STATEMENT OF SCOPE
WISCONSIN DEPARTMENT OF HEALTH SERVICES
CHAPTER: DHS 88
RELATING TO: Licensed Adult Family Homes
RULE TYPE: Permanent
SCOPE TYPE: Original
FINDINGS OF EMERGENCY: Not applicable
1. Description of rule objective/s
Licensed Adult Family Homes (“AFHs”) provide care, treatment, or services to three or four adults that are above the level of room and board, including up to seven hours per week of nursing care per resident. Currently, there are 2,015 AFHs in Wisconsin. Chapter DHS 88 establishes licensing standards for the operation of these AFHs. The department proposes to update ch. DHS 88 for the purpose of strengthening provisions related to the health, safety and rights of residents. The rule was created on June 1, 1995 and has not been substantially revised since that time.
2. Existing policies relevant to the rule
AFHs have traditionally cared for elders with minor health problems or individuals with mild intellectual disabilities. Over the past several years, a new type of AFH has emerged that provides care to residents who have significant medical needs, intellectual disabilities, mental illness, or who are a part of the correctional system. These residents require complex care and highly trained staff to meet their needs. Chapter DHS 88 must be updated to address these needs and ensure adequate protection of AFH residents.
3. Policies proposed to be included in the rule
Pursuant to s. 50.02 (2) (am), Wis. Stats., the department proposes to updated ch. DHS 88 to accomplish the following:
- Focus on resident outcomes and quality of life and care.
- Support reasonable and flexible regulatory processes.
- Improve readability and organization of the rule.
- Address increasing acuity care levels of residents living in AFHs.
- Improve assessment and care planning.
- Include use of temporary service plans, developed and implemented on admission, to address immediate needs of residents.
- Update training standards to enhance the ability of staff to meet the increasing care needs of residents in AFHs, including the provision of personal care.
- Establish minimum staff training requirements regarding medication administration, standard precautions, changes of condition, challenging behaviors, abuse, neglect and misappropriation, fire safety and first aid and choking.
- Clarify medication administration requirements and the monitoring of psychotropic medication.
- Clarify nurse delegation responsibilities to a non-licensed caregiver to address acuity and allow the facility to provide appropriate care in a time of limited nurse availability.
- Promote the use of nationally recognized standards of practice.
- Provide or arrange for services to meet the needs of residents in the areas of personal care, supervision, leisure time activities, community activities, family and social contacts, communication skills, health monitoring, and behavior management.
- Update provisions relating to reporting, investigating, and documenting allegations of caregiver misconduct to include resident protection.
- Establish an infection control program based on current standards of practice to prevent the development and transmission of communicable disease and infection.
- Modernize environmental accessibility requirements to meet the needs of residents with physical and intellectual disabilities.
4. Analysis of policy alternative
The department has determined that oversight of AFHs is not adequate to ensure a minimum standard of care for vulnerable residents, and to protect the health, safety, and rights residents. There are no reasonable alternatives to updating the rule.
5. Statutory authority for the rule
a. Explanation of authority to promulgate the proposed rule
b. The department is authorized to establish requirements for certification, certification application procedures and forms, standards for operation, and procedures for monitoring, inspection, decertification and appeal of decertification for adult family homes. The rules must be designed to protect and promote the health, safety and welfare of the disabled adults receiving care and maintenance in certified adult family homes. The department is also authorized to promulgate rules that establish minimum requirements for licensure, licensure application procedures and forms, standards for operation and procedures for monitoring, inspection, revocation and appeal of revocation.
Statute/s that authorize/s the promulgation of the proposed rule
The department shall promulgate all of the following rules with respect to adult family homes: 50.02(2)(am)1. 1. For the purposes of s. 50.032, defining the term “permanent basis" and establishing minimum requirements for certification, certification application procedures and forms, standards for operation and procedures for monitoring, inspection, decertification and appeal of decertification. The rules shall be designed to protect and promote the health, safety and welfare of the disabled adults receiving care and maintenance in certified adult family homes.
2. For the purposes of s. 50.033, establishing minimum requirements for licensure, licensure application procedures and forms, standards for operation and procedures for monitoring, inspection, revocation and appeal of revocation. Regulation. Except as provided in sub. (2d), standards for operation of certified adult family homes and procedures for application for certification, monitoring, inspection, decertification and appeal of decertification under this section shall be under rules promulgated by the department under s. 50.02 (2) (am) 1. An adult family home certification is valid until decertified under this section. Certification is not transferable.