Trending and Best Practices in Assisted Living Programs Jana Illingworth Health Facilities Surveyor Adult Services Bureaus Iowa Department of Inspections and Appeals

Background Checks-67.19 Must be completed prior to date of hire Valid for 30 days If initial check results in a “hit”, evaluation by DHS must be completed. Date of hire versus date of offer acceptance Have to wait for the approval by DHS in writing

Evaluations-69.22 Cognitive, Functional, and Health Prior to admission, within 30 days, annually, and/or significant change Cognitive-when the tool indicates moderate cognitive impairment and risk, GDS will be used for all subsequent cognitive evaluations

Service Plans-69.26 Develop based on evaluations Prior to signing of OA, within 30 days of admission (if personal and/or health related care), with significant change, and at least annually. If no significant change and after nurse review, can add minor discretionary changes without evaluations and signatures. If significant change relates to recurring or chronic condition, a previous evaluation and service plan can be utilized without new signatures. Minor discretionary-application of TED hose or reminders for activities

Service Plans Contain: tenant needs and preferences, services and care, service providers Planned and spontaneous activities for those who are unable, including tenants with dementia (GDS 4 or higher) Planned and spontaneous activities for redirection from wandering or exit seeking, calming agitation or anxiety

Service Plans Wound care and treatment Hospice Services Behavioral issues and interventions Exit Seeking and interventions Falls and interventions General lack of specificity with cares Whether an outside agency is providing services or not, should be noted on SP and what responsibility the outside agency has versus the Program staff, also includes PT, OT, etc. Behavioral issues and interventions-redirection, involvement in activities, one on one time, etc. What more are you doing with someone with continued falls, LOC?

Physician Orders 67.5(6) d. Medications should be administered as prescribed by the tenant’s physician, advanced registered nurse practitioner, or physician assistant. Transcription errors from the order to the MAR PRN medication given for reason other than the order indicated Failure to document medications as given Failure to document desired effect of PRN

Medication-Infection Control Failure to wash hands/sanitizer Failure to wear and remove gloves

Tenant on Tenant Aggression Identify and implement interventions Beyond medication change or doctor visit Other interventions for staff to follow Look at level of care

Sexuality Basic Human Need Independence Choices Privacy, dignity, respect Policies to facilitate safe sexual expression

Notification to the Department DHS vs DIA Thefts-medication, money, belongings Falls with Fractures Mistreatment Thefts-police involvement Falls with fractures-if independently ambulatory no need unless Program has culpability Mistreatment by staff and/or other tenant if suspect crime.

Notification to the Department Elopement-March 2017-March 2018 *Data collected from DIA Facility Self Reporting System Door Alarms-2 choices- operating alarm system all exit doors or dual certification. If want to dually certify-must make known to Department by September 1 unless you’re due for renewal prior to that. Next certification Two applications-full set of policies with the new (ALP) application, then changes after that No blueprint If dually certified and a tenant elopes from the ALP/D (memory care) into the ALP, it would be considered elopement. Monitoring visits-Department will make every effort to conduct at the same time. Two reports.

Door Alarms in ALP/D 69.32 (2) An operating alarm system shall be connected to each exit door in a dementia- specific program. Safety and Autonomy Options Dually certify the Program when current certification expires Install alarms on all exit doors September 1, 2018

Determination of Dependent Adult Determination is made in the office Evaluations Service Plans ACU

Waiver of Criteria for Retention 67.7 (1) Time-limited waiver. Upon receipt of a Program’s request for waiver of the criteria for retention of a tenant, the Department may grant a waiver for a time- limited basis. A waiver of the criteria for retention of a tenant is limited to a period of six months or less.

Involuntary Discharge from the Program 30 days notice in writing Reason for discharge LTCO contact information Copy to the LTCO Internal appeals process (not with the Department)

Best Practices Implementation of interventions for tenants with dementia and behavioral issues- aggression, agitation, exit seeking, redirection and activities-staff training of such interventions Identify level of care issues and assistance with seamless discharge process Investment in staff to encourage retention and tenure

Best Practices Cameras in hallways and common areas Attendance at meals

Contact Info Linda Kellen, Bureau Chief (515) 281-7624 linda.kellen@dia.iowa.gov Catie Campbell, Program Coordinator (A-L) (515) 281- 3759 catie.campbell@dia.iowa.gov Deb Dixon, Program Coordinator (M-Z) (515) 281-4081 deb.dixon@dia.iowa.gov Tamara Brockob, Administrative Assistant (515) 281-5721 tamara.brockob@dia.iowa.gov

References Iowa Administrative Code (IAC) (2016). 481- 67.5(6)d.,67.19, 69.22, 69.26. Office of the State Long-Term Care Ombudsman. Disability Rights Iowa (2016) Sexual Expression Policy Development, A Guide for Long-Term Care Facilities & Assisted Living Programs, (p.3)