to provide care management services for those patients who do
not qualify for home health care. Either the agency or the nursing
home may provide the care management services, but in the event that
medically focused services are required, regardless of qualifying
criteria, this does not preclude the home health or home care agency
from providing those same medically focused services.
NEW SECTION. Sec. 10 A new section is added to chapter 74.42 RCW
to read as follows:
The department shall adopt rules to establish postacute care
program certification standards. The postacute care program
certification standards established under this section must be designed
for patients requiring medical care, skilled nursing care, or
rehabilitation services due to complex medical conditions or multiple
acute or chronic illnesses following an acute hospital stay and prior
to returning to home. Postacute care programs authorized under this
section must be limited to persons expected to have relatively shorter
stays in duration of ninety days or less. The department may establish
exceptions to the ninety day limitation. Persons requiring chronic
care or convalescent care may not be admitted to or retained in a
postacute care certified unit unless they otherwise need the level and
intensity of the care and services offered by the postacute care
programs. Certification of a postacute care unit is optional and
nothing in this section shall require that postacute services be
limited to this unit.
NEW SECTION. Sec. 11 A new section is added to chapter 74.39A
RCW to read as follows:
The department of social and health services shall convene a work
group of acute care facilities, long-term care facilities, housing for
seniors, services for seniors, state agencies, the long-term care
ombudsman's office, and consumers. The work group shall identify the
chronic and acute care service needs of the region's residents over the
next ten years and the existing service capacity of the provider
community to meet those identified needs. The work group shall develop
a plan to coordinate care to achieve efficiencies, cost savings, and
improve quality outcomes. The work group shall submit its plan to the
governor and the legislature by December 31, 2011.
NEW SECTION. Sec. 12 The department of social and health
services shall convene a work group of stakeholders to discuss and
identify one or more mechanisms to incentivize nursing facilities to
close or to eliminate licensed beds from active service. The
department shall adopt rules to implement the recommendations of the
work group. By September 1, 2011, the department shall report to the
governor and the legislature on the recommendations of the work group
and the status of the department's rule-making efforts and any
statutory impediments to the implementation of any of the
recommendations.
NEW SECTION. Sec. 13 If any part of this act is found to be in
conflict with federal requirements that are a prescribed condition to
the allocation of federal funds to the state, the conflicting part of
this act is inoperative solely to the extent of the conflict and with
respect to the agencies directly affected, and this finding does not
affect the operation of the remainder of this act in its application to
the agencies concerned. Rules adopted under this act must meet federal
requirements that are a necessary condition to the receipt of federal
funds by the state.