Boarding homes are licensed by the Aging and Disability Services Administration (ADSA). Inspections are conducted every 12-15 months. The process for inspecting nursing homes and boarding homes is similar. ADSA dropped “quality improvement consultation” because of budget reductions. The consultation service helped facilities understand regulatory requirements and share best practices. Funds to continue the program have not been approved.
Case managers are a primary source of monitoring for quality assurance for Medicaid beneficiaries. During regular visits, the case manager checks to see if the client is satisfied, the negotiated service plan is being carried out, and that the plan is appropriate for the resident. Homes can maintain a quality assurance committee that includes a licensed registered nurse, the administrator, and three other staff members. When established, these committees meet at least quarterly to identify issues that may adversely affect quality of care and services to residents and to develop and implement plans of action to correct identified quality concerns or deficiencies.
To promote quality of care through self-review without fear of reprisal, and to enhance the objectivity of the review process, the department does not require (and the long-term care ombudsman program does not request) disclosure of any quality assurance committee records or reports. Exceptions are when the disclosure is related to the committee's compliance with regulations, the records or reports are not maintained pursuant to statutory or regulatory mandate, or the records or reports are created for and collected and maintained by the committee.
The ADSA home page has a button for boarding homes that connects to a consumer guide and a database that searches for facilities by county or ZIP code. The results include the facility's name, address, phone, Medicaid contract status if any, and capacity.
Under the “professionals” button, click “residential care" for a section for providers that includes regulations, a licensing application, frequently asked questions about licensing, a required disclosure form, other documents related to licensing, enforcement principles and procedures, instructions about nurse delegation, and a schedule of training programs. It also includes an aggregate list of the most frequent citations.
The Department of Health and Human Resources, Office of Health Facility Licensure and Certification licenses assisted living residences annually. The Office conducts on-site, unannounced inspections annually and as needed to investigate complaints. Survey reports are completed on laptop computers and E-mailed to the State office. Facilities with Class I violations are re-inspected until they reach compliance. Survey teams include an RN, a social worker, and an environmental surveyor. Surveyors review a sample of staff and resident records based on the size of the facility. The process is described as outcome oriented. Surveyors examine the facility's policies and procedures to determine if there is a policy to prevent or address poor outcomes. For example, staff are required to weigh residents monthly and report changes greater than 5 pounds to the physician.
Under previous regulations, facilities were assigned a grade, but the process was replaced by a system that groups deficiencies by class. State officials believe this process will result in a fairer description of the quality of care.
Survey teams can provide technical assistance to facility managers and staff. Assistance is often provided when a surveyor identifies an issue that could become a future violation. The team may provide written information about the issue, the regulatory requirement, and recommendations for addressing the issue.
The Office posts a list of licensed facilities that includes the name of the facility, address, phone number, and type of facility on the agency's Web site. The Web site also includes application and renewal forms, a form to request a waiver of the 90-day limit for providing health and nursing services, and program licensing, survey requirements, and a disclosure form for Alzheimer's special care units. The Office is considering posting survey findings and deficiency reports.
The Department of Health and Family Services, Bureau of Quality Assurance conducts periodic inspections of certified residential care apartment complexes (RCACs) and has the authority (but is not required) to inspect registered RCACs to determine compliance with regulatory requirements.
The Department maintains a Web site on RCACs and community-based residential facilities. The site has two databases of facilities. One links to the Wisconsin Assisted Living Association site and is organized by county. It lists name, address, phone number, contact, capacity, and E-mail and Web site addresses. It also includes a map. The State site lists facilities in pdf and Excel spreadsheet formats. In addition to the information included on the association site, the State site contains the number of apartments/units, the lowest and highest rates charged, the initial certification/licensing date, and any specialized programs (Medicaid waiver, developmental disabilities, dementia, or alcohol/drug abuse).
The Department's Web site includes regulations and statutes, licensing/certification information, applications, a description of the survey process and a guide, background checks, incident reporting forms, guidance on medication errors based on common errors, and a copy of residents' rights. A consumer guide to selecting community-based residential facilities is also available. Descriptive information in available for both RCACs and community-based residential facilities. The site links to county agencies and lists of all facilities in the county.
The Web site includes survey findings by type of facility for the previous 3 years. Facilities are grouped alphabetically by type. The information includes the date and type of survey, the number of the deficiency cited, the subject matter and the date compliance was verified, and whether the deficiency was corrected.
The Bureau of Aging and Long Term Care Resources home page links to the Bureau of Quality Assurance Web site.
The Department of Health licenses assisted living facilities. The State has a contract employee who surveys facilities at least once a year. The cost of the contract is borne by the assisted living facilities. The survey division is required to provide a list of deficiencies to the facility within 10 working days of the survey, and the facility has 10 calendar days to provide a plan of correction for each of the cited deficiencies. If the facility fails to provide a plan of correction, licensure revocation proceedings may ensue. Each facility must have an active quality improvement program that is re-evaluated at least annually to ensure effective use and delivery of services. The program must have a written description, problem areas identified, monitor identified, frequency of monitoring, and a provision requiring the facility to complete annually a self-assessment survey of compliance with regulations, as well as a satisfaction survey that must be provided to the resident, resident's family, or resident's responsible party at least annually. The State is responsible for receiving and investigating complaints.
Licensing regulations are posted on the Secretary of State's Web site. The State Aging Division of the Department of Health's Web site lists assisted living facilities that participate in the Medicaid waiver program.
This report was prepared for AHRQ by the National Academy for State Health Policy under a subcontract with Westat (Contract No. 290-01-0003). It was prepared by Robert L. Mollica, Ed.D., Senior Program Director, National Academy for State Health Policy, Washington, DC. The information and recommendations in this report do not necessarily represent the views of AHRQ or the U.S. Department of Health and Human Services.
This document is in the public domain and may be used and reprinted without permission.
Current as of September 2006
AHRQ Publication No. 06-M051-EF
Internet Citation:
Residential Care and Assisted Living: State Oversight Practices and State Information Available to Consumers. AHRQ Publication No. 06-M051-EF, September 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/residentcare/
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