Minnesota Department of Health - Assisted Living Teleconference June 10, 2021 PROTECTING, MAINTAINING AND IMPROVING THE HEALTH OF ALL ...

Minnesota Department of Health

   Assisted Living Teleconference │ June 10, 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
 • Lindsey Krueger (MDH)

Person-Centered Care & Services
 • Scott Schifsky and Amber Maki (DHS)

                                                  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

Staffing Requirements
                        5

Licensed Staff Requirements

                     Assisted Living Director                              Clinical Nurse Supervisor
A person who administers, manages, supervises, or is in general            All assisted living facilities
administrative charge of an assisted living facility and is licensed by    must have a clinical nurse
the Board of Executives for Long Term Services and Supports
pursuant to section 144A.20. It doesn’t matter if the individual has
                                                                               supervisor who is a
an ownership interest in the facility or if the person’s functions or     registered nurse licensed in
duties are shared with one or more individuals.                                    Minnesota.
---------------------------                                               The Assisted Living Director
  Assisted Living Director of an Assisted Living Facility
                  with Dementia Care                                         and the Clinical Nurse
Additional requirement for ALFDC: Must complete and document
                                                                          Supervisor may be held by
that at least ten hours of the required annual continuing                  the same individual if the
educational requirements related to the care of individuals with                individual holds
dementia.
                                                                                 both licenses.
                                                                                                            6

Rule 4659.0180 Staffing

Subp. 3. Direct-care staffing; plan required.
A clinical nurse supervisor must develop and implement a written staffing plan that
provides an adequate number of qualified direct-care staff to meet the residents' needs
24-hours a day, seven-days a week. When developing a direct-care staffing plan, the
clinical nurse supervisor must ensure that staffing levels are adequate to address the
following:

                                 Direct Care Staff: Staff who provide
                                 services for residents that include assistance
                                 with activities of daily living, medication
                                 administration, resident-focused activities,
                                 supervision, and support.

                                                                                          7

Staffing Levels Are Adequate to Address

Each resident's needs, as                                   Whether the facility has a
identified in the resident's                                secured dementia care
service plan and assisted                                   unit.
living contract.

Each resident's acuity         The ability of staff to      Staff experience, training,
level, as determined by        timely meet the residents'   and competency.
                               scheduled and reasonably
the most recent                foreseeable unscheduled
assessment or                  needs given the physical
individualized review.         layout of the facility
                               premises.
                                                                                          8

Daily Staffing Schedule

Rule 4659.0180 Subp. 4

Clinical Nurse Supervisor must develop a 24-hr daily staffing schedule.

The schedule must:

  1)   Include direct-care staff work schedules for each staff member,
       showing all shifts, including days and hours worked

  2)   Identify the direct-care staff member’s resident assignments or work
       location

                                                                              9

Posting of Daily Staffing Schedule

Rule 4659.0180 Subp. 4
The daily work schedule must be posted…
  After redacting direct-care staff members’ resident assignments
  At the beginning of each work shift in a central location
  In each building of a facility or campus
  Accessible to staff, residents, volunteers, and the public

                                                                     10

Direct Care Staff Availability

Rule 4659.0180 Subp. 5
A minimum of two direct-care staff must be scheduled
and available to assist at all times whenever a resident
requires the assistance of two direct-care staff for
scheduled and reasonably foreseeable unscheduled
needs, as reflected in the resident’s assessments and
service plan.
                                                          11

Direct Care Staff Availability - Night Supervision

Rule 4659.0180 Subp. 6
During the hours of 10:00 p.m. to 6:00 a.m.
   Direct-care staff shall respond to request’s
   requests for assistance with health or safety needs
   Respond within a reasonable amount of time, as
   provided in 144G.41 subd. 1 (12)(ii)
                                                           12

Acceptance of Residents

144G.70
An assisted living facility
may not accept a person as
a resident unless the facility
has staff, sufficient in
qualifications, competency,
and numbers, to adequately
provide the services agreed
to in the assisted living
contract.
                                                      13

Availability to Staff

144G.62
Assisted living facilities must have
a registered nurse available for
consultation by staff performing
delegated nursing tasks…must be
readily available either in person,
by telephone, or by other means
to the staff at times when the staff
is providing services.

                                  14

Awake Staff Requirement

144G.41
One or more persons available 24 hours per day, seven days per
week,…awake; located in the same building, in an attached building, or on a
contiguous campus with the facility in order to respond within a reasonable
amount of time.

144G.81
An assisted living facility with dementia care providing services in a secured
dementia care unit must have an awake person who is physically present in
the secured dementia care unit 24 hours per day, seven days per week.
                                                                                 15

Overview of Person-Centered Practices
       Scott Schifsky BA, Person-Centered/Positive Supports Coord.

Amber Maki MS, BCBA Community Capacity and Positive Supports Team Lead

DHS Agenda

Agenda and introductions

   What are person-centered practices?

    What are some of the basic principles behind person-
    centered practices?

   Why is it important to use a person-centered approach?

Resources
                                                            17

Housekeeping

• Introductions
• Navigating technology
• What do you think it means to be
  “person-centered” or to use “person-centered”
  care/approaches/supports?

                                                  18

What are person-centered practices?   19

Expectations and Informed Choice

                                   20

The CORE Concept

             At its core,
  person-centered practices are
rooted in active incorporation of
   a balance between what is
   important to a person with
   what is important for them
 in all the services they receive.

                                       21

Important
   To
 What is important to a
 person includes those                It includes:
things in life which help             • People to be with /relationships
   us to be satisfied,                • Culture & Identity
  content, comforted,                 • Purpose and Meaning
  fulfilled, and happy.               • Status and control
                                      • Things to do and Places to go
                                      • Rituals or routines
                                      • Rhythm or pace of life
 ©TLCPCP 2020 Remote www.tlcpcp.com   • Things to have                     22

Important To Also Includes…
 What matters the most to the person – their own definition of quality of life.

 What is important to a person includes only what people “say”:
   • with their words
   • with their behavior

                    When words and behavior are in conflict,

                  pay attention to the behavior and ask “why?”

                                                                                   23

Important For:

Issues of health:                Issues of safety:         What others see as necessary
• Prevention of illness          • Environment             to help the person:
• Treatment of                   • Well-being - physical   • Be valued
   illness/medical conditions       and emotional          • Be a contributing member
• Promotion of wellness (e.g.,   • Free from Fear            of their community
   diet, exercise)
                                                                                24

Important To and Important For are Connected

Important to    No one does
and important   anything that    Balance is dynamic (changing)
for influence   is “important      and always involves tradeoffs:
each other      for” them           – Among the things that are
                (willingly)           “important to”;
                unless a piece
                of it is            – Between important to and
                “important”           for
                to them

Examples/Story

Basic principles of person-centered practices

Basic Principle - Focus on the Person

• The person’s desires should be heard,
  honored, valued and reflected in the
  services received
• People who are important in the
  person’s life should be part of the
  planning process
• A team provides expertise to address
  what a person needs support with to
  achieve the vision they have for their
  own life
   Taken from: Person-Centered Thinking, Planning, and Practice: A National Environmental Scan of Definitions and
   Principles. Prepared by the Human Services Research Institute as part of NCAPPS technical assistance. Nov 2019.   28

Basic Principle - Choice and Self-Determination

• People should make choices (with
  support if needed and wanted) about
  services and supports as well as
  decisions regarding their own health,
  well-being and life goals
• The person directs their life
• Basic assumption that everyone can
  make their own choices – even bad
  choices
      Taken from: Person-Centered Thinking, Planning, and Practice: A National Environmental Scan of Definitions and
      Principles. Prepared by the Human Services Research Institute as part of NCAPPS technical assistance. Nov 2019.   29

Basic Principles - Community Inclusion

• People must have full access to
  the community and be treated
  with dignity and respect

• The service system is not
  supposed to surround a person
  and cut them off from
  community and social life
  Taken from: Person-Centered Thinking, Planning, and Practice: A National Environmental Scan of Definitions and
  Principles. Prepared by the Human Services Research Institute as part of NCAPPS technical assistance. Nov 2019.   30

Basic Principle - Availability of Services and Supports

• People should have access to
  an array of individualized
  services that meet their needs

• Using language that is inclusive
  and respectful

  Taken from: Person-Centered Thinking, Planning, and Practice: A National Environmental Scan of Definitions and
  Principles. Prepared by the Human Services Research Institute as part of NCAPPS technical assistance. Nov 2019.   31

Why is it Important to use a Person-Centered Approach?   32

Questions to Ask Yourself

Why did you get into this field?

What do you love about your work?

Why do you keep doing this work?

                                           33

Importance of Environments

                             34

Connection to Quality of Life

• What we know about quality of life:

   • Higher quality of life correlates with
     fewer challenging behaviors/mental
     health symptoms

   • #1 Factor in a person’s quality of life:
     Autonomy

   • Having a supportive and healing
     environment (place to live)

                                                  35

When We Use Person-Centered Practices, the People
     We Serve Experience a Better Quality of Life
• Grow in relationships

• Contribute to their community

• Make choices and have positive control over
  their lives

• Are treated with dignity and respect

• Have a valued social role

• Share ordinary places and activities

• Participate in local community life.

                                                      36

People Who Deliver Services Benefit As Well

• Witness the people they support achieve goals
  that are meaningful to them

• Can work creatively and collaboratively with
  others to find successful solutions

• Experience fewer disruptions and crises
  because plans are successful more often

• Empower the people they support

• Share the responsibility of resource allocation
  and decision-making

                                                      37

Why is Language Important

• People First Language
  (www.disabilityisnatural.com
  /people-first-language.html)

• What language is
  appropriate for older adults?

                                           38

Questions   39

Training Resources
 Institute on Community Integration (ICI University of MN)
   • Person-Centered Thinking is foundational to supporting how a person truly wants to direct their
     lives. Person-centered practices are at the forefront as services shift away from a system-
     centered focus.
   • Link to find training in your area: Person-Centered Thinking and Planning (https://pctp.umn.edu/)
 STAR Services
   • Link to search their training offerings: STAR Services (https://starsvcs.com/pcp/)
 The Metro Crisis Coordination Program offers trainings in a vast number of topics.
   • Link to search their training offerings: MCCP (http://metrocrisis.org/training.html)
 The College of Direct Support courses are designed to promote high-quality services
  that support people with disabilities in leading self-directed, person-centered lives.
   • Link to learn more: MDH College of Direct Support (https://mn.gov/dhs/partners-and-
     providers/training-conferences/long-term-services-and-supports/college-of-direct-support/)
                                                                                                40

Training Resources Continued…
 Support Development Associates offers specialized consultation and training organization designed
  to promote the abilities and talents of every individual and every agency with whom they engage.
    • Link to search their training offerings: Support Development Associates (www.sdaus.com/services)
 Helen Sanderson Associates is a social enterprise, working to create person-centered change by
  transforming how we think, plan and meet. We work internationally to embed person-centered
  practices into the heart of organizations and communities – creating better lives together.
    • Link to search their training offerings: Helen Sanderson Associates (http://helensandersonassociates.co.uk/)
 The Charting the LifeCourse framework was developed by families to help individuals with
  disabilities and families at any age or stage of life develop a vision for a good life, think about what
  they need to know and do, identify how to find or develop supports, and discover what it takes to live
  the lives they want to live.
    • Link to search their training offerings: Charting the LifeCourse (www.lifecoursetools.com/about-us/the-lifecourse-
      nexus/)
 Beth Mount Person Centered Design
    • Link to search their training offerings: Beth Mount (www.bethmount.org/about.html)
                                                                                                                 41

Website Resources

• MN Department of Human Services Person-centered practices
  (https://mn.gov/dhs/partners-and-providers/program-overviews/long-term-
  services-and-supports/person-centered-practices/)

• DHS Community-Based Services Manual
  (www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION
  &RevisionSelectionMethod=LatestReleased&dDocName=dhs-299403)
• Minnesota Postitive Supports (https://mnpsp.org/)

                                                                            42

Articles

• A Measure of Person-Centered Practices in Assisted Living: The PC-
  PAL(www.sciencedirect.com/science/article/abs/pii/S1525861014004757?via
  %3Dihub)

• Person-Centered Communication with Older Adults
  (www.sciencedirect.com/book/9780124201323/person-centered-
  communication-with-older-adults)
• Person-Centered Care For Nursing Home Residents: The Culture-Change
  Movement
  (https://d10k7k7mywg42z.cloudfront.net/assets/4e586cccdabe9d592401490
  8/person_centered_care_article_by_koren.pdf)

                                                                        43

Articles Continued…

• Person-Centered Thinking, Planning, and Practice: A National Environmental
  Scan of Definitions and Principles
  (https://ncapps.acl.gov/docs/NCAPPS_Principles_NationalEnvironmentalScan
  %20191202.pdf)

• Initiating Person-Centered Care Practices in Long-Term Care Facilities
  (https://journals.healio.com/doi/10.3928/00989134-20071101-08)

                                                                           44

Thank you!

positivesupports@state.mn.us

                               45

Upcoming Presentations

  Thursday, June 17, 2021      Thursday, June 24, 2021
  10:00 a.m. to 11:30 a.m.     10:00 a.m. to 11:30 a.m.
 Staffing Requirements cont.   Food & Kitchens Part 2
   Assessments & Reviews
                                    LALD Update
Things You Need Ready by 8/1
                                  Appendix Z Part 1
   Food & Kitchens Part 1

                                                          46

Questions?
             47

Thank you.

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