State of Washington | 62nd Legislature | 2011 Regular Session |
READ FIRST TIME 02/23/11.
AN ACT Relating to reshaping the delivery of long-term care services; amending RCW 18.20.020, 18.20.030, and 18.52.030; reenacting and amending RCW 70.127.040; adding a new section to chapter 18.20 RCW; adding a new section to chapter 74.42 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 which may include reminding
or coaching the nonresident, opening the nonresident's medication
container, using an enabler, and prefilling insulin syringes; (h) falls
risk assessment; (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.))
NEW SECTION. Sec. 4 A new section is added to chapter 18.20 RCW
to read as follows:
(1) A boarding home must provide each nonresident a disclosure
statement upon admission and at the time that additional services are
requested by a nonresident.
(2) The disclosure statement shall notify the nonresident that:
(a) The resident rights of chapter 70.129 RCW do not apply to
nonresidents;
(b) Licensing requirements for boarding homes under this chapter do
not apply to nonresident units; and
(c) The jurisdiction of the long-term care ombudsman does not apply
to nonresidents and nonresident units.
Sec. 5 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. 6 RCW 70.127.040 and 2003 c 275 s 3 and 2003 c 140 s 8 are
each reenacted and amended to read as follows:
The following are not subject to regulation for the purposes of
this chapter:
(1) A family member providing home health, hospice, or home care
services;
(2) A person who provides only meal services in an individual's
permanent or temporary residence;
(3) An individual providing home care through a direct agreement
with a recipient of care in an individual's permanent or temporary
residence;
(4) A person furnishing or delivering home medical supplies or
equipment that does not involve the provision of services beyond those
necessary to deliver, set up, and monitor the proper functioning of the
equipment and educate the user on its proper use;
(5) A person who provides services through a contract with a
licensed agency;
(6) An employee or volunteer of a licensed agency who provides
services only as an employee or volunteer;
(7) Facilities and institutions, including but not limited to
nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41
RCW, adult family homes under chapter 70.128 RCW, boarding homes under
chapter 18.20 RCW, developmental disability residential programs under
chapter 71A.12 RCW, other entities licensed under chapter 71.12 RCW, or
other licensed facilities and institutions, only when providing
services to persons residing within the facility or institution;
(8) Local and combined city-county health departments providing
services under chapters 70.05 and 70.08 RCW;
(9) An individual providing care to ill individuals, ((disabled))
individuals with disabilities, or vulnerable individuals through a
contract with the department of social and health services;
(10) Nursing homes, hospitals, or other institutions, agencies,
organizations, or persons that contract with licensed home health,
hospice, or home care agencies for the delivery of services;
(11) In-home assessments of an ill individual, ((disabled)) an
individual with a disability, or a vulnerable individual that does not
result in regular ongoing care at home;
(12) Services conducted by and for the adherents of a church or
religious denomination that rely upon spiritual means alone through
prayer for healing in accordance with the tenets and practices of such
church or religious denomination and the bona fide religious beliefs
genuinely held by such adherents;
(13) A medicare-approved dialysis center operating a medicare-approved home dialysis program;
(14) A person providing case management services. For the purposes
of this subsection, "case management" means the assessment,
coordination, authorization, planning, training, and monitoring of home
health, hospice, and home care, and does not include the direct
provision of care to an individual;
(15) Pharmacies licensed under RCW 18.64.043 that deliver
prescription drugs and durable medical equipment that does not involve
the use of professional services beyond those authorized to be
performed by licensed pharmacists pursuant to chapter 18.64 RCW and
those necessary to set up and monitor the proper functioning of the
equipment and educate the person on its proper use;
(16) A volunteer hospice complying with the requirements of RCW
70.127.050; ((and))
(17) A person who provides home care services without compensation;
and
(18) Nursing homes that provide telephone or web-based transitional
care management services.
NEW SECTION. Sec. 7 A new section is added to chapter 74.42 RCW
to read as follows:
(1) Nursing facilities may provide telephone or web-based
transitional care management services to persons discharged from the
facility to home for up to thirty days postdischarge.
(2) When a nursing facility provides transitional care management
services, the facility must coordinate postdischarge care and service
needs with in-home agencies licensed under chapter 70.127 RCW, and
other authorized care providers, to promote evidence-based transition
care planning. In-home service agencies and other authorized care
providers, including the department, shall, when appropriate, determine
resident eligibility for postdischarge care and services and coordinate
with nursing facilities to plan a safe transition of the client to the
home setting. When a resident is discharged to home and is without in-home care or services due to the resident's refusal of care or their
ineligibility for care, the nursing facility may provide telephone or
web-based transitional care management services. These services may
include care coordination services, review of the discharge plan,
instructions to promote compliance with the discharge plan, reminders
or assistance with scheduling follow-up appointments with other health
care professionals consistent with the discharge plan, and promotion of
self-management of the client's health condition. Web-based transition
care services may include patient education and the provision of
services described in this section. They are not intended to include
telehealth monitoring.
(3) If the nursing facility identifies concerns in client care that
result from telephone or web-based transitional care management
services, the nursing facility will notify the client's primary care
physician. The nursing facility will also discuss with the client
options for care or other services which may include in-home services
provided by agencies licensed under chapter 70.127 RCW.
NEW SECTION. Sec. 8 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. 9 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.