Chapter DHS 132

DHS 132.60 Note Note: The department encourages and promotes the principles of resident self-determination and person directed care.

DHS 132.60 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (5) (d) 1., Register, February, 1983, No. 326, eff. 3-1-83; am. (1) (d), (2) (d), (3) (5) (a) 1. to 3., (6) (c) and (8) (a), r. and recr. (1) (b) and (6) (f), Register, January, 1987, No. 373, eff. 2-1-87; am. (6) (a) 1. Register, February, 1989, No. 398, eff. 3-1-89; cr. (8) (d), Register, November, 1990, No. 419, eff. 12-1-90; correction in (5) (d) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; CR 04-053: cr. (1) (c) 5., am. (5) (a) 1. and 2., (5) (d) 2., and (6) (b), r. (5) (a) 3. and (c) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (1) (a) 2. and 3., (c) 1., and (e), (2) (c), (4), (5) (a) 4., (b), (d) 3., 4., 6. and (e), (6) (a), (c), (d), (g), (7), and (8) (a) 1., and 2., and (d), am. (5) (a) 1., (6) (b), and (8) (a) (intro.), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.61 DHS 132.61 Medical services. Every skilled care facility shall retain, pursuant to a written agreement, a physician to serve as medical director on a part-time or full-time basis as is appropriate for the needs of the residents and the facility. Medical direction and coordination of medical care in the facility shall be provided by the medical director.

DHS 132.61 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (2) (b), Register, January, 1987, No. 373, eff. 2-1-87; correction in (2) (b) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1996, No. 492; CR 06-053: r. (1) (c), (2), cons., renum. and am. (1) (a) and (b) to be DHS 132.61, Register August 2007 No. 620, eff. 9-1-07.

DHS 132.62 DHS 132.62 Nursing services.

DHS 132.62(1) (1) Definitions. “Nursing personnel” means nurses, nurse aides, nursing assistants, and orderlies.

DHS 132.62(2) (2) Nursing administration.

DHS 132.62(2)(a) (a) Director of nursing services in skilled care and intermediate care facilities.

DHS 132.62(2)(a)1. 1. ‘Staffing requirement.’ Every skilled care facility and every intermediate care facility shall employ a full-time director of nursing services who may also serve as a charge nurse in accordance with par. (b).

DHS 132.62(2)(a)2. 2. ‘Qualifications.’ The director of nursing services shall be a registered nurse.

DHS 132.62(2)(a)3. 3. ‘Duties.’ The director of nursing services shall be responsible for:

DHS 132.62(2)(a)3.a. a. Supervising the functions, activities and training of the nursing personnel;

DHS 132.62(2)(a)3.b. b. Developing and maintaining standard nursing practice, nursing policy and procedure manuals, and written job descriptions for each level of nursing personnel;

DHS 132.62(2)(a)3.c. c. Coordinating nursing services with other resident services;

DHS 132.62(2)(a)3.d. d. Designating the charge nurses provided for by this section;

DHS 132.62(2)(a)3.e. e. Being on call at all times, or designating another registered nurse to be on call, when no registered nurse is on duty in the facility; and

DHS 132.62(2)(a)3.f. f. Ensuring that the duties of nursing personnel shall be clearly defined and assigned to staff members consistent with the level of education, preparation, experience, and licensing of each.

DHS 132.62(2)(b) (b) Charge nurses in skilled care facilities and intermediate care facilities.

DHS 132.62(2)(b)1. 1. ‘Staffing requirement.’ A skilled nursing facility shall have at least one charge nurse on duty at all times, and:

DHS 132.62(2)(b)1.a. a. A facility with fewer than 60 residents in need of skilled nursing care shall have at least one registered nurse, who may be the director of nursing services, on duty as charge nurse during every daytime tour of duty;

DHS 132.62(2)(b)1.b. b. A facility with 60 to 74 residents in need of skilled nursing care shall, in addition to the director of nursing services, have at least one registered nurse on duty as charge nurse during every daytime tour of duty;

DHS 132.62(2)(b)1.c. c. A facility with 75 to 99 residents in need of skilled nursing care shall have, in addition to the director of nursing services, at least one registered nurse on duty as charge nurse during every daytime tour of duty. In addition, the facility shall have at least one registered nurse on duty as charge nurse every day on at least one other non-daytime tour of duty.

DHS 132.62(2)(b)1.d. d. A facility with 100 or more residents in need of skilled nursing care shall have, in addition to the director of nursing services, at least one registered nurse on duty as charge nurse at all times.

DHS 132.62(2)(b)1.e. e. An intermediate care facility shall have a charge nurse during every daytime tour of duty, who may be the director of nursing.

DHS 132.62(2)(b)3. 3. ‘Duties.’

DHS 132.62(2)(b)3.a. a. The charge nurse, if a registered nurse, shall supervise the nursing care of all assigned residents, and delegate the duty to provide for the direct care of specific residents, including administration of medications, to nursing personnel based upon individual resident needs, the facility’s physical arrangement, and the staff capability.

DHS 132.62(2)(b)3.b. b. The charge nurse, if a licensed practical nurse, shall manage and direct the nursing and other activities of other licensed practical nurses and less skilled assistants and shall arrange for the provision of direct care to specific residents, including administration of medications, by nursing personnel based upon individual resident needs, the facility’s physical arrangement, and the staff capability. A licensed practical nurse who serves as a charge nurse shall be under the supervision and direction of a registered nurse who is either in the facility or on call.

DHS 132.62(3) (3) Nurse staffing. In addition to the requirements of sub. (2), there shall be adequate nursing service personnel assigned to care for the specific needs of each resident on each tour of duty. Those personnel shall be briefed on the condition and appropriate care of each resident.

DHS 132.62 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (2) (b) 2. and (c), r. (2) (d), Register, January, 1987, No 373, eff. 2-1-87; am. (3) (a), Register, February, 1989, No. 398, eff. 3-1-89; CR 04-053: am. (2) (a) 1. and r. and recr. (3) (a) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (1) (b), (2) (a) 2. b., (b) 2. and (c), (3) (a) and (c) to (h), renum. (1) (a) to be (1), cons., renum. and am. (2) (a) 2. (intro.) and a. to be (2) (a) 2., cons., renum. and am. (3) (intro.) and (b) to be (3), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.63 DHS 132.63 Dietary service.

DHS 132.63(1) (1) Dietary service. The facility shall provide each resident a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.

DHS 132.63(2) (2) Staff.

DHS 132.63(2)(a) (a) Dietitian. The nursing home shall employ or retain on a consultant basis a dietitian to plan, direct and ensure implementation of dietary service functions.

DHS 132.63(2)(b) (b) Director of food services.

DHS 132.63(2)(b)1. 1. The nursing home shall designate a person to serve as the director of food services. A qualified director of food services is a person responsible for implementation of dietary service functions in the nursing home and who meets any of the following requirements:

DHS 132.63(2)(b)1.a. a. Is a dietitian.

DHS 132.63(2)(b)1.b. b. Has completed at least a course of study in food service management approved by the dietary managers association or an equivalent program.

DHS 132.63(2)(b)1.c. c. Holds an associate degree as a dietetic technician from a program approved by the American dietetics association.

DHS 132.63(2)(b)2. 2. If the director of food services is not a dietitian, the director of food services shall consult with a qualified dietitian on a frequent and regularly scheduled basis.

DHS 132.63 Note Note: For inservice training requirements, see s. DHS 132.44 (2) (b).

DHS 132.63(4) (4) Menus.

DHS 132.63(4)(a) (a) General. The facility shall make reasonable adjustments to accommodate each resident’s preferences, habits, customs, appetite, and physical condition.

DHS 132.63(4)(a)6. 6. A variety of protein foods, fruits, vegetables, dairy products, breads, and cereals shall be provided.

DHS 132.63(4)(b) (b) Therapeutic diets. Therapeutic diets shall be prescribed by the attending physician. The attending physician may delegate to a licensed or certified dietitian the prescribing of a resident’s diet, including a therapeutic diet, to the extent allowed by law. Therapeutic diets shall be served consistent with such orders.

DHS 132.63(5) (5) Meal service.

DHS 132.63(5)(c) (c) Table service. The facility shall provide table service in dining rooms for all residents who can and want to eat at a table, including residents in wheelchairs.

DHS 132.63(5)(g) (g) Drinking water. When a resident is confined to bed, a covered pitcher of drinking water and a glass shall be provided on a bedside stand. The water shall be changed frequently during the day, and pitchers and glasses shall be sanitized daily. Single-service disposable pitchers and glasses may be used. Common drinking utensils shall not be used.

DHS 132.63(7) (7) Sanitation. All readily perishable food and drink, except when being prepared or served, shall be kept in a refrigerator which shall have a temperature maintained at or below 40° F. (4°C.).

DHS 132.63 Note Note: See ch. DHS 145 for the requirements for reporting incidents of suspected disease transmitted by food.

DHS 132.63 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (2) (a), (4) (a) 3., (5) (d) and (f) and (7) (a) 4., Register, January, 1987, No. 373, eff. 2-1-87; r. and recr. (5) (c), Register, February, 1989, No. 398, eff. 3-1-89; CR 04-053: am. (1), r. and recr. (2), r. (6) (c) and (7) (a) 4. Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (2) (c), (3) (4) (a) 1. to 3., and 5., (b) 2. and 3., (5) (a), (b), (d) to (f), (6), (7) (a), (b) 1. and (c), and (8), renum. (4) (a) 4., (b) 1., and (7) (b) 2. to be (4) (a) and (b), (7), Register August 2007 No. 620, eff. 9-1-07; 2017 Wis. Act 101: am. (4) (b) Register December 2017 No. 744, eff. 1-1-18.

DHS 132.64 DHS 132.64 Rehabilitative services.

DHS 132.64(1) (1) Provision of services. Each facility shall either provide or arrange for, under written agreement, specialized rehabilitative services as needed by residents to improve and maintain functioning.

DHS 132.64(2) (2) Service plans and restrictions.

DHS 132.64(2)(b) (b) Report to physician. Within 2 weeks of the initiation of rehabilitative treatment, a report of the resident’s progress shall be made to the physician.

DHS 132.64(2)(c) (c) Review of plan. Rehabilitative services shall be re-evaluated at least quarterly by the physician and therapists, and the plan of care updated as necessary.

DHS 132.64(3) (3) Specialized services — qualifications.

DHS 132.64(3)(a) (a) Physical therapy. Physical therapy shall be given or supervised only by a physical therapist.

DHS 132.64(3)(b) (b) Speech and hearing therapy. Speech and hearing therapy shall be given or supervised only by a therapist who:

DHS 132.64(3)(b)1. 1. Meets the standards for a certificate of clinical competence granted by the American speech and hearing association; or

DHS 132.64(3)(b)2. 2. Meets the educational standards, and is in the process of acquiring the supervised experience required for the certification of subd. 1.

DHS 132.64(3)(c) (c) Occupational therapy. Occupational therapy shall be given or supervised only by a therapist who meets the standards for registration as an occupational therapist of the American occupational therapy association.

DHS 132.64(3)(d) (d) Equipment. Equipment necessary for the provision of therapies required by the residents shall be available and used as needed.

DHS 132.64 Note Note: For record requirement, see s. DHS 132.45.

DHS 132.64 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; CR 06-053: r. (2) (a), Register August 2007 No. 620, eff. 9-1-07.

DHS 132.65 DHS 132.65 Pharmaceutical services.

DHS 132.65(1) (1) Definitions. As used in this section:

DHS 132.65(1)(a) (a) “Medication” has the same meaning as the term “drug” defined in s. 450.06, Stats.

DHS 132.65(1)(b) (b) “Prescription medication” has the same meaning as the term“prescription drug” defined in s. 450.07, Stats.

DHS 132.65(1)(c) (c) “Schedule II drug” means any medication listed in s. 961.16, Stats.

DHS 132.65(2) (2) Services.

DHS 132.65(2)(a) (a) Each facility shall provide for obtaining medications for the residents directly from licensed pharmacies.

DHS 132.65(2)(b) (b) The facility shall establish, maintain, and implement such policies and procedures as are necessary to comply with this section and assure that resident needs are met.

DHS 132.65(4) (4) Emergency medication kit.

DHS 132.65(4)(a) (a) A facility may have one or more emergency medication kits. All emergency medication kits shall be under the control of a pharmacist.

DHS 132.65(4)(b) (b) The emergency kit shall be sealed and stored in a locked area.

DHS 132.65(5) (5) Contingency supply of medications.

DHS 132.65(5)(a) (a) Maintenance. A facility may have a contingency supply of medications not to exceed 10 units of any medication. Any contingency supply of medications must be under the control of a pharmacist.

DHS 132.65(5)(b) (b) Storage. Contingency drugs shall be stored at a nursing unit, except that those medications requiring refrigeration shall be stored in a refrigerator.

DHS 132.65(5)(c) (c) Single units. Contingency medications shall be stored in single unit containers, a unit being a single capsule, tablet, ampule, tubex, or suppository.

DHS 132.65(5)(d) (d) Committee authorization. The quality assessment and assurance committee shall determine which medications and strengths of medications are to be stocked in the contingency storage unit and the procedures for use and re-stocking of the medications.

DHS 132.65(5)(e) (e) Control. Unless controlled by a “proof-of-use” system, as provided by sub. (6) (e), a copy of the pharmacy communication order shall be placed in the contingency storage unit when any medication is removed.

DHS 132.65(6) (6) Requirements for all medication systems.

DHS 132.65(6)(b) (b) Storing and labeling medications. Unless exempted under par. (f), all medications shall be handled in accordance with the following provisions:

DHS 132.65(6)(b)1. 1. ‘Storage.’ Medications shall be stored near nurse’s stations, in locked cabinets, closets or rooms, conveniently located, well lighted, and kept at a temperature of no more than 85° F. (29° C.).

DHS 132.65(6)(b)2. 2. ‘Transfer between containers.’ Medications shall be stored in their original containers, and not transferred between containers, except by a physician or pharmacist.

DHS 132.65(6)(b)3. 3. ‘Controlled substances.’ Separately locked and securely fastened boxes or drawers, or permanently affixed compartments, within the locked medication area shall be provided for storage of schedule II drugs, subject to 21 USC ch. 13, and Wisconsin’s uniform controlled substance act, ch. 961, Stats.

DHS 132.65(6)(b)4. 4. ‘Separation of medications.’ Medications packaged for individual residents shall be kept physically separated.

DHS 132.65(6)(b)5. 5. ‘Refrigeration.’ Medications requiring refrigeration shall be kept in a separate covered container and locked, unless the refrigeration is available in a locked drug room.

DHS 132.65(6)(b)6. 6. ‘External use of medications.’ Poisons and medications for external use only shall be kept in a locked cabinet and separate from other medications, except that time-released transdermal drug delivery systems, including nitroglycerin ointments, may be kept with internal medications.