1. Legal Issues for Social Workers October 5, 2007 By: Susan M. Voigt VOIGT, KLEGON, and RODÉ Law Firm (651) 209-6161

2. Increase in Responsibility for Social Services in L-T-Care How many residents do you serve? How many residents do you serve? What happens when you drop the ball? What happens when you drop the ball? Why is the licensing Board calling you? Why is the licensing Board calling you? Why do you need legal advice before you speak to the family? Why do you need legal advice before you speak to the family? Who wants to be conservator? Who wants to be conservator? Where is the resident going? Where is the resident going? Another new regulation? Another new regulation?

3. ADMISSION Admission pressures Admission pressures Financial information Financial information Assessment – care and financial Assessment – care and financial PPS and payment on admission issues PPS and payment on admission issues Predatory offender law changes Predatory offender law changes DNR/DNI policies, PSDA procedures/Advance directives DNR/DNI policies, PSDA procedures/Advance directives

4. LEGAL AND PRACTICAL ASPECTS OF DOCUMENTATION New documentation requirements New documentation requirements - resident advocate/psycho social services, activities Changes in nursing home rules and regs and areas of survey focus: Changes in nursing home rules and regs and areas of survey focus: - activities, unnecessary meds, anxiety, family and physician notification of significant change, F323, OHFC incidents/accidents; psycho-social requirements

5. DOCUMENTATION CONTINUED Resident and family interview relied upon for deficiencies (F241) Dignity; MI issues Resident and family interview relied upon for deficiencies (F241) Dignity; MI issues New social service staff – no such response as “I don’t know.” New social service staff – no such response as “I don’t know.” Progress notes critical – follow up after psych eval and recommendations must be timely’ Progress notes critical – follow up after psych eval and recommendations must be timely’ New focus on suicidal ideation and safety plans New focus on suicidal ideation and safety plans Medication review and effectiveness documented Medication review and effectiveness documented

6. KNOW THE REGULATIONS AND USE TERMINOLOGY Appendix PP in state operations manual at www.cms website Appendix PP in state operations manual at www.cms website www.cms MDH website at www.health.state.mn.us MDH website at www.health.state.mn.uswww.health.state.mn.us Know your residents and families and connect with nursing Know your residents and families and connect with nursing F323 – “identify risk”; “evaluate”; “implement interventions”; “monitor and modify” magic words F323 – “identify risk”; “evaluate”; “implement interventions”; “monitor and modify” magic words

7. THE VULNERABLE ADULTS ACT Unexplained incidents – bruising – determine a reasonable explanation Unexplained incidents – bruising – determine a reasonable explanation Falls elopements, smoking risks new focus Falls elopements, smoking risks new focus Reporting requirements – is it abuse or neglect? Is it an error? An accident? Is it financial exploitation? Reporting requirements – is it abuse or neglect? Is it an error? An accident? Is it financial exploitation? OHFC appeals increasing due to more investigations and serious level deficiencies OHFC appeals increasing due to more investigations and serious level deficiencies Vulnerable adult neglect and abuse are connected to wrongful death cases Vulnerable adult neglect and abuse are connected to wrongful death cases

8. HEALTH CARE DIRECTIVES DNR/DNI DNR/DNI Comfort care measures policy Comfort care measures policy Directive for Health Care and POA for financial are not the same Directive for Health Care and POA for financial are not the same Informed consent and patient right to refuse Informed consent and patient right to refuse Medication administration issues Medication administration issues Risk management vs. legal decision making Risk management vs. legal decision making

9. DISCHARGE AND TRANSFER REQUIREMENTS Social service documentation regarding discharge and transfer - guidelines Social service documentation regarding discharge and transfer - guidelines Commitment process for behaviors Commitment process for behaviors New conservator/guardianship process for behaviors and nonpayment New conservator/guardianship process for behaviors and nonpayment Role of Ombudsman and Adult Protection Role of Ombudsman and Adult Protection Medical Assistance application and social service role Medical Assistance application and social service role

10. Predatory Offender Changes 2006 – You can decide NOT to admit an offender or violent person 2006 – You can decide NOT to admit an offender or violent person Abuse prevention/assessment/individual plans Abuse prevention/assessment/individual plans Notification requirements Notification requirements HIPAA release HIPAA release To admit or not admit? To admit or not admit?

11. Why do you do this? Grace moments Grace moments Mission and paycheck Mission and paycheck For the residents For the residents Because you can – and you do it well Because you can – and you do it well

12. Legal Issues Update Social Workers October 5, 2007 By: Susan M. Voigt Attorney Voigt, Klegon and Rode Law firm (651) 209-6161