Chapter DHS 134

DHS 134.53 Note Note: The discharge planning conference requirement for a resident receiving recuperative care is found in s. DHS 134.70 (6).

DHS 134.53(4)(c)3. 3. Removal activities shall include:

DHS 134.53(4)(c)3.a. a. Counseling the resident about the impending removal;

DHS 134.53(4)(c)3.b. 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;

DHS 134.53(4)(c)3.c. c. Providing assistance in moving the resident and the resident’s belongings and funds to the new facility or quarters; and

DHS 134.53(4)(c)3.d. d. Making sure that the resident receives needed medications and treatments during relocation.

DHS 134.53(4)(d) (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.

DHS 134.53(5) (5) Voluntary discharge. When a discharge is voluntary and expected to be permanent, the facility shall, prior to the removal:

DHS 134.53(5)(a) (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;

DHS 134.53(5)(b) (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;

DHS 134.53(5)(c) (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

DHS 134.53(5)(d) (d) Notify the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats.

DHS 134.53(6) (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.

DHS 134.53 History 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 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.

DHS 134.54 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88.

subch. V of ch. DHS 134 Subchapter V — Services

DHS 134.60 DHS 134.60 Resident care.

DHS 134.60(1) (1) Resident care planning.

DHS 134.60(1)(a) (a) Interdisciplinary team.

DHS 134.60(1)(a)1. 1. An interdisciplinary team shall develop a resident’s individual program plan.

DHS 134.60(1)(a)2. 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).

DHS 134.60(1)(a)3. 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.

DHS 134.60(1)(b) (b) Development and content of the individual program plan.

DHS 134.60(1)(b)1. 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.

DHS 134.60(1)(b)2. 2. The IPP shall include:

DHS 134.60(1)(b)2.a. a. A list of realistic and measurable goals in priority order, with time limits for attainment;

DHS 134.60(1)(b)2.b. b. Behavioral objectives for each goal which must be attained before the goal is considered attained;

DHS 134.60(1)(b)2.c. 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;

DHS 134.60(1)(b)2.d. d. Evaluation procedures for determining whether the methods or strategies are accomplishing the care objectives; and

DHS 134.60(1)(b)2.e. 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.

DHS 134.60 Note 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).

DHS 134.60(1)(c) (c) Reassessment of individual program plan.

DHS 134.60(1)(c)1. 1. ‘Special and professional services review.’

DHS 134.60(1)(c)1.a. 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.

DHS 134.60(1)(c)1.b. 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.

DHS 134.60(1)(c)1.c. c. Documentation of the reassessment results, treatment objectives, plans and procedures, and continuing treatment progress reports shall be recorded in the resident’s record.

DHS 134.60(1)(c)2. 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:

DHS 134.60(1)(c)2.a. a. The appropriateness of the individual program plan and the individual’s progress toward meeting plan objectives;

DHS 134.60(1)(c)2.b. b. The advisability of continued residence, and recommendations for alternative programs and services; and

DHS 134.60(1)(c)2.c. c. The advisability of guardianship and a plan for assisting the resident in the exercise of his or her rights.

DHS 134.60(1)(d) (d) Implementation. Progress notes shall reflect the treatment and services provided to meet the goals stated in the IPP.

DHS 134.60(1)(e) (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:

DHS 134.60(1)(e)1. 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.

DHS 134.60(1)(e)2. 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.

DHS 134.60(1)(f) (f) Emergencies.

DHS 134.60(1)(f)1. 1. In the event of a medical emergency, the facility shall provide or arrange for appropriate emergency services.

DHS 134.60(1)(f)2. 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.

DHS 134.60(1)(f)3. 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.

DHS 134.60(1)(g) (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.

DHS 134.60(2) (2) Resident care staffing.

DHS 134.60(2)(a) (a) Definitions. For each resident with a developmental disability, required minimum hours of direct care shall be calculated based on the following definitions:

DHS 134.60(2)(a)1. 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.

DHS 134.60(2)(a)2. 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.

DHS 134.60(2)(a)3. 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.

DHS 134.60(2)(a)4. 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.

DHS 134.60(2)(a)5. 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.

DHS 134.60(2)(a)6. 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.

DHS 134.60(2)(a)7. 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.

DHS 134.60(2)(a)8. 8. “Profound intellectual disability” means a diagnosis of an intelligence quotient (IQ) below 20 to 25.

DHS 134.60(2)(a)9. 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.

DHS 134.60(2)(b) (b) Total staffing.

DHS 134.60(2)(b)1. 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.

DHS 134.60(2)(b)2. 2.

DHS 134.60(2)(b)2.a. 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.

DHS 134.60(2)(b)2.b. 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.

DHS 134.60(2)(c) (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.

DHS 134.60(2)(d) (d) Minimum direct care staff hours.

DHS 134.60(2)(d)1. 1. In this paragraph,“resident care staff time” means only the time of direct care staff on duty.

DHS 134.60(2)(d)2. 2.

DHS 134.60(2)(d)2.a. 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.

DHS 134.60(2)(d)2.b. 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.

DHS 134.60(2)(d)2.c. c. For each residential living unit which has one or more residents with a classification of DD level III, the facility shall provide a direct care staff-to-resident ratio of 1 to 6.4 each day, with ratios of one direct care staff person on duty to 16 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 32 residents on the night shift.

DHS 134.60(3) (3) Active treatment programming.

DHS 134.60(3)(a) (a) Except as provided in par. (b), each resident shall receive active treatment. Active treatment shall include:

DHS 134.60(3)(a)1. 1. The resident’s regular participation, in accordance with the IPP, in professionally developed and supervised activities, experiences and therapies. The resident’s participation shall be directed toward:

DHS 134.60(3)(a)1.a. a. The acquisition of developmental, behavioral and social skills necessary for the resident’s maximum possible individual independence; or

DHS 134.60(3)(a)1.b. b. For dependent residents where no further positive growth is demonstrable, the prevention of regression or loss of current optimal functional status; and

DHS 134.60(3)(a)2. 2. An individual post-institutionalization plan, as part of the IPP developed before discharge by a qualified intellectual disabilities professional and other appropriate professionals. This shall include provision for appropriate services, protective supervision and other follow-up services in the resident’s new environment.

DHS 134.60(3)(b) (b) Active treatment does not include the maintenance of generally independent residents who are able to function with little supervision or who require few, if any, of the significant active treatment services described in this subsection.

DHS 134.60(4) (4) Medications, treatments and therapies.

DHS 134.60(4)(a) (a) Orders.

DHS 134.60(4)(a)1. 1. Medications, treatments and habilitative or rehabilitative therapies shall be administered as ordered by a physician or dentist subject to the resident’s right to refuse them. If the resident has a court-appointed guardian, the guardian’s consent rather than the resident’s consent is required. No medication, treatment or changes in medication or treatment may be administered to a resident without a physician’s or dentist’s written order which shall be filed in the resident’s record.

DHS 134.60 Note Note: Section 51.61 (6), Stats., requires that written informed consent for treatment, including medications, be obtained from any person who was voluntarily admitted for treatment for developmental disabilities, mental illness, drug abuse or alcohol abuse. Section 42 CFR 442.404 (b) and (f) requires the written informed consent of every resident for treatment, including medications. This includes voluntary admissions as well as involuntary admissions under ch. 51 or 55, Stats.

DHS 134.60(4)(a)4. 4. Each resident’s medications shall be reviewed by a registered nurse at the time of the annual review of the IPP.

DHS 134.60(4)(b) (b) Stop orders.

DHS 134.60(4)(b)1. 1. Medications not specifically limited as to time or number of doses when ordered shall be automatically stopped in accordance with facility policies and procedures developed under s. DHS 134.67 (3) (a) 5.

DHS 134.60(4)(b)2. 2. The facility shall notify each resident’s attending physician or dentist of stop order policies and shall contact the physician or dentist promptly for renewal of orders that are subject to automatic termination.

DHS 134.60(4)(d) (d) Administration of medications.