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Regulation Update and Review

Regulation Update and Review. Introduction. New laws Other Bills of Interest Medication Management Admission and Retention Hospice Care Total Care Exceptions First Aid, CPR, DNRs Staff Training Requirements. NEW LAWS 2014. New Laws. Assembly Bill 261 – Billing Clarification

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Regulation Update and Review

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  1. Regulation Update and Review

  2. Introduction New laws Other Bills of Interest Medication Management Admission and Retention Hospice Care Total Care Exceptions First Aid, CPR, DNRs Staff Training Requirements

  3. NEW LAWS 2014

  4. New Laws • Assembly Bill 261 – Billing Clarification • Amendment to H & S Section 1569.884; addition to Section 1569.652 • Prohibits advance notice for terminating an admission agreement due to death of the resident

  5. New Laws • Assembly Bill 261 – Billing Clarification • Fees must stop accruing once all personal property is removed • Can’t impede removal of property during reasonable hours • Licensee must refund fees paid in advance covering the time after the property has been removed. • Refund issued to whoever is contractually responsible for the fees, or resident’s estate

  6. New Laws • Assembly Bill 261 – Billing Clarification • If fees are assessed while personal property remains in the apartment after death, the licensee must inform resident’s responsible person • Policy must be disclosed in the admission agreement

  7. New Laws • Assembly Bill 261 – Billing Clarification • Applications to Assisted Living • Documentation • Penalties

  8. New Laws Assembly Bill 581 – Retaliation Prohibition Amendments to H & S Sections 1539, 1568.07 and 1569.37 Prohibits licensee and staff from discriminating or retaliating against a resident or employee for complaining to CCLD or LTC Ombudsman

  9. New Laws Assembly Bill 581 – Retaliation Prohibition Current law states: “No licensee shall discriminate against resident or employee” New law adds officer or employee of the licensee

  10. New Laws Assembly Bill 581 – Retaliation Prohibition Current law states: No licensee shall discriminate or retaliate “for initiating or participating in CCLD inspection” New law includes filing complaint or grievance with CCLD and adds complaint, grievance or request for investigation by ombudsman

  11. New Laws • Assembly Bill 581 – Retaliation Prohibition • Applications to Assisted Living • Penalties and Citations

  12. New Laws Assembly Bill 633 - CPR Additions to Section 1799.103 to H & S Code Prohibits any employer from having a policy that prevents an employee from voluntarily performing CPR

  13. New Laws Assembly Bill 633 - CPR Exceptions: DNR and Trained Staff Liability protections: Employer – no duty to train Employee – Good Samaritan

  14. New Laws Assembly Bill 663 – LGBT Training Amendment to Sections 1562.3 and 1569.616 of the H & S Code Adds cultural competency and sensitivity in LGVT issues to required 40-hour administrator certification course

  15. New Laws Assembly Bill 663 – LGBT Training Applies to RCFE’s and ARF’s Also requires training for LTC ombudsman

  16. New Laws Assembly Bill 620 – Missing Resident Notification Plan Addition to Sections 1279.8, 1507.15, 1569.317 and 1584 of the H & S Code

  17. New Laws Assembly Bill 620 – Missing Resident Notification Plan Every RCFE (and other licensees) shall, for the purpose of addressing issues that arise when a resident is missing from the facility, develop and comply with an absentee notification plan as part of the written record of care the resident will receive.

  18. New Laws Assembly Bill 620 – Missing Resident Notification Plan The plan shall include and be limited to the following: a requirement that an administrator, or his or her designee, inform the resident’s authorized representative when that resident is missing and circumstances under which law enforcement shall be notified.

  19. Other Bills Assembly Bill 10 – Minimum Wage Increase Assembly Bill 241 – Domestic Worker Bill of Rights Assembly Bill 1217 – Home Care Licensure

  20. Regulation Review: Medication Management

  21. Medications: Assist vs. Administer

  22. Medications F.A.Q.’s: When can staff assist with eye drops to residents? Ear drops? Nose drops? Are trained staff allowed to measure medications with an oral syringe? Can unlicensed staff apply a patch or topical medication for a resident who cannot reach the area? Can liquid narcotics be centrally stored? Is an exception required for medications to be crushed?

  23. Medications F.A.Q.’s: Is it necessary to contact the physician before each does when assisting a resident with PRN morphine? Can a family member administer medication to a resident NOT on hospice? If a medication label only has a month and year listed for the expiration date, does it expire on the first day of the month listed, or the last day?

  24. Medications F.A.Q.’s: Are medications purchased from Canada and Mexico safe and/or legal? Does CCL allow electronic physician signatures for medication orders and prescriptions?

  25. Regulation Review: Admission and Retention

  26. Admission & Retention • Allowable Conditions • Restricted Conditions • Prohibited Conditions

  27. Regulation Review: Hospice Care

  28. End of Life • Hospice Care • Waivers • Care Plans • Training

  29. End of Life Hospice Care Plan • Agency contact info • Description of services to be provided by the agency • Primary contacts • Licensee responsibilities • Services by other persons • Training needs

  30. End of Life Hospice Training Needs • Dying process • Psychosocial support • Care of bedridden residents • Pain management

  31. End of Life • Total Care: • What it means for staff/residents • Exceptions and waivers

  32. Regulation Review: Total Care

  33. BACKGROUND WHAT IS TOTAL CARE? • Total care is defined as a condition where residents depend on others to perform all of their activities of daily living. • A prohibited condition, per regulation 87615.

  34. Background • An exception must be obtained to retain a resident who requires total care in an RCFE • Old process:

  35. New CCL Total Care Policy

  36. New CCL Total Care Policy • CCL has updated their total care policy to streamline and expedite the process. • Update is in section 87632 of the RCFE Evaluator Manual. Available at www.ccld.ca.gov • As written it only applies to “total care” residents who are receiving hospice services.

  37. New CCL Total Care Policy • New policy in a “nutshell:” Submit 2 (of 3) required exception components in advance as part of your hospice waiver (Total Care Plan)

  38. New CCL Total Care Policy • All exception requests must include (87616): Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. Plan for minimizing the impact on other residents.

  39. New CCL Total Care Policy • New Total Care Policy Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. Plan for minimizing the impact on other residents. SUBMIT IN ADVANCE AS PART OF HOSPICE WAIVER

  40. New CCL Total Care Policy • New Total Care Policy Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. Plan for minimizing the impact on other residents. MET VIA RESIDENT”S HOSPICE CARE (RETAIN ON FILE)

  41. New CCL Total Care Policy

  42. New CCL Total Care Policy What if I already have a hospice waiver? Submit an addendum to the existing hospice care waiver plan that includes the total care component. If the Department approves this addendum, the licensee may then use the option of requesting the total care exception under the simplified methods noted above.

  43. The Total Care Plan

  44. Total Care Plan • Submit in advance as part of hospice waiver. • Must include: The licensee’s plan for ensuring that current total care residents’ health related needs can be met, or provisions made for them to be met by the licensee. How it will minimize this impact on the other residents.

  45. Total Care Plan PLAN FOR ENSURING HEALTH RELATED NEEDS CAN BE MET: • Staff training • Additional support from hospice care staff • Family/volunteers • How will you manage medications? • Bedridden?

  46. Total Care Plan MINIMIZING IMPACT ON OTHER RESIDENTS: • Private rooms • Ensuring “sufficient” staff • Adjustments to staff schedules • Backup staff

  47. Regulation Review: First Aid, CPR, and DNRs

  48. Effectiveness of CPR • CPR is not like you see in movies and television.

  49. Effectiveness of CPR 5-10% • of people who undergo CPR will survive

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