BILL REQ. #:  S-1787.1 

READ FIRST TIME 02/21/11.   

     AN ACT Relating to reshaping the delivery of long-term care services; amending RCW 18.20.020, 18.20.030, 18.52.030, and 70.126.020; 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 70.126.020 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 authorized under section 7 of this act.

NEW SECTION.  Sec. 7   A new section is added to chapter 74.42 RCW to read as follows:
     Nursing homes may establish and provide nonmedical care management services to persons discharged to home for a period of up to thirty days following discharge from the nursing home. The services provided under this section should improve care transitions to the home, minimize patient safety concerns within the home environment, lead to improved care outcomes by monitoring patient compliance with the postdischarge plan of care, and lead to more timely intervention and coordination with outside service providers when needed. The on-site or remote visit schedule should occur within two, seven, fourteen, twenty-one, and thirty days following the nursing home discharge. The follow to home services provided under this section are not available to patients who are eligible for and require home health services under chapter 70.126 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.