RCF Rule Overview 122014 - Iowa Health Care€¦ · and variance. The list of items that a ... approved by DIA for RCF admins

IHCA ICAL RCF Rule Overview – December 2014 1

Issue Proposed Rule Current 481‐57 RCF Rules Waiver or Variances

Under the proposed rule, the waiver and variance section provides for a direct reference to 481‐6, which is DIA’s chapter for the procedures to be used for a waiver and variance. The list of items that a provider must use to seek a waiver is more specific than what is listed in current rules.

Provides for a list of items the licensee must discuss when requesting a waiver.

Application for Licensure This proposed rule would be different because it applies when a) obtaining an initial RCF license for a facility not currently licensed as a RCF and b) for a RCF when a change of ownership is contemplated. It doesn’t provide for situations when obtaining an initial RCF license for an RCF currently licensed. The proposed rule differs from the current rules in that it calls for in the application “written resume of care”. Please see page 4 of the rules under 57.3(2) for what is to be contained in resume of care. Rest of application criteria is the same as current. Same provision for renewal application, with the addition of “changes to resume of care, if any”.

Current rule applies when: a) obtaining an initial RCF license for an RCF currently licensed and b) obtaining an initial RCF license for a facility not currently licensed as a residential care facility. Lists specific items that must be included in an application. Provides for provisions dealing with renewal application.


Licenses Issuance of license the same as current rules. Same language as current rules for licenses for distinct parts is virtually the same. Current rules state that separate licenses may be issued for distinct parts of a heath care facility which are clearly identifiable, containing contiguous rooms “in a separate wing or building or on a separate floor of the facility” and which provide care services of separate categories. The new rule strikes the above portion in quotes.

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Special Categories Proposed rules differ from current rules on this issue in two respects a) language regarding special categories and variances are not in current rule b) provides for express rules on the special classification of memory care with an RCF Memory Care Rule states that an RCF may choose to have a memory care unit or designate the entire RCF as a memory care facility. Memory Care is defined as “care of persons with early Alzheimer’s type dementia or other disorders causing dementia”. The draft rules are clear that the residents who would receive memory care still must meet the level of care requirements for a RCF.

481‐57.4 Current rules recognize that special categories such as ID, PD or mental disability that can best be treated in a specialized environment may require special variations and considerations from DIA Criteria for these specialized programs and services furnished by the RCF are established by DIA based on the resume of programs and services furnished by the RCF, and number and qualifications of the admin., and staff.


Would require that prior to transfer or admission to the memory care unit, a complete assessment of physical, mental, social and behavioral status must be completed to determine if applicant meets admission criteria. The facility would be required to submit a form application to DIA to add this category of care to the RCF. Résumé of Care Under the draft rule the RCF would be required to submit a resume of the program of care to DIA for approval within at least 30 days before a separate memory care unit or facility is opened. The draft rule enumerates 10 items the resume of the program of care must include. Policies and Procedures The draft rule would require separate written policies and procedures to be implemented in the memory care unit or facility. The rule further enumerates what the policies and procedures must contain: a) Criteria for admission and pre‐admission. The rule would require the policy must require a statement from the attending physician agreeing to the placement prior to placement in the unit. b) Safety provisions that address plans in the event of an emergency, what the


facility will do when the resident is discovered to be missing, the type of chemicals or potentially dangerous equipment being used in the unit or facility and how the security system will be monitored. c) The RCF must lay out in the written policies and procedures the staffing requirements, including the minimum number, types and qualifications of staff in the unit or facility in accordance with the resident needs. d) Visitation polices. e) Process and criteria which will be used to monitor and to respond to risks specific to the residents. Staffing and Training Requirement The draft rule would require that all staff working in a memory care unit or facility must have “training appropriate to the needs of the resident” Once a staff member is assigned to the unit or facility, the rule would require that the staff member is “oriented to the needs of the resident requiring memory care”. The staff must have at least 6 hours of special training appropriate to their job description within 30 days of assignment to


the unit or facility. The rule further enumerates 11 topics the training must include. Structural If the unit or facility is to be a locked unit or facility; all locking devices must meet the life safety code and any requirements of the State Fire Marshal. If the unit or facility is to be unlocked, a system of security monitoring is required. Plans to modify the physical environment must be submitted to the department for review.

General Requirements 481‐57.7 Same as current rules, excepts adds the requirement that the licensee must:

a) Assume the responsibility for the overall operation of the RCF

b) Responsible for compliance with all applicable laws and with the rules of the department

c) Provide organized, continuous 24 hour program of care commensurate with the needs of the resident.

481‐57.5 Current Rules provide for 5 specific general requirements every RCF must comply with as being a licensee. They deal with the following:

a) Display of license b) Valid possession of license c) Posted license should accurately reflect current

status of RCF d) Expiration e) Posting of citations from DIA

Notification to DIA Requirements

481‐57.9 Proposed rules different from current in the following respects, if not noted the old requirements to the right still exist:

a) Strikes the 48 hour requirement

481‐57.6 Current rules lay out various notification requirements to DIA, such as:

a) Within 48 hours of any reduction in direct or dietary staff lasting more than 7 days which


relating to the reduction in staff b) Adds the time frame of within 30

days for any changes in RCFs functional operation or additions or deletion of service

c) Now reads 30 days before the beginning of the renovation, addition, functional alteration, change of space utilization, or conversion in the RCF

d) Adds time frame of within 90 days in change of category of license is sought.

places RCF below staffing ratio required for license b) Any proposed change in RCF’s functional

operation or addition or deletion of service c) 30 days before any addition, alteration, or new

construction is begun d) 30 days in advance of closure of RCF e) Within 2 weeks of change of admin f) When any change in category of license is sought g) Requirements when there is a change transaction

concerning the RCF

Administrator Requirements

481‐57.10 Qualifications Maintains current criteria as options but makes the following additional options and changes:

a) Increase age to 21 and have a high school diploma or equivalent.

b) Adds “2 year degree in human services, psychology, sociology, nursing, health care administration, or a related field and have a minimum of 1 year experience in the field” as an option

c) Adds, “4 year degree in human services, psychology, sociology, nursing, health care administration, or a related field” as an option

d) Adds, “master’s degree in human services, human services, psychology, sociology, nursing, health care administration, or a

481‐57.9 Qualifications Must be at least 18, have a high school diploma or equivalent and meet one of 3 criteria as listed in the rule


related field” as an option e) Be a licensed nursing home

administrator f) Have completed a 1 year

educational training program approved by DIA for RCF admins.

g) Have passed the national Association of Long Term care Administrator Boards (NAB) RC/AL admin licensure exam.

h) Changes one of the options from “have two years of supervised experience in a RCF and at least 6 months of which is in an administrative capacity” to “Have 2 years of direct care experience and at least 6 months administrative experience an in RCF

Duties of an Administrator the proposed rule maintains for the most part most of the duties of an administrator under current rules but differs from the current rule in the following ways:

a) When admin arranges for heads of nursing, social services, dietary and activities to attend a minimum of 10 contact hours of educational programs, the proposed rule exempts maintenance and housekeeping.

b) The proposed rule also states that these 9 hours are in addition to the in‐service requirements.


c) Maintains the responsibility for an in‐service, but proposed rule lists 10 topics that must be included each calendar year. See page 7 @57.10(2) to see the list

Acting as Admin at more than one facility the proposed rules are significantly different in the following ways:

a) Removes the cap of 2 facilities, but retains the 150 bed

b) Removes the 50 mile requirement c) Removes the 3, 8 hour days per

week requirement However the rules adds the following requirements:

a) If you are an admin of more than 1 facility, you must designate in writing an administrative staff person in each facility that shall be the person responsible for directing programs in the facility.

b) This designated staff person must also meet 7 qualifications laid out in the rule.

c) Lastly, if an admin serves more than 1 facility, the admin must designate in writing regular and specific times during which the admin will be available to consult with staff and residents to provide direction and supervision of resident care and services.

Acting as Admin at more than one facility the current rules state that an admin may act as an admin for not more than 2 facilities

a) Distance no greater than 50 miles b) Must spend equivalent of 3, 8 hour days per week

in each RCF c) Can’t be responsible for more than 150 beds if

admin of more than 1 facility


Provisional Administrator Proposed rules are the exact same as current rule, but with one change. The current rule requires that the provisional administrator meet the qualifications that are the new qualifications of the “designated administrative person” for purposes of when an admin is acting as admin for more than one facility. See above. Temporary Absence of an Administrator Acting as Admin at more than one facility The proposed rules are almost exactly identical to the current rules on this topic, but add the following changes:

a) Increases age from 18 to 21 b) And adds provision that states if the

admin is going to be gone for more than 6 weeks, a provisional admin must be appointed.

Personnel Regulations 481‐57.11 General Qualifications the proposed rules differ from the current rules in the following ways:

a) Removes express requirement that no person with record of habitual intoxications or addition to drugs can serve in managerial role, but maintains prohibition on persons under the influence from providing services

481‐57.12 General Qualifications Under current rules, general qualifications for staff are laid out.

f) No person with record of habitual intoxications or addition to drugs can serve in managerial role

g) No person under the influence of drugs or alcohol can permit services inside RCF

h) No person shall be allowed to provide services in a facility if the person has a disease if the disease meets certain criteria

i) Individuals with either physical or mental


b) Removes the express prohibition on persons with certain types of diseases from providing services

c) Removes language dealing with persons with mental or physical disabilities from being employed.

d) Moves a requirement that there must be a written job description developed for each category of worker to this section of the regulations.

e) Adds a requirement for a Personnel Record for each employee must be kept and must include name, address, social security #, date of birth, date of employment, position, experience and education, references, results of criminal record checks, child abuse checks, DAA checks, and date of discharge or resignation.

Background Checks The background check requirements are same as current rules Staffing and Supervision The proposed rule is similar to the current rule in the following ways:

a) Maintains personnel in a RCF to provide 24 hour coverage for residential care services.

b) Direct Care staff shall be present in the facility unless all residents are away from the facility

disabilities may be employed for specific duties depending on the circumstances

Staffing and Supervision Under current rules, DIA provides for specific staffing requirements:

a) If a RCF is licensed for than 1 level of care, DIA must establish the number and qualifications of the staff required in a RCF based on the needs of the residents.

b) In a facility licensed for residential care the facility must provide the following staffing ratios for personal care staff a) Day = 1:25 or less b) EVENINGS: 1:35 or less c) NIGHTS 1:45 or less

c) Shall provide 24 hour coverage for residential care services

d) Direct care staff shall be present in facility unless


The proposed rules regarding staffing is different in the following respects:

a) Removes the requirement that DIA must establish the number and qualifications of the staff required in a RCF if licensed for more than 1 level of care

b) Removes the staffing ratios from the regulations

c) Adds the facility must provide sufficient staff to meet the needs of the resident served

d) Adds requirement staff shall be aware of and provide supervision levels based on the present needs of the residents. And the facility must document the supervision of residents requiring more than general supervision as defined by facility policy.

e) Adds requirement the facility must maintain an accurate record of actual hours worked by employees.

f) Moves requirement that employees must have a physical examination before employment and every 4 years thereafter. Screening for TB is required as well to this section

all residents are gone from the facility e) MD orders shall be implemented by qualified

personnel

General Policies 481.57.12 General Policies the proposes rules differ from current rules in the following respects:

481‐57.11 General Policies Current rules provide for a long list of current policies a RCF must have. For a complete list


a) Written job description for each

category of worker is retained , but just moved to a different section of the regulations

b) Physical and TB screening requirement is maintained, but moved to a different section

c) Removes requirement to have health certificates for all employees for review

d) Maintains requirement to have written emergency medical care requirements

e) Removes requirement for written agreement with a hospital for timely admission of a resident that needs hospitalization

f) Removes requirement for policy relating to funeral director notifications upon death.

g) ADDS ALL RCFs must have written policies for “facility operations” that include policies on

a. Personnel , admission, evaluation services, programming and individual program plans, registered sex offender management, crisis interventions, discharge or transfer , med management, resident property and finance ,

please reference this link (https://www.legis.iowa.gov/docs/aco/rule/481.57.11.pdf)


records, health and safety, nutrition, maintenance, resident rights, dependent adult abuse, reporting, transportation of residents, resident supervision, smoking, visitor, emergency planning and infection control

h) Maintains current requirements for personnel policies, infection control and aseptic technique.

Admission Requirements

481‐57.13 General Admission Policies the proposed rules are similar to the current rule in the following ways:

a) No one admitted who has needs that exceed RCF ability to provide

b) Can’t admit more residents that the number of beds for which RCF is licensed.

c) Admission of resident does not give the RCF the authority to manage the resident’s personal affairs except for safety reasons

d) No RCF employee can act as agent for the resident

The proposed rules are different in the following ways:

a) Moves current requirement that is in a different section to this section

481‐57.13 General Admission Policies the current rules lay out 12 regulations on point that relate to general admission to a RCF in Iowa.

a) No one admitted who has needs that exceed RCF ability to provide

b) Can’t admit more residents that the number of beds for which RCF is licensed.

c) No more beds erected than stipulated in the license

d) No more beds in a room that its size will permit e) Admission does not give RCF the right to manage,

us , or dispose of any property of the resident, except for written authorization

f) Admission of resident does not give the RCF the authority to manage the resident’s personal affairs except for safety reasons

g) Funds received by the RCF, belonging to or due to a resident or expendable for the resident’s account must be trust funds.


that residents must be admitted to a RCF only on a written order signed by a MD specifying the level of care and certifying the individual being admitted requires no more than personal care and supervision, bit does not require routine nursing care.

b) Changes age from 16 to 18 to who cannot be admitted to a health care facility for adults unless prior written approval by DIA.

c) Removes no more beds erected than stipulated in the license

d) Removes no more beds in a room that its size will permit

e) Removes admission does not give RCF the right to manage, use , or dispose of any property of the resident, except for written authorization. Financial management is in a separate section and has language to this effect.

f) Moves to a different section under Resident Property funds received by the RCF, belonging to or due to a resident or expendable for the resident’s account must be trust funds.

g) Removes district court can appoint administrator of a county care facility as a conservator or guardian

h) Age restrictions i) No RCF employee can act as agent for the resident j) District court can appoint administrator of a

county care facility as a conservator or guardian


Discharge or Transfer the proposed rule has the same requirements for discharge and transfer as current rules except the following:

a) Removes next of kin from notification requirements.

b) Adds when a resident is transferred or discharged, the resident’s unused prescriptions must be send with resident only upon written MD or physician extender’s order

c) Removes requirement that proper arrangements shall be made by the RCF for the welfare of the resident prior to the transfer or discharge in the event of an emergency or inability to reach the next of kin or legal rep.

d) Removes requirement that prior to the transfer or discharge of a resident to another health care facility, arrangements to provide for continuity of care must be made.

481‐57.14 Involuntary Discharge The proposed rules are very similar to the current rules when it comes to involuntary discharge.

Admission Agreement 481‐57.15 Admission Agreement The proposed rules as it relates to the admission agreement is


the exact same. The only difference is that under the current rules the section is entitled “contracts”, the proposed rule it is entitled “admission agreement”

Medical Examination 481‐57.16 Medical Examinations the proposed rules have the exact same requirements as current rules, with a few minor changes:

a) In the requirement that each resident in a RCF must have a designated licensed physician who may be contacted when needed, add “or physician extender”. Same with the requirement that a record of examination be signed by a physician, this rule would just add as an option a physician extender.

b) Adds in the requirements for part of the records of examination to portray diet now.

c) Removes requirement that arrangements must be made to have a physician available to furnish medical care in cases of emergency. Likely because the rule discussed above in (a) essentially covers this requirement.

Records 481‐57.17 Resident Records The proposed rule has the exact same resident record requirements as current


rules. Some of the current record requirement (medication related) are moved to a different section and tweaked slightly, I will discuss when that section is addressed. But does add that there must be documentation regarding services provide by other providers, including, but not limited to home health agencies ,hospice, day treatment and those providing medical, mental health and waiver services. Confidentiality of Records uses the exact same confidentially language from current rules Incident Record the proposed rule has the exact same requirements as the current rules for incident records but with a one change:

a) Under the requirement that the person in charge at the time of the incident must oversee the preparation and sign the incident report, the new rule adds a requirement that the administrator or designee shall review, sign and date the incident report within 72 hours of the accident, incident or unusual occurrence.

Retention of Records the proposed rules for the most part adopt the same language as current rules require for retention of


records requirements. Below are the differences:

a) Current rules require retention of records to be retained in the RCF for 5 years following the termination of service. This new rule eliminates the 5 years, so must keep records for as long as the RCF operates and subject to the below rule

b) Adds the requirement that when a RCF ceases to operate, records shall be maintained for 5 years in a clean dry secured storage area.

c) Removes the requirement if no transfer occurs when a RCF ceases to operate that the record must be released to the individual physician.

NEW Electronic Records In addition to the access in 481—50.10(2), an authorized representative of the department shall be provided unrestricted access to electronic records pertaining to the care provided to the residents of the facility. (II, III) a. If access to an electronic record is requested by the authorized representative of the department, the facility shall provide a tutorial on how to use its particular electronic system and designate an individual who will, when requested, access the system, respond to any questions or assist the authorized representative as needed in accessing electronic information


in a timely fashion. (II, III) b. The facility shall provide a terminal where the authorized representative may access records. (II, III) c. If the facility is unable to provide direct print capability to the authorized representative, the facility shall make available a printout of any record or part of a record on request in a timeframe that does not intentionally prevent or interfere with the department’s survey or investigation. (II, III)

Resident Care and Personal Services

481‐57.18 Resident Care and Personal Services the proposed rule keep many of the same requirements, but makes the following changes:

a) Removes the requirement that beds should be made daily.

b) Tweaks the current maintain cleanliness requirement so instead of maintaining cleanliness, RCF’s are to “promote” cleanliness”

c) Removes requirement clothing must present neat appearance, be free of odors and to be comfortable

d) Moves requirement to encourage resident to leave rooms and use of recreational or living room of the facility to a later section

e) Removes pass through requirement

481‐57.17 Resident Care and Personal Services Current rules state:

a) Beds must be made daily and complete change to linens must be made at least once a week

b) Residents must have supervision so their personal cleanliness is maintained

c) Necessary clothing to be clean, present neat appearance, be free of odors and to be comfortable. Clothing must be appropriate to their activities ad to the weather

d) Encourages to leave rooms and use of recreational or living room of the facility

e) Residents must not be required to pass through another’s bedroom to reach a bathroom, living room, dining room, corridor, or other common area

f) Uncontrollable residents must be discharged g) Required to bathe a least twice a week h) Non ambulatory residents must be housed on the


grade level floor.

Drugs 481‐57.19 Drug Storage the proposed rule maintains many of the requirements for drug storage as the current rules. But there are notable changes:

a) When dealing with residents who are deemed capable of taking their own medications and that they are allowed to keep the medication in their bedroom, but it must be locked, this new rule also ADDS the requirement that storage must be provided with staff and resident having access. In addition, monitoring of the storage, administration and documentation by the resident must be carried out by a person meeting certain requirements.

b) Removes requirement the drug cabinet must have a work counter

c) Removes requirement running water must be available in the room which the medicine cabinet is located or in an adjacent room

d) Removes requirement double‐lock storage of schedule II shall not be required under single‐unit package drug distribution system in which the quantity stored does not exceed a 3 day supply


481‐57.19(2) Drug Safeguards The requirements for drug safeguards in the proposed rule are substantially similar to the current rule. Difference include:

a) Removes the prohibition from paper envelopes being considered as standard containers.

b) Adds a requirement that sample medications provided by the resident’s MD must clearly identify to whom the medications belong

481‐57.19(3) Drug Administration –authorized personnel the requirements in the proposed rule are virtually identical to the rules laid out in the current rule, with one minor change:

a) The current rule requires a properly trained person shall be charged with the responsibility of administering “nonparental medications”. The new rule would read “a properly trained person shall be charged with the responsibility of administering medications as ordered by a physician or physician extender”.

Drug Administration the proposed rule is mirrors the current rule with the following differences:


a) Adds the provision that for purposes of injectable medications, this definition would not include an epipen.

b) Adds a requirement to the current language that deals with an individual inventory record being maintained for each schedule II drug prescribed for each resident by adding :with an accurate count and authorized signature every shift”

NEW Medication Aides Medication aides and medication managers may administer PRN medications without contacting a licensed nurse, physician, or physician extender if all of the following apply: (I, II, III)

(1) A written order from the resident’s physician specifies the purpose of the PRN medication and the frequency, dosage and strength of the PRN medication.

(2) The resident’s physician provides in writing specific criteria for administering PRN medications.

(3) The pharmacist shall assess the resident’s use of PRN medications quarterly when conducting quarterly review.

h. If the physician or physician extender has certified in writing that the resident is capable of self‐administering medications and determining the need for PRN medications, the physician or physician


extender shall provide in writing specific criteria for the self‐administration of the PRN medications. The pharmacist shall assess the resident’s use of PRN medications quarterly when conducting quarterly review. (I, II, III) i. If the physician or physician extender has certified that the resident is not capable of taking prescribed medication, it must be administered by a qualified person of the facility. A “qualified person,” for purposes of this subrule, means a registered or licensed practical nurse or an individual who has completed the state‐approved training course in medication administration. (I, II, III) j. Medications administered by an employee of the facility shall be recorded on a medication record by the individual who administers the medication. (I, II, III)

Dental Services

481‐57.20 Dental Services the proposed rules mirror the current rules with just a few differences

a) Adds to the list of individuals that upon request can trigger dental services to be performed is physician and physician extender

b) Removes the requirement that dentists shall be asked to participate in the in‐service program of the RCF


c) Added that as available, the facility shall make reasonable efforts to obtain the records following the provision of service. Under current law it states that all dental reports or progress notes shall be included in the clinical record.

Dietary

NEW All food shall be handled, prepared served and stored in compliance with the Food Code adopted pursuant to Iowa Code 137F.2 (2009 Food Code) and deletes outdated and duplicative rules already covered by the Food Code). A minimum of one person directly responsible for the food preparation shall successfully complete a course meeting the requirements for a food protection program included in the Food Code adopted pursuant to 137F. Another course may be substituted if the course curriculum includes substantially simmer competencies to a course that meets the requirement of the food code and the provider of the course files with the Department a statement indicating that the course provides similar instruction as it relates to sanitation and safe food handling Nutrition and Menu Planning: a. Menus shall be planned and followed to


meet the nutritional needs of residents in accordance with the primary care provider’s orders. Diet orders should be reviewed as necessary, but at least quarterly, by the primary care provider. (II, III) b. Menus shall be planned and served to include foods and amounts necessary to meet federal dietary guidelines. (II, III) c. At least three meals or their equivalent shall be served daily, at regular hours. (II, III) (1) There shall be no more than a 14-hour span between offering a substantial evening meal and breakfast. (II, III) (2) Unless contraindicated, evening snacks shall be offered routinely to all residents. Special nourishments shall be available when ordered by the primary care provider. (II, III) d. Menus shall include a variety of foods prepared in various ways. (III) e. Menus shall be written at least one week in advance. The current menu shall be located in an accessible place for easy use by persons purchasing, preparing, and serving food. (III) f. Records of menus as served shall be filed and maintained for 30 days and shall be available for review by departmental personnel. When substitutions are necessary or requested, they shall be of similar nutritive value and recorded on the menu or in a notebook. (III) g. The facility shall provide an alternative choice at scheduled meal

Orientation and Service


Plan 481‐57.212 Orientation and Service Plan The proposed rules are fairly similar to the current rules with the following additions:

a) Still have to have an orientation plan, except that under the new rules it must be completed within 24 hours of admission It must be documented in the resident’s file and is not limited to a review of the resident’s rights, daily schedule, house rules and the facility’s evacuation plan.

b) NEW must have an initial service plan completed within 48 of admission to address immediate health needs, plan is based on from info from family, resident, MD and significant parties. Must follow plan until Service plan is followed

c) Just like the current rule, must have a service plan within 30 days of admission, in conjunction with any organization or responsible party that works with the resident. The plan must address the same needs and areas as laid out in current rules.

d) NEW the service plan must now have measureable goals, objectives and services to achieve those goals and provide documentation. The current rules just require the service plan to include goals.


Resident Activities Program

481‐57.23 Resident Activities Program the proposed rules mirror the current rules with the follow additions and removals:

a) For the requirement that an RCF must have an organized resident activity program, the new rule adds that the facility must have at least 2 organized evening group activities per week and two organized weekend group activities per month

b) Maintains that the programs should have goals for each resident, adds that the goals must be measureable

c) Maintains the activity program shall include group and individual activities and that residents are not required to participate.

Coordination of the Activities Program mirrors the current rules with one a few additions and one removal. Otherwise the same.

a) NEW Adds that each RCF over 15 beds must designate a person to oversee the activity program

Duties of the Activity Coordinator are the exact same as the current rules with one addition and one removal:

a) Adds that monthly calendars, prepared in advance, must be


maintained for one year b) Removes requirement that the

activity coordinator participates in in‐service training.

Residents’ Rights 481‐57.24 Residents’ Rights The proposed rule is significantly different than the current rules in so far as that it tries to clean‐up and tighten‐up the provision. Current regulations on this point are verbose and overly complex.

a) Maintains language that an RCF must have policies in place that are written to ensure these policies govern all areas of service

b) The proposed is the exact same for complaint/recommendation mechanism, with the addition, that a RCFs policy must include assistance for resident to submit a claim.

c) Maintains policies governing access to records by resident.

d) Maintains requirement that a resident must be fully informed of their rights and their responsibilities upon admission

e) Maintains that the RCF must communicate to the resident what they can expect from the RCF and its staff and what is expected from

481‐57.35 Residents’ Rights Begins with the same language in the proposed rules that the facility must ensure that policies and procedures to ensure these polices govern all areas of service.

a) Current rules provide for a section requiring policies regarding admission, transfer and discharge shall ensure various requirements

b) Policies regarding chemical and physical restraints shall provide details on who and when to apply restraints

c) Policies for a mechanism for residents to submit complaints

d) Polices governing access to resident records e) Policies that the resident will be fully informed of

what will be expected of staff and what will be expected of resident. RCF must communicate between 5 days and no later than 2 weeks upon admission.

f) Polices that the resident shall be fully informed of the resident rights and provide at the time of admission.

g) Must be communicated in a language understood by resident

h) Requirements for resident to sign, posting of the rights and responsibilities and any changes made to resident rights residents must be advised within 30 days.


the resident. However, differs from current rules in that the current rules allows for 5 days up to 2 weeks. The proposed rule states this must be done within 5 days.

f) Maintains must be communicated in a language resident understands

g) Maintains resident signature requirement that they understand

h) Maintains requirement that a copy be posted prominently

i) Maintains the requirement that any changes to the rights that residents must be advised within 30 days

Choice of Physician The proposed ruled virtually strike the entire medical rights section in current law and replace it with:

a) Each resident can have choice of physician if accessible. The RCF may require the pharmacy to utilize a drug distribution system compatible with the system the RCF uses

b) Does maintain language that the resident does have the right to participate in planning of their total care. And that a resident has the right to refuse care

c) Does maintain that the resident shall be encouraged and assisted to exercise their rights and may voice grievances and recommend

i) Each resident shall be informed in a contract of the services made available in the facility and items not covered in facilities’ per diem.

Medical rights

a) Each resident must be made fully informed by a physician of the resident’s health and medical conditions

b) Each resident has a right to participate in the planning of their total care

c) Provisions regarding experimental research d) Resident has a right to refuse treatment e) In the case of an intellectually disabled person, the

responsible party has the right to participate in the planning in the total care of the resident.

f) Right to be informed of their condition and the admin shall be responsible for working with the attending MD for the implementation of this

g) More provisions regarding human subjects h) Policies on people with dangerous or disturbing

behavior and criteria for their retention or admission


changes free from reprisal d) Adds RCF must provide ongoing

opportunities for residents to be aware of and exercise their rights as a resident

e) Adds residents must be informed of issues or pending decisions of the RCF that affect the resident and their vies shall be solicited prior to action

f) Maintains to post in prominent area the name of ombudsman, local law enforcement and survey agency.

Dignity Preserved Proposed rule mirror current rules on dignity issues

New Communications the proposed rule is virtually the same as current rules with one minor change:

a) The current rules require that telephones consistent with ANSI standards are made available; the proposed rule merely strikes the ANSI standard.

Resident Activities the proposed rule has the exact same language as current rules 481‐57.28 Resident Property the proposed rule is essentially completely different.

a) It strikes b‐d of the analysis to the

481‐57.37 More Resident Rights

a) Right to be encouraged and assisted to to carry our resident rights and express grievances

b) Must have written procedure for resident to voice complaints

c) Must post in prominent area the name of ombudsman, local law enforcement and survey agency.

481‐57.45 Resident Property

a) Residents allowed to keep reasonable amounts of


right. b) It adds to section a) The facility

must offer the resident the opportunity to have personal property itemized and documented on an inventory sheet upon admission, at discharge residents may sign off on a list of the personal property they are taking with them.

c) Facility must provide for safekeeping of personal effects, funds and other property of resident

d) RCF may require that items of exceptional value be removed from RCF for safekeeping

e) Funds or properties received by the RCF belonging or due to a resident shall be trust funds

Financial affairs management the proposed rule is the exact same as current rules Resident Work the proposed rules are the exact same as current rules NEW Family Shared Rooms 481‐57.31 The proposed rule adds a section stating that family members shall be allowed to share a room if available and requested by both parties unless MD says otherwise.

personal clothing. Must be kept in a safe location and convenient for resident

b) Prior to or at admission resident will be advised of what kind and amount of clothing will be permitted and what the RCF will be responsible for

c) Property cannot be sued without written consent of resident

d) A resident’s personal property must be returned when it has been used without consent.


Resident Abuse prohibition – The proposed rule is the exact same as the current rule except removes “each resident shall be free from chemical and physical restraints, except in an emergency (then lays out details of when and how). NEW Crisis Intervention the proposed rule devote a new section regarding if a facility uses physical restraints what the regualtiosn require: Shall be written policies that define the uses of physical restraints, designate the administrator or designee as those who may authorize its use, and establish a mechanism for monitoring and controlling its use. (I, II)

57.33(1) Temporary physical restraint of residents shall be used only under the following conditions: (I, II) a. An emergency to prevent injury to the resident or to others; or (I, II) b. For crisis intervention, but shall not be used for punishment, for the convenience of staff or as a substitution for supervision or program; (I, II) and c. No staff person shall use any restraint that obstructs the airway of the resident. (I, II) 57.33(2) Authorization for the use of physical restraints must be prior to or immediately after application of the restraint. (I, II)


57.33(3) Prone restraint is prohibited. Staff persons who find themselves involved in the use of a prone restraint when responding to an emergency must take immediate steps to end the prone restraint. (I, II)

57.33(4) The rationale and authorization for the use of physical restraint and staff action and procedures carried out to protect the resident’s rights and to ensure safety shall be clearly set forth in the resident’s record by the responsible staff persons. (I, II) 57.33(5) The physician or physician extender, interdisciplinary team and the resident’s responsible party shall be notified of any restraints administered. (I, II, III)

57.33(6) The facility shall provide a department‐approved training program by qualified professionals to the staff on physical restraint techniques. (I, II) a. The facility shall keep a record of training for review by the department and shall include attendance. (II, III) b. Only staff with documented training in physical restraint and techniques shall be authorized to assist with physical restraint of a resident. (I, II) c. Under no circumstances shall a resident be allowed to actively or passively assist in the restraint of another resident. (I, II)


57.33(7) Residents shall not be kept behind locked doors. (I, II)

Safety 481‐57.34 Fire Safety The proposed rules are the exact same as current rules Safety Duties of Administrator The proposed rules are the exact same as the current rules Resident Safety are the same as current rules with the following changes:

a) Removes all smoking rules, and replaced with that smoking shall be permitted except as allowed for Iowa’s Smoke Free Clean Air Act

b) Moves from housekeeping to this section, storage area for cleaning agents or any other poisonous material must be locked, and residents that are permitted access to these materials must be supervised as identified in the service plan

c) Moves to this section from housekeeping Sufficient # of noncombustible trash cans with covers must be made available

d) Moves from housekeeping section to this section personal possessions that may constitute a hazard to


themselves or others shall be removed and stored

e) Moves from supplies section to this section a first aid kit must be available on each floor in every RCF

Housekeeping 481‐57.35 Housekeeping –The proposed rule is the exact same as the current rule except that old rules did not allow for throw or scatter rugs. The proposed new rule will allow for them as long as the have a nonskid backing

481‐57.26

Maintenance 481‐57.36 Maintenance The proposed rule is the exact same as the current rule

481‐57.27

Laundry 481‐57.38 Laundry The proposed rule is the exact same as the current rule, except the rule does remove:

a) Removes the requirement that special provisions must be made for the disposal of soiled dressings and similar items in a safe, sanitary manner

b) Old rules required personal laundry shall be marked with an identification. New rules say that only applies now if the laundry is co‐mingled.

481‐57.29

Supplies 481‐57.39 Supplies this sections is the exact same as


current rules except for 3 new additions: a) Adds each facility shall provide a

variety of supplies and equipment of a nature to fit the needs and interests of residents

b) Locked storage should be available for potentially dangerous items such as knives and scissors and toxic materials

c) Current rules called for “uncrowded and convenient” storage for linens and pillows and bedding. New rules strike uncrowded and convenient and replace with adequate

Buildings, Furnishings and Equipment

481‐57.40 Building General Requirements the proposed rule is trimmed down considerably, but RCFs are still required to adhere to physical requirements in chp 60 and Life Safety Code. In fact, all of the items listed to the right are found in 481‐.60, except items (b),(k) and (n)

a) Keeps whenever glass sliding doors or transparent panels are used, they shall be marked conspicuously in chp 57

b) Keeps the facility shall meet the equivalent requirements of the appropriate group occupancy of the state building code in chp 57

Furnishing and Equipment Keeps the exact

481‐57.30 Building General Requirements

a) Lays out computation for usable floor space in bedrooms and other living area.

b) Must have a battery operated portable emergency light, at a ratio of 1 light per employee on duty from 6 to 6

c) Light fixtures equipped to prevent glare and hazard

d) Exposed heating pipes, etc need to be covered in rooms used by residents

e) All windows have clean curtains and in good repair f) Fans located within 7 feet of floor must be

protected by screen guards g) Glass sliding doors must be marked h) RCF must meet equivalent requirements of the

appropriate group occupancy of the state bldg. code


same rules for furnishing and equipment, but removes requirement from chp 57 that night lights shall be provided in corridors at stairways, attendant’s station and resident’s bedrooms, and hazardous areas because it is in chp 60 Dining and Living Room the new proposed rule is very similar to the current rule with the following changes:

a) Removes requirement dining room and living rooms shall at no time be used as bedrooms

b) Removes combination dining room and living room may be permitted if the space requirements of a multipurpose room are met.

c) Removes multipurpose rooms requirements , but only because they are already in Chp. 60

d) Removes space requirements for living room when used for activity and rec. purposed only because this rule is already in chp 60.

e) Removes when space is provided to be used only for dining, the area shall total at least 15 square feet per bed

Bedrooms the proposed rule maintains many of the same current rules, and vast majority of the removals are again because they are listed in chp 60. That being said, there are a few changes to be aware of:

i) No room can be enclosed, subdivided unless part is separately lighted and ventilated

j) All stairways in resident‐occupied areas must have substantial handrails on both sides

k) Each open stairway must have protective barrier l) Screen of 16 mesh per square must be at all

openings m) Screen doors must swing outward and be self‐

closing, unless SFM Office say otherwise n) All resident rooms must have a door o) Rooms in resident occupied area must have a

general lighting switched at the entrance of each room


a) Removes requirement there shall be a drawer space for each resident’s clothing

b) Removes ceilings and floors shall have cleanable surfaces and kept in good repair. But chp 60 still requires wall assemblies must be constructed to present a cleanable surface

c) Removes wardrobe or closet dimensions requirements from chp 57, but there is the same requirement in chp 60 but with different dimensions

d) Removes requirement that each room have accessible mirrors

e) Removes requirement from chp 57 regarding each room be provided with light and ventilation by means of a widow an area equal to 1/8 the floor area. But the same requirement exists in chp 60, but instead of 1/8 pf floor area, the rule calls for 10 % of the floor area in a supervised care unit

Bath and Toilet the proposed rule maintains many of the same current rules, and vast majority of the removals are again because they are mostly listed in chp 60 in the supervised care unit. That being said, there are a few changes to be aware of:

a) Adds that toilet paper shall be readily available to residents


b) Virtually everything else is removed, but that’s because the rule is already covered under the supervised care unit section of chp 60

Heating both the proposed and current rule in chp 57 require a centralized heating system and portable units or space heaters are prohibited from being used except for in emergency. However, the draft rule only requires that the system be maintained in good working order and capable of maintaining a comfortable temp for resident. The current rule in chp 57 requires that the centralized heating system is capable of maintaining a temp of 78 degrees. In looking at chp 60 a similar requirement is made in that it states “the heating system must be capable of maintaining a temp of 78 in all occupied areas at a winter design temp of 10”. Water Supply The proposed rules are the exact same as the current rules with 2 changes

a) Current rules require every facility to have an adequate water supply from an approved source. The proposed rules strike this requirement, but current rules in chp 60 requires facilities shall have a potable water source from a city water system or a private source which complies with the


regulations and is approved by the department of natural resources

b) For the annual private source of water test, the RCF just now make it available for review upon DIA request, whereas current 57 stated this report must be submitted with the annual application for license.

Sewage System the proposed rules remove these requirements, by they are already in chp 60 Attendant’s Station the proposed rules remove this requirement, but it is already in chp 60 under supervised care unit section.

Family and Employee Accommodations

481‐57.41 Family and Employee Accommodation the proposed rules are the exact same current rules except that it removes:

a) Removes prohibition of children under 14 from being the service area

b) Removes prohibition that residents bedrooms shall not be occupied by employees, family members of employees or family members of the licensee

c) Removes the requirement that in an RCF of less than 5 total occupancy of family, employees and residents , there must be one

481‐57.31


toilet and one tub or shower as the minimum

Family Visits Current rules remove the section under current rules relating to family visits 481‐57.46

Another business or activity in a facility

481‐57.43 The proposed rule is the exact same as the current rules

Respite Care services

481‐57.44 Rules are the exact same with the following key difference

a) Inserts new time frame of no more than 30 consecutive days and for no more than 60 consecutive days in a12 month period.

b) Adds admissions items for consideration

a. Respite resident shall not be considered as part of the admission to RCF but shall be part of a facility’s census

b. Cannot enter into multiple 30 day contracts

c. If the resident is there longer than the 30 days and is eligible for admission, DIA will consider that person as a resident

481.57.51

Documents

RCF Rule Overview 122014 - Iowa Health Care€¦ · and variance. The list of items that a ... approved by DIA for RCF admins