Assisted Living Forum State of Assisted Living September 9, 2008 New DQA Assisted Living Boundaries effective 1-1-2007 Where are we going? 2008 - 2009 Continue and Expand Collaborations Using data to effect positive change Deploying Resources to Effect Positive Change Proactive Compliance Implement HFS 83 New facility video on Web Medication Management Initiative Make more information available on the web statistics, trends, etc.
Support and Encourage Innovation To have the best staff with the tools and training to do their job Trends & Statistics Assisted Living Trend in # of Facilities 1600 1400 1200 1000 800 600 400 200 0 1348 1352 1359 1367
2007 Jun-08 Family Care Impact on AL Industry Family Care counties Rest of State 2000 Capacity 4.3 beds/100 3.2 beds/100 2006 Capacity 5.9 beds/100 3.7 beds/100 36.3% 21.8%
Average increase Projections indicate 62% of the state will be covered by Family Care by June, 2009 Relocations 540 of 1412 residents of ICF/MRs have been moved: 449 moved into BAL regulated facilities 341 into 3-4 bed AFHs 108 into 5-8 bed CBRFs 872 residents are left to be moved 1,282 nursing home relocations have been completed (majority to BAL regulated facilities) 905 elderly residents 379 individuals with developmental disabilities Nursing Home Diversions 300 slots Majority to BAL regulated facilities Population Served 4215 assisted living residents with Long Term Care Functional Screen data:
34% have diagnosis of Alzheimers disease 92.6% need assistance with bathing 70.5% need assistance with dressing 33.4% need assistance with eating 49.9% need assistance with toileting 18.3% require a behavior intervention 3,460 MH diagnoses (depression, anxiety, bipolor, schizophrenia) 56.7% use a walker 26.7% use a wheelchair or scooter These residents are publicly funded under MA Waivers, Family Care, or Pace/Partnership to live in AFHs, CBRFs, and RCACs Waiting Lists As of May 31, 2007 11,625 on the COP/Waiver waiting list With entitlement, how many of these will be
living in BAL regulated facilities.? Publicly Funded Clients in AL * Estimated publicly funded clients in occupied AL beds 45% 40% 35% 44% 30% 25% 20% 28% 15% 10% 5% 0% 2004 2006 Public Funding becoming more influential driver..
New AL vs. Closed AL 400 350 307 300 261 256 250 352 322 289276 247 223 323 321 293 243
30 40 50 60 70 T o p T e n C it a t io n C B R F s ( J a n - J u n 2008) R E S P O N S IB IL IT IE S B U IL D IN G M A IN T E N A N C E P R OM P T A N D A D EQU A TE TR EA TM EN T M E D IC A T IO N S S L E E P IN G H O U R S E V A C U A T IO N D R IL L 14 18 18
17 17 16 26 25 25 35 Top Citations RCACs (CY 2007) 0 1 2 3 4 5 Number of Citations 89.34(16)
89.56(2) 89.26(4) 89.29(2)(b)1 89.34(1) 89.23(4)(b)1 89.23(4)(a)2 89.28(1) TENANT RIGHTS PLAN OF CORRECTION ANNUAL REVIEW ADMISSION & RETENTION OF TENANTS TENANT RIGHTS SERVICES SERVICES RISK AGREEMENT 6 Top Citations (RCAC) Jan-Jun 2008 3 2 1 Tenant Services Rights 89.23(2)(c)
89.34(16) 1 1 1 1 1 1 1 1 1 Top Ten Citations AFH CY 2007 MEDICATION - WRITTEN ORDER 41 TRAINING-15 HOURS WITHIN 6 MONTHS
31 HOME ENVIRONMENT 29 FIRE EVACUATION ANNUAL EVALUATION 29 RESPONSIBILITIES 28 FIRE SAFETY-FIRE EXTINGUISHERS 25 TRAINING-8 HOURS ANNUALLY 23 SMOKE DETECTORS-TESTING AND MAINTENANCE 23
SEMI-ANNUAL FIRE DRILLS 22 HEALTH SCREENING FOR STAFF 22 Top Twelve Citations AFH CY 2006 ADMISSION-HEALTH EXAM 14 INDIVIDUAL SERVICE PLAN & ASSESSMENT 14 FREE OF HAZARDS 14 SEMI-ANNUAL FIRE DRILLS FIRE EVACUATION ANNUAL EVALUATION HOME ENVIRONMENT 16 17
18 RESPONSIBILITIES 19 TRAINING-8 HOURS ANNUALLY 19 TRAINING-15 HOURS WITHIN 6 MONTHS MEDICATION- WRITTEN ORDER HEALTH SCREENING FOR STAFF REVIEW OF ISP 23 24 25 31 Top 11 Citations (AFH) Jan-Jun 2008 21 HOME ENVIRONMENT 18
RESPONSIBILITIES MEDICATION- WRITTEN ORDER DIFFICULTY WALKING FIRE SAFETY- FIRE EXTINGUISHERS FIRE EVACUATION ANNUAL EVALUATION PRESCRIPTION MEDICATIONS SMOKE DETECTORS- TESTING AND MAINTENANCE INDIVIDUAL SERVICE PLAN & ASSESSMENT TRAINING- 15 HOURS WITHIN 6 MONTHS SEMI- ANNUAL FIRE DRILLS 16 16 15 14 14 14 13 12 12 Surveys with Enforcement 600 471 500 373
400 505 447 409 467 294 300 200 545 245 162 100 0 2000 2001 2002 2003 2004 2005 2005- 2006 2007 Jun4yr 08 % of Facilities making up % of Enforcement
CBRF AFH RCAC ADC Type of Sanctions CY 2007 4 15 61 49 370 362 216 Comply POC Comply Req. Forfeiture Provide Training
Revoke/Deny No Admission Other Type of Sanctions June 30, 2008 8 9 57 147 25 160 80 Comply POC Comply Req. Forfeiture Provide Training Revoke/Deny No Admission Other Top Ten Citations w/Forfeitures CBRF CY 2007 $33,875
PROMPT AND ADEQUATE TREATMENT $16,850 SUPERVISION $15,800 FIRE SAFETY, FIRST AID & CHOKING $11,875 MEDICATIONS RESPONSIBILITIES $8,800 INDIVIDUALIZED SERVICE PLAN-SCOPE $8,100 ADEQUATE STAFFING $7,760 UNIVERSAL PRECAUTIONS
$7,400 PREPAID FEES RETURNED WITHIN 10 DAYS STAFFING PATTERNS $6,875 $6,300 Top Ten Citations w/Forfeiture (CBRF) Jan-Jun 2008 $31,020 RES P ONS IB ILITIES P ROMP T AND ADEQUATE TREATMENT $23,570 $17,940 MEDIC ATIONS ADEQUATE S TAFFING S UP ERVIS ION C BRF ARRANGE HEALTH VIS ITS AND DOC UMENT C LIENT GROUP S P EC IFIC S ERVIC ES S AFE ENVIRONMENT MEDIC ATION ERRORS AND ADVERS E REAC TIONS
FIRE S AFETY, FIRS T AID & C HOKING $17,310 $8,900 $8,425 $8,000 $7,300 $6,600 $5,800 Forfeiture Assessments $600,000 $547,300 $459,830 $439,406 $407,102 $500,000 $400,000 $433,055 $314,954
Abuse Neglect Fire Comm. Disease Self Reports Investigated - CY 2007 (1,271) 1206 65 No SOD SOD Self Reports Investigated - June 2008 (715) 672 43 No SOD SOD Facilities Qualifying for Abbreviated Surveys June 2008 Adult Day Care
Adult Family Homes Community Based Residential Facility Residential Care Apartment Complex Statewide 61.3% 42.7% 38.9% 50.4% 42.2% Facilities Qualifying for an Abbreviated Survey 43.00% 42.20% 42.00% 40.50% 41.00% 40.00% 39.00% 38.00% 37.90%
IN SUMMARY. Growth continues across all Assisted Living providers although new licenses issued appears to be declining somewhat. More RCAC growth with certified as the gap with registered continues to widen. ICF/MR rebalancing, NH relocation initiative and Family Care expansion having direct impact on AL growth. AL licensed beds projected to exceed NH & ICF/MR licensed beds by end of 2008 or early 2009 In addition to overall growth, there is significant turnover with increases in voluntary closures, and Change of Ownership (CHOW) Fit and Qualified policy having a positive effect with increase of license denials and withdrawn applications IN SUMMARY. Citations per survey decreased slightly. Top citations and type of sanctions more reflective of deployment of resources to facilities with non-compliance concerns or allegations BAL continues to refine directed plans of correction to help facilities achieve and sustain compliance. When this does not work, progressive, punitive enforcement usually does Compared to number of facilities and beds, CBRFs make up a significantly high proportion of enforcement Compared to number of beds, AFHs make up a significantly high proportion of enforcement although it did
decrease from CY 2007 IN SUMMARY. Complaints projected to increase slightly Compared to number of facilities and beds, CBRFs make up a significantly high proportion of complaints Compared to number of beds AFHs make up a significantly high proportion of complaints and appears to be increasing IN SUMMARY. Self reports received is projected to increase again, but when investigated rarely result in deficiencies. BAL not meeting the workload with overall growth in industry, more complex investigations, increased enforcement and self reports. IN SUMMARY. The new resident is impacting the regulatory activity Majority of assisted living in Wisconsin is very good and continues to improve Collaboration continues to move the bell curve to the right
More facilities qualifying for abbreviated surveys For CY 2007 only 15 % of facilities make up 100% of the complaints and enforcement action. Moving the Bell Curve to the Right... Thank You!
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