Chapter DHS 132

DHS 132.51 Note Note: For administration of medications to day care clients, see s. DHS 132.60 (5) (d) 6.; for required records, see s. DHS 132.45 (4) (c).

DHS 132.51 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; emerg. r. and recr. (2) (d) and (3), eff. 9-15-86; r. and recr. (2) (d) am. (1) (b) 1., (2) (e) 1. and 2. intro., (3) (a) and (b), (4) (c), Register, January, 1987, No. 373, eff. 2-1-87; am. (2) (b) 2. and 3. (d) 2., r. (2) (d) 3. and (3), renum. (2) (e), (f) and (4) to be (2) (f), (g) and (3), cr. (2) (e), Register, February, 1989, No. 398, eff. 3-1-89; correction in (2) (b) 3. made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; CR 03-033: r. and recr. (2) (b) 1. Register December 2003 No. 576, eff. 1-1-04: CR 04-053: r. and recr. (2) (b) and am. (2) (c) Register October 2004 No. 586, eff. 11-1-04; correction in (2) (b) 2. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (2) (d) 1. Register May 2019 No. 761, eff. 6-1-19.

DHS 132.52 DHS 132.52 Procedures for admission.

DHS 132.52(2) (2) Physician’s orders. No person may be admitted as a resident except upon:

DHS 132.52(2)(a) (a) Order of a physician;

DHS 132.52(2)(b) (b) Receipt of information from a physician, before or on the day of admission, about the person’s current medical condition and diagnosis, and receipt of a physician’s initial plan of care and orders from a physician for immediate care of the resident; and

DHS 132.52(2)(c) (c) Receipt of certification in writing from a physician, physician assistant or advanced practice nurse prescriber that the individual has been screened for the presence of clinically apparent communicable disease that could be transmitted to other residents or employees, including screening for tuberculosis within 90 days prior to admission, or a physician, physician assistant or advanced practice nurse prescriber has ordered procedures to treat and limit the spread of any communicable diseases the individual may be found to have.

DHS 132.52(3) (3) Medical examination and evaluation.

DHS 132.52(3)(a) (a) Examination. Each resident shall have a physical examination by a physician or physician extender within 48 hours following admission unless an examination was performed within 15 days before admission.

DHS 132.52(3)(b) (b) Evaluation. Within 48 hours after admission the physician or physician extender shall complete the resident’s medical history and physical examination record.

DHS 132.52 Note Note: For admission of residents with communicable disease, see s. DHS 132.51 (2) (b).

DHS 132.52(4) (4) Initial care plan. Upon admission, a plan of care for nursing services based on an initial assessment shall be prepared and implemented, pending development of the plan of care required by s. DHS 132.60 (8).

DHS 132.52 Note Note: For care planning requirements, see s. DHS 132.60 (8).

DHS 132.52(7) (7) Family care information and referral. If the secretary of the department has certified that a resource center, as defined in s. DHS 10.13 (42), is available for the facility under s. DHS 10.71, the facility shall provide information to prospective residents and refer residents and prospective residents to the aging and disability resource center as required under s. 50.04 (2g) to (2i), Stats., and s. DHS 10.73.

DHS 132.52 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; renum. (1) to (5) to be (2) to (6) and am. (2) and (3), cr. (1), Register, January, 1987, No. 373, eff. 2-1-87; cr. (7), Register, October, 2000, No. 538, eff. 11-1-00; CR 03-033: am. (2) (c) Register December 2003 No. 576, eff. 1-1-04; CR 04-053: am. (2) (c) and (4) and r. (5) and (6) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (1), Register August 2007 No. 620, eff. 9-1-07; corrections in (7) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 132.53 DHS 132.53 Transfers and discharges.

DHS 132.53(1) (1) Scope. This section shall apply to all resident transfers and discharges, except that in the event of conflict with s. 49.45 (6c) (c) and (d), 49.498 (4) or 50.03 (5m) or (14), Stats., the relevant statutory requirement shall apply.

DHS 132.53(2) (2) Conditions.

DHS 132.53(2)(a) (a) Prohibition and exceptions. No resident may be discharged or transferred from a facility, except:

DHS 132.53(2)(a)1. 1. Upon the request or with the informed consent of the resident or guardian;

DHS 132.53(2)(a)2. 2. For nonpayment of charges, following reasonable opportunity to pay any deficiency;

DHS 132.53(2)(a)3. 3. If the resident requires care other than that which the facility is licensed to provide;

DHS 132.53(2)(a)4. 4. If the resident requires care which the facility does not provide and is not required to provide under this chapter;

DHS 132.53(2)(a)5. 5. For medical reasons as ordered by a physician;

DHS 132.53(2)(a)6. 6. In case of a medical emergency or disaster;

DHS 132.53(2)(a)7. 7. If the health, safety or welfare of the resident or other residents is endangered, as documented in the resident’s clinical record;

DHS 132.53(2)(a)8. 8. If the resident does not need nursing home care;

DHS 132.53(2)(a)9. 9. If the short-term care period for which the resident was admitted has expired; or

DHS 132.53(2)(a)10. 10. As otherwise permitted by law.

DHS 132.53(2)(b) (b) Alternate placement.

DHS 132.53(2)(b)1. 1. Except for transfers or discharges under par. (a) 2. and 6., for nonpayment or in a medical emergency, no resident may be involuntarily transferred or discharged unless an alternative placement is arranged for the resident. The resident shall be given reasonable advance notice of any planned transfer or discharge and an explanation of the need for and alternatives to the transfer or discharge except when there is a medical emergency. The facility, agency, program or person to which the resident is transferred shall have accepted the resident for transfer in advance of the transfer, except in a medical emergency.

DHS 132.53(2)(b)2. 2. No resident may be involuntarily transferred or discharged under par. (a) 2. for nonpayment of charges if the resident meets both of the following conditions:

DHS 132.53(2)(b)2.a. a. He or she is in need of ongoing care and treatment and has not been accepted for ongoing care and treatment by another facility or through community support services; and

DHS 132.53(2)(b)2.b. b. The funding of the resident’s care in the nursing home under s. 49.45 (6m), Stats., is reduced or terminated because either the resident requires a level or type of care which is not provided by the nursing home or the nursing home is found to be an institution for mental diseases as defined under 42 CFR 435.1009.

DHS 132.53(3) (3) Procedures.

DHS 132.53(3)(a) (a) Notice. The facility shall provide a resident, the resident’s physician and, if known, an immediate family member or legal counsel, guardian, relative or other responsible person at least 30 days notice of transfer or discharge under sub. (2) (a) 2. to 10., and the reasons for the transfer or discharge, unless the continued presence of the resident endangers the health, safety or welfare of the resident or other residents. The notice shall also contain the name, address and telephone number of the board on aging and long-term care. For a resident with developmental disability or mental illness, the notice shall contain the mailing address and telephone number of the protection and advocacy agency designated under s. 51.62 (2) (a), Stats.

DHS 132.53(3)(b) (b) Planning conference.

DHS 132.53(3)(b)1. 1. Unless circumstances posing a danger to the health, safety or welfare of a resident require otherwise, at least 7 days before the planning conference required by subd. 2., the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident’s physician, shall be given a notice containing the time and place of the conference, a statement informing the resident that any persons of the resident’s choice may attend the conference, and the procedure for submitting a complaint to the department.

DHS 132.53(3)(b)2. 2. Unless the resident is receiving respite care or unless precluded by circumstances posing a danger to the health, safety, or welfare of a resident, prior to any involuntary transfer or discharge under sub. (2) (a) 2. to 10., a planning conference shall be held at least 14 days before transfer or discharge with the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident’s physician, to review the need for relocation, assess the effect of relocation on the resident, discuss alternative placements and develop a relocation plan which includes at least those activities listed in subd. 3.

DHS 132.53(3)(b)3. 3. Transfer and discharge activities shall include:

DHS 132.53(3)(b)3.a. a. Counseling regarding the impending transfer or discharge;

DHS 132.53(3)(b)3.b. b. The opportunity for the resident to make at least one visit to the potential alternative placement, if any, including a meeting with that facility’s admissions staff, unless medically contraindicated or waived by the resident;

DHS 132.53(3)(b)3.c. c. Assistance in moving the resident and the resident’s belongings and funds to the new facility or quarters; and

DHS 132.53(3)(b)3.d. d. Provisions for needed medications and treatments during relocation.

DHS 132.53(3)(b)4. 4. A resident who is transferred or discharged at the resident’s request shall be advised of the assistance required by subd. 3. and shall be provided with that assistance upon request.

DHS 132.53(3)(c) (c) Records. Upon transfer or discharge of a resident, the documents required by s. DHS 132.45 (5) (L) and (6) (h) shall be prepared and provided to the facility admitting the resident, along with any other information about the resident needed by the admitting facility.

DHS 132.53(4) (4) Transfer agreements.

DHS 132.53(4)(a) (a) Requirement. Each facility shall have in effect a transfer agreement with one or more hospitals under which inpatient hospital care or other hospital services are available promptly to the facility’s residents when needed. Each intermediate care facility shall also have in effect a transfer agreement with one or more skilled care facilities.

DHS 132.53(4)(b) (b) Transfer of residents. A hospital and a facility shall be considered to have a transfer agreement in effect if there is a written agreement between them or, when the 2 institutions are under common control, if there is a written statement by the person or body which controls them, which gives reasonable assurance that:

DHS 132.53(4)(b)1. 1. Transfer of residents will take place between the hospital and the facility ensuring timely admission, whenever such transfer is medically appropriate as determined by the attending physician; and

DHS 132.53(4)(b)2. 2. There shall be interchange of medical and other information necessary for the care and treatment of individuals transferred between the institutions, or for determining whether such individuals can be adequately cared for somewhere other than in either of the institutions.

DHS 132.53(4)(d) (d) Notice requirements.

DHS 132.53(4)(d)1. 1. Before a resident of a facility is transferred to a hospital or for therapeutic leave, the facility shall provide written information to the resident and an immediate family member or legal counsel concerning the provisions of the approved state medicaid plan about the period of time, if any, during which the resident is permitted to return and resume residence in the nursing facility.

DHS 132.53(4)(d)2. 2. At the time of a resident’s transfer to a hospital or for therapeutic leave, the facility shall provide written notice to the resident and an immediate family member or legal counsel of the duration of the period, if any, specified under subd. 1.

DHS 132.53 Note Note: The “approved state medicaid plan” referred to s. 49.498 (4) (d) 1a, Stats., and subd. 1. states that the department shall have a bedhold policy. The bedhold policy is found in s. DHS 107.09 (4) (j).

DHS 132.53(5) (5) Bedhold.

DHS 132.53(5)(a) (a) Bedhold. A resident who is on leave or temporarily discharged, as to a hospital for surgery or treatment, and has expressed an intention to return to the facility under the terms of the admission statement for bedhold, shall not be denied readmission unless, at the time readmission is requested, a condition of sub. (2) (b) has been satisfied.

DHS 132.53(5)(b) (b) Limitation. The facility shall hold a resident’s bed under par. (a) until the resident returns, until the resident waives his or her right to have the bed held, or up to 15 days following the temporary leave or discharge, whichever is earlier.

DHS 132.53 Note Note: See s. DHS 107.09 (4) (j) for medical assistance bedhold rules.

DHS 132.53(6) (6) Appeals on transfers and discharges.

DHS 132.53(6)(a) (a) Right to appeal.

DHS 132.53(6)(a)1. 1. A resident may appeal an involuntary transfer or discharge decision.

DHS 132.53(6)(a)2. 2. Every facility shall post in a prominent place a notice that a resident has a right to appeal a transfer or discharge decision. The notice shall explain how to appeal that decision and shall contain the address and telephone number of the nearest bureau of quality assurance regional office. The notice shall also contain the name, address and telephone number of the state board on aging and long-term care or, if the resident is developmentally disabled or has a mental illness, the mailing address and telephone number of the protection and advocacy agency designated under s. 51.62 (2) (a), Stats.

DHS 132.53(6)(a)3. 3. A copy of the notice of a resident’s right to appeal a transfer or discharge decision shall be placed in each resident’s admission folder.

DHS 132.53(6)(a)4. 4. Every notice of transfer or discharge under sub. (3) (a) to a resident, relative, guardian or other responsible party shall include a notice of the resident’s right to appeal that decision.

DHS 132.53(6)(b) (b) Appeal procedures.

DHS 132.53(6)(b)1. 1. If a resident wishes to appeal a transfer or discharge decision, the resident shall send a letter to the nearest regional office of the department’s bureau of quality assurance within 7 days after receiving a notice of transfer or discharge from the facility, with a copy to the facility administrator, asking for a review of the decision.

DHS 132.53(6)(b)2. 2. The resident’s written appeal shall indicate why the transfer or discharge should not take place.

DHS 132.53(6)(b)3. 3. Within 5 days after receiving a copy of the resident’s written appeal, the facility shall provide written justification to the department’s bureau of quality assurance for the transfer or discharge of the resident from the facility.

DHS 132.53(6)(b)4. 4. If the resident files a written appeal within 7 days after receiving notice of transfer or of discharge from the facility, the resident may not be transferred or discharged from the facility until the department’s bureau of quality assurance has completed its review of the decision and notified both the resident and the facility of its decision.

DHS 132.53(6)(b)5. 5. The department’s bureau of quality assurance shall complete its review of the facility’s decision and notify both the resident and the facility in writing of its decision within 14 days after receiving written justification for the transfer or discharge of the resident from the facility.

DHS 132.53(6)(b)6. 6. A resident or a facility may appeal the decision of the department’s bureau of quality assurance in writing to the department of administration’s division of hearings and appeals within 5 days after receipt of the decision.

DHS 132.53 Note Note: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, Wisconsin 53707.

DHS 132.53(6)(b)7. 7. The appeal procedures in this paragraph do not apply if the continued presence of the resident poses a danger to the health, safety or welfare of the resident or other residents.

DHS 132.53 Note Note: The bureau of quality assurance was renamed the division of quality assurance.

DHS 132.53 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; cr. (2) (b) 8. and 9., am. (2) (c), (3) (b) 2. and (c), Register, January, 1987, No. 373, eff. 2-1-87; renum. (2) (c) to be (2) (c) 1. and am., cr. (2) (c) 2., Register, February, 1989, No. 398, eff. 3-1-89; am. (2) (c) 2. b., Register, October, 1989, No. 406, eff. 11-1-89; r. and recr. (1) to (3), cr. (4) (d) and (6), Register, June, 1991, No. 426, eff. 7-1-91; CR 06-053: am. (2) (b) 1., r. (4) (c), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.54 DHS 132.54 Transfer within the facility. Prior to any transfer of a resident between rooms or beds within a facility, the resident or guardian, if any, and any other person designated by the resident shall be given reasonable notice and an explanation of the reasons for transfer. Transfer of a resident between rooms or beds within a facility may be made only for medical reasons or for the resident’s welfare or the welfare of other residents or as permitted under s. DHS 132.31 (1) (p) 1.

DHS 132.54 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. Register, January, 1987, No. 373, eff. 2-1-87.

subch. VI of ch. DHS 132 Subchapter VI — Services

DHS 132.60 DHS 132.60 Resident care.

DHS 132.60(1) (1) Individual care. Unless it is in conflict with the plan of care, each resident shall receive care based upon individual needs.

DHS 132.60(1)(a) (a) Hygiene.

DHS 132.60(1)(a)1. 1. Each resident shall be kept comfortably clean and well-groomed.

DHS 132.60(1)(b) (b) Decubiti prevention. Nursing personnel shall employ appropriate nursing management techniques to promote the maintenance of skin integrity and to prevent development of decubiti (bedsores). These techniques may include periodic position change, massage therapy and regular monitoring of skin integrity.

DHS 132.60(1)(c) (c) Basic nursing care.

DHS 132.60(1)(c)2. 2. Nursing personnel shall provide care designed to maintain current functioning and to improve the resident’s ability to carry out activities of daily living, including assistance with maintaining good body alignment and proper positioning to prevent deformities.

DHS 132.60(1)(c)3. 3. Each resident shall be encouraged to be up and out of bed as much as possible, unless otherwise ordered by a physician.

DHS 132.60(1)(c)4. 4. Any significant changes in the condition of any resident shall be reported to the nurse in charge or on call, who shall take appropriate action including the notice provided for in sub. (3).

DHS 132.60(1)(c)5. 5. The nursing home shall provide appropriate assessment and treatment of pain for each resident suspected of or experiencing pain based on accepted standards of practice that includes all of the following: