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

2. 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

3. 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

4. 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

5. 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

6. 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?

7. 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

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

9. 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

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

11. 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.

12. 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.

13. Door Alarms in ALP/D (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

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

15. 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.

16. 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)

17. 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

18. Best Practices Cameras in hallways and common areas
Attendance at meals

19. Contact Info
Linda Kellen, Bureau Chief (515)
Catie Campbell, Program Coordinator (A-L) (515)
Deb Dixon, Program Coordinator (M-Z) (515)
Tamara Brockob, Administrative Assistant (515)

20. References
Iowa Administrative Code (IAC) (2016) (6)d.,67.19, 69.22, 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)