Chapter DHS 89

DHS 89.23(4)(a)2. 2. Nursing services and supervision of delegated nursing services shall be provided consistent with the standards contained in the Wisconsin nurse practice act. Medication administration and medication management shall be performed by or, as a delegated task, under the supervision of a nurse or pharmacist.

DHS 89.23 Note Note: The nurse practice act is published as “Wisconsin Statutes and Administrative Code Relating to the Practice of Nursing” and is available from the Department of Safety and Professional Services, Board of Nursing, P.O. Box 8935, Madison, WI 53708.

DHS 89.23(4)(a)3. 3. Personal and supportive services shall be provided by staff who have documented training or experience in needs and techniques for assistance with tenant care and activities of daily living, such as bathing, grooming, skin care, transfer, ambulation, exercise, meal preparation and eating assistance, dressing, and use of adaptive aids and equipment.

DHS 89.23(4)(b) (b) Service manager.

DHS 89.23(4)(b)1. 1. Each residential care apartment complex shall have a designated service manager who shall be responsible for day-to-day operation of, including ensuring that the services provided are sufficient to meet tenant needs and are provided by qualified persons; that staff are appropriately trained and supervised; that facility policies and procedures are followed; and that the health, safety and autonomy of the tenants are protected. The service manager shall be capable of managing a multi-disciplinary staff to provide services specified in the service agreements.

DHS 89.23(4)(b)2. 2. A person shall be designated to be in charge of the facility whenever there is not a service manager present. The person in charge shall be competent to supervise staff of the residential care apartment complex. The person in charge shall be available to the residential care apartment complex and shall be identified to and easily reachable by all tenants and staff. In this subdivision “available” means accessible and able to ensure that services are provided to tenants as required under sub. (1). The person in charge is available if he or she is either present in the facility or present, awake and on duty in an attached or adjacent residential, health care or other similar facility and able to be physically present in the facility on short notice.

DHS 89.23(4)(c) (c) Freedom from abuse, neglect and exploitation. A residential care apartment complex shall ensure that tenants are free from abuse, neglect or financial exploitation by the facility or its staff. A residential care apartment complex shall not employ an individual who has been convicted of a crime that is substantially related to the circumstances of the job or for whom there is a substantiated finding of abuse or neglect or misappropriation of property in the department’s registry for nurse aides, home health aides and hospice aides. The facility shall conduct a criminal records check with the Wisconsin department of justice and shall check with the department’s registry for nurse aides, home health aides and hospice aides when hiring a service manager, service providers and other persons to work in the facility or have contact with tenants.

DHS 89.23 Note Note: Substantiated findings of client abuse or neglect or misappropriation of client property are recorded in the department’s registry which can be accessed 24 hours a day by calling [phone]. See ch. DHS 12 for required background checks including a criminal record check.

DHS 89.23(4)(d) (d) Staff training.

DHS 89.23(4)(d)1. 1. All facility staff shall have training in safety procedures, including fire safety, first aid, universal precautions and the facility’s emergency plan, and in the facility’s policies and procedures relating to tenant rights.

DHS 89.23(4)(d)2. 2. Staff providing residential care apartment complex services to tenants shall have documented training or experience in the following areas:

DHS 89.23(4)(d)2.a. a. Physical, functional and psychological characteristics associated with aging or likely to be present in the tenant population and their implications for service needs.

DHS 89.23(4)(d)2.b. b. The purpose and philosophy of assisted living, including respect for tenant privacy, autonomy and independence.

DHS 89.23(4)(d)2.c. c. Assigned duties and responsibilities, including the needs and abilities of individual tenants for whom staff will be providing care.

DHS 89.23(5) (5) Documentation. A residential care apartment complex shall document that the requirements for provider qualifications have been met.

DHS 89.23(6) (6) Written staffing plan. A residential care apartment complex shall maintain an up-to-date, written staffing plan which describes how the facility is staffed to provide services that are sufficient to meet tenant needs and that are provided by qualified staff. The facility shall inform current and prospective tenants and their representatives about the existence and availability of the staffing plan and shall provide copies of the plan upon request.

DHS 89.23 History History: Cr. Register, February, 1997, No. 494, eff. 3-1-97; am. Register, November, 1998, No. 515, eff. 12-1-98.

DHS 89.24 DHS 89.24 Hours of service.

DHS 89.24(1) (1) Limit on hours of service provided. A residential care apartment complex shall provide not more than 28 hours per week of supportive, personal and nursing services to each tenant. There is no limit on the type or amount of other services, activities or amenities which the facility provides.

DHS 89.24 Note Note: Some individuals may initially need little or no service but, over time, may need more services up to the full 28 hours per week.

DHS 89.24(2) (2) Amount of service provided to individual tenants.

DHS 89.24(2)(a) (a) Services provided by the residential care apartment complex. The amount of supportive, personal and nursing service which a facility provides to a tenant, either directly or under contract, shall be determined by the tenant’s needs and preferences, as documented in the service agreement. A residential care apartment complex shall not limit the hours of service it makes available for an individual tenant to less than 28 hours per week if needed by the tenant.

DHS 89.24(2)(b) (b) Services from providers other than the residential care apartment complex.

DHS 89.24(2)(b)1. 1. A tenant may contract for additional services not included in the service agreement from providers of the tenant’s choice, so long as the tenant informs the facility, complies with applicable facility policies and procedures and agrees to have the arrangements reflected in the risk agreement. Except as limited by a facility under subd. 3., there is no restriction on the amount or type of service which a tenant may receive from providers other than the facility.

DHS 89.24(2)(b)2. 2. A residential care apartment complex may approve the provider of supportive, personal or nursing services for any particular tenant and require that providers of these services comply with established facility standards and policies.

DHS 89.24(2)(b)3. 3. A residential care apartment complex may only limit the amount of supportive, personal and nursing service a tenant purchases from outside providers when the total amount of supportive, personal and nursing services that the tenant receives from all paid providers exceeds 28 hours per week. A facility may not limit the amount of hospice care a tenant receives or the amount of unpaid services provided by the tenants family or friends. A facility may not limit the amount of recuperative care which a tenant receives, provided the recuperative care will not raise the total service level above 28 hours per week for more than 90 days.

DHS 89.24(3) (3) Computing hours of service.

DHS 89.24(3)(a) (a) Purpose. A residential care apartment complex shall compute hours of service provided to an individual tenant when necessary for the purpose of determining whether the 28 hour per week limit on services under sub. (1) has been reached and making related decisions about the appropriateness of continued residency in the facility. The computation may be initiated by the facility or at the request of the tenant, the tenant’s family or other representative, or the department. Facilities are not required to continually document the amount of time spent in providing services to each tenant.

DHS 89.24 Note Note: This requirement is intended solely for the purpose of determining whether a person can appropriately reside in a residential care apartment complex. It is not intended for the purposes of documenting or billing for services provided or for determining facility staffing levels.

DHS 89.24(3)(b) (b) Method for computing hours of service.

DHS 89.24(3)(b)1. 1. Only staff time that is directly attributable to providing or arranging supportive, personal and nursing services to a tenant shall count toward the 28-hour per week limit on services. Hours of service include time devoted to nursing assessment, documentation and consultation, stand-by assistance for activities of daily living and any other services directly attributable to an individual tenant.

DHS 89.24(3)(b)2. 2. Congregate services such as meals served in a common dining room, housekeeping in common areas of the facility, laundry and social and recreational activities which would be typically available in a hotel or in unlicensed housing for the elderly shall not be counted toward the 28-hour per week limit on services.

DHS 89.24(3)(b)3. 3. Time spent in meeting a tenant’s unscheduled care needs shall be included in the 28 hours.

DHS 89.24(3)(b)4. 4. Services arranged directly by an individual tenant from a provider other than the residential care apartment complex shall not count toward the limit on the amount of services provided by a facility under sub. (1).

DHS 89.24 History History: Cr. Register, February, 1997, No. 494, eff. 3-1-97; am. Register, November, 1998, No. 515, eff. 12-1-98.

DHS 89.25 DHS 89.25 Schedule of fees for services.

DHS 89.25(1) (1) Residential care apartment complexes shall have a written schedule of fees for services which includes all of the following:

DHS 89.25(1)(a) (a) Separately identified charges for rent, meals and services. The schedule of fees for services shall clearly identify those services which are included in any base service rate or rates and those for which there will be separate charges.

DHS 89.25(1)(b) (b) The amount of any application fee, entrance fee or security deposit.

DHS 89.25(1)(c) (c) The facility’s refund policy regarding application and entrance fees, security deposits and monthly rent, meal and service charges in the event of death or termination of the contract between the tenant and the facility.

DHS 89.25(2) (2) The schedule of fees for services shall be presented in language and a format that make it possible for tenants to readily identify the cost of the components of the service agreement and to be able to make informed choices about the services they receive.

DHS 89.25(3) (3) A copy of the schedule of fees for services shall be given to each prospective tenant and to the prospective tenant’s family or designated representative, where appropriate, along with public information materials on assisted living if provided by the department. Copies of revised fee schedules shall be provided to current tenants and their families or representatives, where appropriate, at least 30 days in advance of an increase in fees.

DHS 89.25 History History: Cr. Register, February, 1997, No. 494, eff. 3-1-97; am. Register, November, 1998, No. 515, eff. 12-1-98.

DHS 89.26 DHS 89.26 Comprehensive assessment.

DHS 89.26(1) (1) Requirement. A comprehensive assessment shall be performed prior to admission for each person seeking admission as a basis for developing the service agreement under s. DHS 89.27 and the risk agreement under s. DHS 89.28.

DHS 89.26(2) (2) Contents. The comprehensive assessment shall identify and evaluate the following factors relating to the person’s need and preference for services:

DHS 89.26(2)(a) (a) Physical health.

DHS 89.26(2)(b) (b) Physical and functional limitations and capacities.

DHS 89.26(2)(c) (c) Medications and ability to self-administer medications.

DHS 89.26(2)(d) (d) Nutritional status and needs.

DHS 89.26(2)(e) (e) Mental and emotional health.

DHS 89.26(2)(f) (f) Behavior patterns.

DHS 89.26(2)(g) (g) Social and leisure needs and preferences.

DHS 89.26(2)(h) (h) Strengths, abilities and capacity for self-care.

DHS 89.26(2)(i) (i) Situations or conditions which could put the tenant at risk of harm or injury.

DHS 89.26(2)(j) (j) Type, amount and timing of services desired by the tenant.

DHS 89.26(2)(k) (k) Frequency of monitoring which the resident’s condition requires.

DHS 89.26(3) (3) Participation in the assessment.

DHS 89.26(3)(a) (a) A comprehensive assessment shall be performed with the active participation of the prospective tenant. That person’s family or designated representative shall also participate in the assessment, if desired by the person.

DHS 89.26(3)(b) (b) Persons performing the comprehensive assessment shall have expertise in areas related to the tenant’s health and service needs. Portions of the comprehensive assessment relating to physical health, medications and ability to self-administer medications shall be performed by a physician or a registered nurse.

DHS 89.26(3)(c) (c) A comprehensive assessment shall be performed or arranged for by:

DHS 89.26(3)(c)1. 1. The residential care apartment complex for tenants whose bills are paid for from private resources or by third party payers.

DHS 89.26(3)(c)2. 2. The county department or aging unit designated to administer the medicaid waiver for those tenants whose services are paid for under s. 46.277, Stats.

DHS 89.26(4) (4) Annual review. A tenant’s capabilities, needs and preferences identified in the comprehensive assessment shall be reviewed at least annually to determine whether there have been changes that would necessitate a change in the service or risk agreement. The review may be initiated by the facility, the county department designated under sub. (3) (c) 2., or at the request of or on the behalf of the tenant.

DHS 89.26 History History: Cr. Register, February, 1997, No. 494, eff. 3-1-97; am. Register, November, 1998, No. 515, eff. 12-1-98; CR 23-046: am. (3) (c) 2. Register April 2024 No. 820, eff. 5-1-24.

DHS 89.27 DHS 89.27 Service agreement.

DHS 89.27(1) (1) Requirement. A residential care apartment complex shall enter into a mutually agreed-upon written service agreement with each of its tenants consistent with the comprehensive assessment under s. DHS 89.26.

DHS 89.27(2) (2) Contents. A service agreement shall identify all of the following:

DHS 89.27(2)(a) (a) Services.

DHS 89.27(2)(a)1. 1. The type, amount and frequency of the services to be provided to the tenant, including services which will be available to meet unscheduled care needs.

DHS 89.27(2)(a)2. 2. Any additional services which are available for purchase by the tenant.

DHS 89.27(2)(a)3. 3. The activities and social connections the tenant will be assisted in maintaining.

DHS 89.27(2)(b) (b) Fees.

DHS 89.27(2)(b)1. 1. The charge for the services covered by the service agreement, both individually and in total, and the time and amount of any fee increase that will occur during the period covered by the service agreement. Facilities shall remind tenants of any fee increase by written notice 30 days in advance of the effective date.

DHS 89.27(2)(b)2. 2. Any supplemental fees for services not covered in the service agreement or other agreement between the facility and the tenant.

DHS 89.27(2)(c) (c) Policies and procedures.

DHS 89.27(2)(c)1. 1. ‘Additional services.’

DHS 89.27(2)(c)1.a. a. Types of additional services which the facility would make available or which the facility would assist in arranging for a tenant during acute episodes, following release from the hospital or during other periods when the tenant may experience temporary needs.

DHS 89.27(2)(c)1.b. b. Policies and procedures regarding services which the tenant arranges to receive from providers other than the residential care apartment complex.

DHS 89.27(2)(c)2. 2. ‘Termination or transfer.’ Grounds for termination of the contract between the tenant and the facility or relocation of the tenant to another residence and the procedure for tenant participation in decisions regarding termination and relocation. Conditions for termination contained in the service agreement shall not be contrary to the requirements relating to contract termination contained in s. DHS 89.29 (3).

DHS 89.27(2)(c)3. 3. ‘Tenant’s rights.’ The residential care apartment complex’s policies relating to tenant rights, including at a minimum, the rights identified in subch. III.

DHS 89.27(2)(c)4. 4. ‘Dispute resolution.’ The facility’s internal grievance procedure for resolving tenant complaints.

DHS 89.27(3) (3) Other specifications.

DHS 89.27(3)(a) (a) Only services selected and agreed to by the tenant may be included in the service agreement.

DHS 89.27(3)(b) (b) A service agreement may not waive any of the provisions of this chapter or other rights of the tenant.

DHS 89.27(3)(c) (c) The service agreement shall be presented in language and a format that make it possible for tenants to readily identify the type, amount, frequency and cost of services they receive, the qualifications of the staff providing those services and whether the services are provided directly by the facility or by subcontract.

DHS 89.27(3)(d) (d) The initial service agreement and any renewals of the service agreement shall be dated and signed by a representative of the facility; by the tenant or by the tenant’s guardian, if any, and all other persons with legal authority to make health care or financial decisions for the tenant; and by the county for a tenant whose services are funded under s. 46.277, Stats. The facility shall provide a copy of the service agreement to all parties who signed the agreement.

DHS 89.27 Note Note: Persons with legal authority to make health care or financial decisions for the tenant include agents designated under an activated power of attorney for health care under ch. 155, Stats., and durable power of attorney under ch. 244, Stats.

DHS 89.27(3)(e) (e) The service agreement shall be completed by the date of admission.