Minnesota Department of Health - Assisted Living Teleconference June 17, 2021 PROTECTING, MAINTAINING AND IMPROVING THE HEALTH OF ALL ...

Minnesota Department of Health

   Assisted Living Teleconference │ June 17, 2021
     PROTECTI NG , M AINTAINING AND IM PROVING THE HEALTH OF ALL M IN N ESOT AN S

Assisted Living Licensure
  2020 Minnesota Statutes Chapter 144G   2

Agenda

 Staffing Requirements Part 2

 Assessments & Reviews

 What to have ready by 8/1

 Food &Kitchens Part 1
                                          3

Housekeeping

• Presenters are unmuted –
  please announce yourself
  and your role prior to
  speaking
• Public attendees are
  muted – please submit
  any comments or
  questions in the chat
  feature (bottom right)
                                        4

Application Stats

   Approx. 2005 conversion applications
    submitted

   51 provisional applications submitted

   MDH has confirmed 1378 payments

   262 open to pay

   102 applicants have notified MDH background
    checks are completed

                                                                  5

Finalize Your License

 Submit Payment

    Once application has been deemed complete, payment email is sent to the PERMANENT BUSINESS
     email address

 Complete DHS Background Study

    Once payment has been submitted, BGS email is sent to the AUTHORIZED AGENT email address

 Notify MDH when all your ALF Background studies for your license are complete
    Once you have received all your BGS confirmations from DHS and all required parties are determined
     to be eligible, notify MDH at health.assistedliving@state.mn.us

    Please include you ALL HFID #

                                                                                                      6

Staffing Requirements Part 2
                               7

144G.60 Staffing Requirements

1. Background Studies required
    Employees, contractors, and regularly scheduled volunteers
2. Qualifications, training, and competency
    Must be trained and competent in the provision of services
3. Licensed Health Professionals and nurses
    Must possess a current Minnesota license or registration to
     practice.
    Must be competent in assessing, planning, and implementing
     appropriate services to meet resident needs.
                                                                   8

144G.60 Staffing Requirements Cont.

4. Unlicensed Personnel
     Must successfully complete a training and competency evaluation appropriate
      to the services provided by the facility.
     Must demonstrate competency by satisfactorily completing a written or oral test
      on the tasks.
     For those providing delegated nursing tasks, the training requirements can be
      considered met, if the unlicensed personnel has either:
          a. Satisfied the current requirements of Medicare for training or competency of
             home health aides or nursing assistants, as provided by Code of Federal
             Regulations, title 42, section 483 or 484.36; or
          b. have, before April 19, 1993, completed a training course for nursing assistants
             that was approved by the commissioner.
5. Temporary Staff
     Must meet the same requirements as personnel employed by the facility.
                                                                                               9

Assessments & Reviews
                        10

Housing Only Residents

    An initial nursing
    assessment is not
 required on residents not
    receiving services.
 They will sign a contract
 only, with no additional
   service agreement.
                                                  11

Individualized Reviews

For residents receiving assisted living services as listed in 144G.08 subd. 9, clauses (1-5):
Subd. 9. Assisted living services.
(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing;
(2) providing standby assistance;
(3) providing verbal or visual reminders to the resident to take regularly scheduled medication, which
includes bringing the resident previously set up medication, medication in original containers, or
liquid or food to accompany the medication;
(4) providing verbal or visual reminders to the resident to perform regularly scheduled treatments
and exercises;
(5) preparing modified diets ordered by a licensed health professional;

                                                                                                        12

Individualized Reviews Continued

WHEN: Must be completed within 30 days from the start of services. Ongoing monitoring
and review must be done, as needed, based on changes in the resident’s needs; not to
exceed 90 days from the previous review.

WHAT:     A review of the resident's needs and preferences.

HOW:      Completed using an assessment tool (must address part 4659.0150 subpart 2,
items A to C and N), and in person. For urgent or unexpected circumstances,
telecommunication methods may be used.

WHO:     Completed by a staff member who meets qualifications under 144G.60, subd. 2.
Must be in writing, dated, and signed by the person who conducted the review.

                                                                                        13

Uniform Assessment Tool - Reviews

Not to be confused with the UDALSA, the ASSESSMENT
TOOL meets the requirements of rule 4659.0150 and is
used by a licensee to​ comprehensively evaluate a
resident's or prospective resident's physical, mental,
and cognitive​ needs.
The independent review utilizes only part of the
uniform assessment tool.

                                                         14

“Individual Review” Tool

A. The resident's personal lifestyle preferences

B. Activities of daily living

C. Independent instrumental activities of daily living

N. Who has decision-making authority for the resident

                                                            15

Initial Assessments & Reassessments

A nursing assessment or reassessment under Minnesota Statutes, section​ 144G.70,
subdivision 2, paragraphs (b) and (c), must be conducted on a prospective resident​ or
resident receiving any of the assisted living services identified in Minnesota Statutes,​
section 144G.08, subdivision 9, clauses (6) to (12).
(6) services of an advanced practice registered nurse, registered nurse, licensed practical
nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
pathologist, dietitian or nutritionist, or social worker;
(7) tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed
health professional within the person's scope of practice;
(8) medication management services;
(9) hands-on assistance with transfers and mobility;
                                                                                              16

Initial Assessments & Reassessments cont.

(10) treatment and therapies;

(11) assisting residents with eating when the residents have
complicated eating problems as identified in the resident
record or through an assessment such as difficulty
swallowing, recurrent lung aspirations, or requiring the use
of a tube or parenteral or intravenous instruments to be fed;

(12) providing other complex or specialty health care
services;

                                                                   17

Initial Assessments & Reassessments continued

WHEN: Prior to the date on which a prospective resident executes a contract with a facility or
the date on which a prospective resident moves in, whichever is earlier. If a facility admits an
individual​ according to a temporary service plan under Minnesota Statutes, section 144G.70,
subdivision​ 3, the nurse assessment must be conducted within 72 hours of initiating services.​

WHAT:       Comprehensively evaluate a resident's or prospective resident's physical, mental, and
cognitive​ needs.

HOW:      Completed using a uniform assessment tool (must address part 4659.0150 subpart 2,
items A to N), and in person. For urgent or unexpected circumstances, telecommunication
methods may be used.

WHO:       All assessments and reassessments shall be completed by a registered nurse. Must be
in writing, dated, and signed by the registered nurse who conducted the review.
                                                                                                    18

Weekend Assessments

An assisted living facility
must be able to conduct​ a
nursing assessment on a
holiday or on a weekend
for a resident who is ready​
to be discharged from the
hospital and return to the
facility.
                               19

Uniform Assessment Tool - Assessments

Not to be confused with the UDALSA, the ASSESSMENT
TOOL meets the requirements of rule 4659.0150 and is
used by a licensee to​ comprehensively evaluate a
resident's or prospective resident's physical, mental,
and cognitive​ needs.
MDH does not have a templated assessment tool for
you to use.

                                                         20

Uniform Assessment Tool - Elements

A. The resident's personal lifestyle preferences
B. Activities of daily living
C. Independent instrumental activities of daily living
D. Physical health status
E. Emotional and mental health conditions
F. Cognition
G. Communication and sensory capabilities
                                                             21

Uniform Assessment Tool – Elements cont.

H. Pain
I. Skin
J. Nutritional and hydration status and preferences
K. List of treatments, including type, frequency,
   and level of assistance needed
L. Nursing needs, including potential to receive nursing-delegated services
M. Risk indicators
N. Who has decision-making authority for the resident

                                                                              22

What to have ready by 8/1
                            23

Paperwork Requirements

Display your new, original license in     Any new policy requirements
 each building                              written and in place

The new Assisted Living Bill of Rights    Have a newly developed assisted
 provided to all current residents          living contract completed and signed
                                            by each current resident
The Uniform Disclosure of Assisted
 Living Services & Amenities (UDALSA)      Design or ensure your assessment
 provided to current residents              tool is complete and meets statute;
                                            ready to use
Develop a staffing plan and have
 daily postings on each shift              Have an emergency preparedness
                                            plan in place
                                                                                  24

Physical Environment Requirements

Have a smoke alarm in each sleeping       Facility is connected to public
 room and outside each separate             utilities and working or inspected
 sleeping room (interconnected), if         and approved water and septic
 not fully sprinkled                        systems in place
If not fully sprinkled, have smoke        Property is accessible to the fire
 alarms on each story within a
 dwelling unit, including basements         department and emergency medical
                                            services
Install portable fire extinguishers
 located so that the travel distance to    Property is not subject to flooding
 the nearest fire extinguisher does not    Facility is accessible by all-weather
 exceed 75 feet                             roads and walks (maintained)
                                                                                    25

Personnel Requirements

 Identify your Clinical Nursing
 Supervisor (RN)

 Ensure your named Licensed
 Assisted Living Director or Assisted
 Living Director in Residence
 completes the licensing process
 with BELTSS

 Ensure you have awake staff on
 duty at all times

                                                            26

Food / Kitchen Requirements

 Make available three nutritious meals
  and snacks daily, seven days per week

 Have a weekly menu prepared at least
  one week in advance, available to
  residents - Residents should be
  involved in the menu planning

 Serve food according to recommended
  dietary USDA guidelines, including
  seasonal fresh fruits and vegetables
                                          27

Miscellaneous Requirements

 Provide a means for residents to
 request assistance for health and
 safety needs 24 hours per day, seven
 days per week

 Have an infection control program in
 place

 Offer the opportunity for each
 resident to identify a designated
 resident representative in writing
                                                                 28

Dementia Care License Requirements

 Have proof that your entity has an applicant who has experience in managing residents
 with dementia or previous long-term care experience.

 Have a documented hazard vulnerability assessment or safety risk performed on and
 around the property – with risks identified and mitigated to protect residents from harm.

 Ensure you have awake staff 24/7 that are physically present in the secured unit.

 Ensure all the additional dementia care related policies are written and implemented.

 Verify job descriptions include the facility’s organizational chart, the roles of staff within
 the facility, and the UDALSA document.

                                                                                                   29

Additional Dementia Care License Requirements

 Verify job descriptions include the facility’s organizational chart, the roles of staff
 within the facility, and the UDALSA document.

 Verify that staff who conduct dementia training comply with training and test
 requirements prior to conducting staff training.

 Have a plan/schedule to get staff working in a dementia licensed facility trained
 (per 144G.83 and 4659.0190 Subp. 3.)

 Validate orientation includes job description review.

                                                                                            30

Food & Kitchens
                  31

Meal Requirements – 144G.41 Subd. 1 (13)

Offer to provide or make at least three nutritious
meals daily with snacks available. This includes:
o seasonal fresh fruit and fresh vegetables
o menus must be prepared at least one week in advance
o meal substitutions must be of similar nutritional
o residents must be informed in advance of menu
  changes
o food must be prepared and served according to the
  Minnesota Food Code
o cannot require a resident to include and pay for meals
  in their contract

                                                                      32

Food & Kitchens

 144G.41 Subd. 1 (13)(B)
 Food must be prepared and served according to the
 Minnesota Food Code, Minnesota Rules, chapter 4626.
 After August 1, 2021, ALL kitchens will be inspected by MDH,
 Health Regulation Division. These kitchen inspection duties will
 transition from the Environmental Health Division
 (EH) and their local delegated programs to HRD.
                                                                    33

Food & Kitchens cont.

 Kitchens/food service at assisted living facilities will be
 inspected every two years, in conjunction with
 the facility survey evaluation process.
 Waterborne and foodborne illness outbreak investigations will
 be handled by MDH’s Environmental Health staff.
 Kitchen plan reviews will be incorporated into the site plan
 reviews of assisted living facilities.
                                                                  34

Food & Kitchens continued

Pools, Spas, and hotel rooms located in ALF’s will continue to
 be licensed and inspected by MDH Environmental Health and
 delegated agencies.
 If you are uncertain about who will license or survey a
 particular kitchen in your facility, please email MDH with your
 specifics for further discussion.

                                                                   35

Food & Kitchens Training/Staff

 Health Regulation Division is in the process of hiring Sanitarians as
 experts in these areas for Assisted Living Licensure.

 Collaborative training between MDH’s Environmental Health and the
 Health Regulation Division is currently being discussed and planned for:
   Knowledge transfer

   Ensuring consistency with surveys

                                                                            36

Upcoming Presentations

Thursday, June 24, 2021     Thursday, July 8, 2021
10:00 a.m. to 11:30 a.m.   10:00 a.m. to 11:30 a.m.
Food & Kitchens Part 2       Appendix Z - Part 2
     LALD Update            Training + Dementia Care
                                  requirements
  Appendix Z - Part 1

                                                       37

Questions?
             38

Thank you.

Lindsey Krueger - health.assistedliving@state.mn.us