Wisconsin Legislature: DHS 134.53(6)

(b) Involuntary removal.

1. For nonpayment of charges, following reasonable opportunity to pay any deficiency;

2. If the resident requires care that the facility is not licensed to provide;

3. If the resident requires care that the facility does not provide and is not required to provide under this chapter;

4. For medical reasons as ordered by a physician;

5. In case of a medical emergency or disaster;

6. For the resident’s welfare or the welfare of other residents;

7. If the resident does not need FDD care;

8. If the short-term care period for which the resident was admitted has expired; or

9. As otherwise permitted by law.

(3) Alternate placement. Except for removals under sub. (2) (b) 5., no resident may be involuntarily removed unless an alternative placement is arranged for the admission of the resident pursuant to sub. (4) (c).

(4) Permanent involuntary removal.

(a) Consultation. Before a decision is made to transfer or discharge a resident under sub. (2) (b), facility staff shall meet with the resident’s parent or guardian, if any, and any other person the resident decides should be present, to discuss the need for and alternatives to the transfer or discharge.

(b) Notice. The facility shall provide the resident, the resident’s family or guardian or other responsible person, the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats., and, if appropriate, the resident’s physician, with at least 30 days notice before making a permanent removal under sub. (2) (b), except under sub. (2) (b) 5. or if the continued presence of the resident endangers his or her health, safety or welfare or that of other residents.

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, the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats., and any person 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 about the prospective removal.

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 permanent involuntary removal under sub. (2) (b), a planning conference shall be held at least 14 days before removal with the resident, the resident’s guardian, if any, any appropriate county agency and any persons designated by the resident, including the resident’s physician or the facility QDIP, 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.

Note: The discharge planning conference requirement for a resident receiving recuperative care is found in s. DHS 134.70 (6).

3. Removal activities shall include:

a. Counseling the resident about the impending removal;

b. Making arrangements for the resident to make at least one visit to the potential alternative placement facility and to meet with that facility’s admissions staff, unless this is medically contraindicated or the resident chooses not to make the visit;

c. Providing assistance in moving the resident and the resident’s belongings and funds to the new facility or quarters; and

d. Making sure that the resident receives needed medications and treatments during relocation.

(d) Transfer and discharge records. Upon removal of a resident, the documents required by s. DHS 134.47 (4) (k) shall be prepared and provided to the facility admitting the resident, along with any other information about the resident needed by the admitting facility. When a resident is permanently released, the facility shall prepare and place in the resident’s record a summary of habilitative, rehabilitative, medical, emotional, social and cognitive findings and progress and plans for care.

(5) Voluntary discharge. When a discharge is voluntary and expected to be permanent, the facility shall, prior to the removal:

(a) Counsel the resident, the parent of a minor resident or the guardian who requests the discharge concerning the advantages and disadvantages of the discharge;

(b) Under the guidance and recommendations of the facility’s interdisciplinary team, make necessary arrangements for appropriate services, including post-discharge planning, protective supervision and follow-up services, during relocation and in the new environment;

(c) Advise the resident who is to be discharged at his or her own request of additional assistance available under sub. (4) (c) 3., and provide that assistance upon request; and

(d) Notify the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats.

(6) Bedhold. If a resident on leave or temporarily discharged expressed the intention on leaving or being discharged of returning to the facility under the terms of the facility’s admission statement for bedhold, the resident may not be denied readmission unless at the time readmission is requested, a condition of sub. (2) (b) exists. The facility shall hold a resident’s bed until the resident returns unless the resident waives his or her right to have the bed held or 15 days has passed following the beginning of leave or temporary discharge.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; 2019 Wis. Act 1: am. (4) (c) 2. Register May 2019 No. 761, eff. 6-1-19.

DHS 134.54 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 or guardian shall be given reasonable notice and an explanation of the reasons for the 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 134.31 (3) (q) 1.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

Subchapter V — Services

DHS 134.60 Resident care.

(1) Resident care planning.

(a) Interdisciplinary team.

1. An interdisciplinary team shall develop a resident’s individual program plan.

2. Membership on the interdisciplinary team for resident care planning may vary based on the professions, disciplines and service areas that are relevant to the resident’s needs, but shall include a qualified intellectual disabilities professional and a nurse, and a physician as required under s. DHS 134.66 (2) (a) 2. and (c).

3. The resident and the resident’s family or guardian shall be encouraged to participate as members of the team, unless the resident objects to participation by family members.

(b) Development and content of the individual program plan.

1. Except in the case of a person admitted for short-term care, within 30 days following the date of admission, the interdisciplinary team, with the participation of the staff providing resident care, shall review the preadmission evaluation and physician’s plan of care and shall develop an IPP based on the new resident’s and an assessment of the resident’s needs by all relevant disciplines, including any physician’s evaluations or orders.

2. The IPP shall include:

a. A list of realistic and measurable goals in priority order, with time limits for attainment;

b. Behavioral objectives for each goal which must be attained before the goal is considered attained;

c. A written statement of the methods or strategies for delivering care, for use by the staff providing resident care and by the professional and special services staff and other individuals involved in the resident’s care, and of the methods and strategies for assisting the resident to attain new skills, with documentation of which professional disciplines or which personnel providing resident care are responsible for the needed care or services;

d. Evaluation procedures for determining whether the methods or strategies are accomplishing the care objectives; and

e. A written interpretation of the preadmission evaluation in terms of any specific supportive actions, if appropriate, to be undertaken by the resident’s family or legal guardian and by appropriate community resources.

Note: For the requirement of a preadmission evaluation, see s. DHS 134.52. For development of a plan of care for short-term care residents, see s. DHS 134.70 (2).

1. ‘Special and professional services review.’

a. The care provided by staff from each of the disciplines involved in the resident ’s treatment shall be reviewed by the professional responsible for monitoring delivery of the specific service.

b. Reassessment results and other necessary information obtained through the specialists’ assessments shall be disseminated to other resident care staff as part of the IPP process.

c. Documentation of the reassessment results, treatment objectives, plans and procedures, and continuing treatment progress reports shall be recorded in the resident’s record.

2. ‘Interdisciplinary review.’ The interdisciplinary team, staff providing resident care and other relevant personnel shall review the IPP and status of the resident at least annually and make program recommendations as indicated by the resident’s developmental progress. The review shall consider at least the following:

a. The appropriateness of the individual program plan and the individual’s progress toward meeting plan objectives;

b. The advisability of continued residence, and recommendations for alternative programs and services; and

c. The advisability of guardianship and a plan for assisting the resident in the exercise of his or her rights.

(d) Implementation. Progress notes shall reflect the treatment and services provided to meet the goals stated in the IPP.

(e) Notification of changes in condition, treatment or status of resident. Any significant change in the condition of a resident shall be reported to the individual in charge or on call who shall take appropriate action, including notification of designated parties, as follows:

1. A resident’s parents, guardian, if any, physician and any other person designated in writing by the resident or guardian to be notified shall be notified promptly of any significant accident or injury affecting the resident or any adverse change in the resident’s condition.

2. A resident’s parents, guardian, if any, and any other person designated in writing by the resident or guardian to be notified shall be notified promptly of any significant non-medical change in the resident’s status, including financial situation, any plan to discharge the resident or any plan to transfer the resident within the facility or to another facility.

(f) Emergencies.

1. In the event of a medical emergency, the facility shall provide or arrange for appropriate emergency services.

2. The facility shall have written procedures available to residents and staff for procuring a physician or an emergency service, such as a rescue squad, to furnish necessary medical care in an emergency and for providing care pending the arrival of a physician.

3. The names and telephone numbers of physicians, nurses and medical service personnel available for emergency calls shall be posted on or next to each telephone in the facility.

(g) Resident safety. The facility is responsible for the safety and security of residents. This includes responsibility for the assignment of specific staff to individual residents. Assigned staff shall be briefed beforehand on the condition and appropriate care of residents to whom they are assigned.

(2) Resident care staffing.

(a) Definitions. For each resident with a developmental disability, required minimum hours of direct care shall be calculated based on the following definitions:

1. “DD level I” means the classification of an individual who has a profound or severe intellectual disability; is under the age of 18; is severely physically disabled; is aggressive, assaultive or a security risk; or manifests psychotic-like behavior and may engage in maladaptive behavior persistently or frequently or in behavior that is life-threatening. This individual’s habilitation program emphasizes basic ADL skills and requires intensive staff effort.

2. “DD level II” means the classification of an individual who has a moderate intellectual disability and who may occasionally engage in maladaptive behavior. This individual’s health status may be stable or unstable. This individual is involved in a habilitation program to increase abilities in ADL skills and social skills.

3. “DD level III” means the classification of an individual who has a mild intellectual disability and who may rarely engage in maladaptive behavior. This individual’s health status is usually stable. This individual is involved in a habilitation program to increase domestic and vocational skills.

4. “Direct care staff on duty” means persons assigned to the resident living unit whose primary responsibilities are resident care and implementation of resident habilitation programs.

5. “Maladaptive behavior” means a person’s act or activity which differs from the response generally expected in the situation and which prevents the person from performing routine tasks.

6. “Mild intellectual disability” means a diagnosis of an intelligence quotient (IQ) of 50 to 55 at the lower end of a range to 70 at the upper end.

7. “Moderate intellectual disability” means a diagnosis of an intelligence quotient (IQ) of 35 to 40 at the lower end of a range to 50 to 55 at the upper end.

8. “Profound intellectual disability” means a diagnosis of an intelligence quotient (IQ) below 20 to 25.

9. “Severe intellectual disability” means a diagnosis of an intelligence quotient (IQ) of 20 to 25 at the lower end of a range to 35 to 40 at the upper end.

(b) Total staffing.

1. Each resident living unit shall have adequate numbers of qualified staff to care for the specific needs of the residents and to conduct the resident living program required by this subchapter.

a. A living unit with more than 16 beds or a living unit that houses one or more residents for whom a physician has ordered a medical care plan or one or more residents who are aggressive, assaultive or security risks, shall have direct care staff on duty and awake within the facility when residents are present. The direct care staff on duty shall be responsible for taking prompt, appropriate action in case of injury, illness, fire or other emergency and for involving appropriate outside professionals as required by the emergency.

b. A living unit with 16 or fewer beds which does not have any resident for whom the physician has ordered a medical care plan or any resident who is aggressive, assaultive or a security risk shall have at least one direct care staff member on duty when residents are present who is immediately accessible to the residents 24 hours a day to take reports of injuries and symptoms of illness, to involve appropriate outside professionals and to take prompt, appropriate action as required by any emergency.

(c) Records and weekly schedules. Weekly time schedules for staff shall be planned, posted and dated at least one week in advance, shall indicate the names and classifications of personnel providing resident care and relief personnel assigned on each living unit for each shift, and shall be updated as changes occur.

(d) Minimum direct care staff hours.

1. In this paragraph,“resident care staff time” means only the time of direct care staff on duty.

a. For each residential living unit which has one or more residents with a classification of DD level I, the facility shall provide a direct care staff-to-resident ratio of 1 to 3.2 each day, with ratios of one direct care staff person on duty to 8 residents on the day shift, one direct care staff person on duty to 8 residents on the evening shift and one direct care staff person on duty to 16 residents on the night shift.

b. For each residential living unit which has one or more residents with a classification of DD level II, the facility shall provide a direct care staff-to-resident ratio of 1 to 4 each day, with ratios of one direct care staff person on duty to 8 residents on the day shift, one direct care staff person on duty to 16 residents on the evening shift and one direct care staff person on duty to 16 residents on the night shift.