Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 134. FACILITIES SERVING PEOPLE WITH DEVELOPMENTAL DISABILITIES
SUBCHAPTER V -- SERVICES
Date:
08/31/2009
Document:
DHS 134.70 Special requirements when persons are admitted for short-term care.
(1) SCOPE. Facilities that admit persons for short-term care may use the procedures included in this section rather than the procedures included in ss. DHS 134.52 and 134.60 (1). The requirements in this section apply to all facilities that admit persons for short-term care when they admit, evaluate or provide care for these persons. Short-term care is for either respite or recuperative purposes. Except as specified in this section, all requirements of this chapter including s. DHS 134.51, apply to all facilities that admit persons for short-term care.
(2) PROCEDURES FOR ADMISSION. (a) Respite care. For a person admitted to a facility for respite care, the following admission and resident care planning procedures may be carried out in place of the requirements under ss. DHS 134.52 and 134.60 (1):
1. A registered nurse or physician shall complete a comprehensive resident assessment of the person prior to or on the day of admission. This comprehensive assessment shall include evaluation of the person's medical, nursing, dietary, rehabilitative, pharmaceutical, dental, social and activity needs. The consulting or staff pharmacist shall participate in the comprehensive assessment as provided under sub. (4)(a). As part of the comprehensive assessment, when the registered nurse or physician has identified a need for a special service, staff from the discipline that provides the service shall, on referral from the registered nurse or physician, complete a and assessment of the person's prior health and care in that discipline. The comprehensive resident assessment shall include:
a. A summary of the major needs of the person and of the care to be provided;
b. A statement from the attending physician that the person is free from tuberculosis and other clinically apparent communicable diseases; and
c. The attending physician's plans for discharge.
2. The registered nurse, with verbal agreement of the attending physician, shall develop a written plan of care for the person being admitted prior to or at the time of admission. The plan of care shall be based on the comprehensive resident assessment under subd. 1., the physician's orders and any special assessments under subd. 1.
3. The facility shall send a copy of the comprehensive resident assessment, the physician's orders and the plan of care under subd. 2. to the person's attending physician. The attending physician shall sign the assessment and the plan of care within 48 hours after the person is admitted.
(b) Recuperative care. For a person admitted to a facility for recuperative care, the following admission and resident care planning procedures may be carried out in place of the requirements under ss. DHS 134.52 and 134.60 (1):
1. The person may be admitted only on order of a physician accompanied by information about the person's medical condition and diagnosis, the physician's initial plan of care, and either the physician's written certification that the person is free of tuberculosis and other clinically apparent communicable diseases or an order of a physician for procedures to treat any disease the person may have.
2. A registered nurse shall prepare an initial plan of care for nursing services to be implemented on the day of admission, which shall be based on the physician's initial plan of care under subd. 1. and shall be superseded by the plan of care under subd. 5.
3. A physician shall conduct a physical examination of the new resident within 48 hours following admission, unless a physical examination was performed by a physician within 15 days before admission.
4. A registered nurse shall complete a comprehensive resident assessment of the person prior to or within 72 hours after admission. The comprehensive assessment shall include evaluation of the person's nursing, dietary, rehabilitative, pharmaceutical, dental, social and activity needs. The consulting or staff pharmacist shall participate in the comprehensive assessment as provided under sub. (4)(a). As part of the comprehensive assessment, when the registered nurse has identified a need for a special service, staff from the discipline that provides the service shall, on referral from the registered nurse, complete a and assessment of the person's prior health and care in that discipline.
5. The registered nurse, with verbal agreement of the attending physician, shall develop a written plan of care for the new resident within one week after admission. The plan of care shall be based on the comprehensive resident assessment under subd. 4., the physician's orders, and any special assessment under subd. 4.
6. The facility shall send a copy of the comprehensive resident assessment, the physician's orders and the plan of care under subd. 5. to the new resident's attending physician. The attending physician shall sign the assessment and the plan of care.
(3) ADMISSION INFORMATION. (a) This subsection takes the place of s. DHS 134.31 (3)(d) 1. for persons admitted for respite care or recuperative care.
(b) No person may be admitted to a facility for respite care or recuperative care without signing or the person's guardian or designated representative signing an acknowledgement of having received a statement before or on the day of admission which contains at least the following information:
1. An indication of the expected length of stay, with a note that the responsibility for care of the resident reverts to the resident or other responsible party following expiration of the designated length of stay;
2. An accurate description of the basic services provided by the facility, the rate charged for those services and the method of payment for them;
3. Information about all additional services regularly offered but not included in the basic services. The facility shall provide information on where a statement of the fees charged for each of these services can be obtained. These additional services include pharmacy, x-ray, beautician and all other additional services regularly offered to residents or arranged for residents by the facility;
4. The method for notifying residents of a change in rates or fees;
5. Terms for refunding advance payments in case of transfer, death or voluntary or involuntary termination of the service agreement;
6. Conditions for involuntary termination of the service agreement;
7. The facility's policy regarding possession and use of personal belongings;
8. In the case of a person admitted for recuperative care, the terms for holding and charging for a bed during the resident's temporary absence; and
9. In summary form, the residents' rights recognized and protected by s. DHS 134.31 and all facility policies and regulations governing resident conduct and responsibilities.
(4) MEDICATIONS. (a) The consulting or staff pharmacist shall review the drug regimen of each person admitted to the facility for respite care or recuperative care as part of the comprehensive resident assessment under sub. (2)(a) 1. or (b) 4.
(b) The consulting or staff pharmacist, who is required under s. DHS 134.67 (3)(b) to visit the facility at least quarterly to review drug regimens and medication practices, shall review the drug regimen of each resident admitted for recuperative care and the drug regimen of each resident admitted for respite care who may still be a resident of the facility at the time of the pharmacist's visit.
(c) Respite care residents and recuperative care residents may bring medications into the facility as permitted by written policy of the facility.
(5) PHYSICIAN VISITS. The requirements under s. DHS 134.66 (2)(b) for physician visits do not apply in the case of a respite care resident, except when the nursing assessment indicates there has been a change in the resident's condition following admission, in which case the physician shall visit the resident if this appears indicated by the assessment of the resident.
(6) PRE-DISCHARGE PLANNING CONFERENCE. (a) For residents receiving recuperative care, a planning conference shall be conducted at least 10 days before the designated date of termination of the short-term care, except in an emergency, to determine the appropriateness of discharge or need for the resident to stay at the facility. At the planning conference a care plan shall be developed for a resident who is being discharged to home care or to another health care facility. If discharge is not appropriate, the period for recuperative care shall be extended, if it was originally less than 90 days, for up to the 90 day limit, or arrangements shall be made to admit the person to the facility for care that is not short-term, as appropriate.
(b) Paragraph (a) takes the place of s. DHS 134.53 (4)(c) 1. and 2. for recuperative care residents.
(7) RECORDS. (a) Contents. The medical record for each respite care resident and each recuperative care resident shall include, in place of the items required under s. DHS 134.47 (4):
1. The resident care plan prepared under sub. (2)(a) 2. or (b) 5.;
2. Admission nursing notes identifying pertinent problems to be addressed and areas of care to be maintained;
3. For recuperative care residents, nursing notes addressing pertinent problems identified in the resident care plan and, for respite care residents, nursing notes prepared by a registered nurse or licensed practical nurse to document the resident's condition and the care provided;
4. Physicians' orders;
5. A record of medications;
6. Any progress notes by physicians or other persons providing health care to the resident that document resident care and progress;
7. For respite care residents, a record of change in condition during the stay at the facility; and
8. For recuperative care residents, the physician's discharge summary with identification of resident progress and, for respite care residents, the registered nurse's discharge summary with notes of resident progress during the stay.
(b) Location and accessibility. The medical record for each short-term care resident shall be kept with the medical records of other residents and shall be readily accessible to authorized representatives of the department.
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