Chapter DHS 132

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:

DHS 132.60(1)(c)5.a. a. An initial assessment of pain intensity that shall include: the resident’s self-report of pain, unless the resident is unable to communicate; quality and characteristics of the pain, including the onset, duration and location of pain; what measures increase or decrease the pain; the resident’s pain relief goal; and the effect of the pain on the resident’s daily life and functioning.

DHS 132.60(1)(c)5.b. b. Regular and periodic reassessment of the pain after the initial assessment, including quarterly reviews, whenever the resident’s medical condition changes, and at any time pain is suspected, including prompt reassessment when a change in pain is self-reported, suspected or observed.

DHS 132.60(1)(c)5.c. c. The delivery and evaluation of pain treatment interventions to assist the resident to be as free of pain as possible.

DHS 132.60(1)(c)5.d. d. Consideration and implementation, as appropriate, of nonpharmacological interventions to control pain.

DHS 132.60(1)(d) (d) Rehabilitative measures. Residents shall be assisted in carrying out rehabilitative measures initiated by a rehabilitative therapist or ordered by a physician, including assistance with adjusting to any disabilities and using any prosthetic devices.

DHS 132.60 Note Note: See s. DHS 132.60 (5) (a) 1. for treatments and orders.

DHS 132.60(2) (2) Nourishment.

DHS 132.60(2)(a) (a) Diets. Residents shall be served diets as prescribed.

DHS 132.60(2)(b) (b) Adaptive devices. Adaptive self-help devices, including dentures if available, shall be provided to residents, and residents shall be trained in their use to contribute to independence in eating.

DHS 132.60(2)(d) (d) Food and fluid intake and diet acceptance. A resident’s food and fluid intake and acceptance of diet shall be observed, and significant deviations from normal eating patterns shall be reported to the nurse and either the resident’s physician or dietitian as appropriate.

DHS 132.60 Note Note: For other dietary requirements, see s. DHS 132.63.

DHS 132.60(3) (3) Notification of changes in condition or status of resident.

DHS 132.60(3)(a) (a) Changes in condition. A resident’s physician, guardian, if any, and any other responsible person designated in writing by the resident or guardian to be notified shall be notified promptly of any significant accident, injury, or adverse change in the resident’s condition.

DHS 132.60(3)(b) (b) Changes in status. A resident’s guardian and any other person designated in writing by the resident or guardian 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 132.60 Note Note: For responses to changes in medical condition, see s. DHS 132.60 (1) (c) 4; for records, see s. DHS 132.45 (5) (c) 4.

DHS 132.60(5) (5) Treatment and orders.

DHS 132.60(5)(a) (a) Orders.

DHS 132.60(5)(a)1. 1. ‘Restriction.’ Medications, treatments and rehabilitative therapies shall be administered as ordered by an authorized prescriber subject to the resident’s right to refuse them. No medication, treatment or changes in medication or treatment may be administered to a resident or a daycare client without an authorized prescriber’s written order which shall be filed in the resident’s or daycare client’s clinical record.

DHS 132.60(5)(a)2. 2. ‘Oral orders.’ Oral orders shall be immediately written, signed and dated by the nurse, pharmacist or therapist on the prescriber’s order sheet, and shall be countersigned by the prescriber and filed in the resident’s clinical record within 10 days of the order.

DHS 132.60(5)(d) (d) Administration of medications.