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Adult and Senior Care Update - August 2005
COMMUNITY CARE LICENSING ADULT & SENIOR CARE UPDATE
This is our third Adult and Senior Care Update for 2005. It also marks the twelfth year of our efforts to keep the residential care community informed about licensing programs and services. The Updates continue to be an important method for sharing information. We appreciate your support in sharing these Updates with members in your organization and others interested in adult and senior care issues.
REGULATION PACKAGES
The following regulation packages for adult and senior care facilities are currently in process or completed. If you have questions about any of the proposed regulations, please contact our Policy Development Bureau at (916) 324-4312. For copies of the proposed regulations or more information about hearing schedules, contact the Office of Regulation Development (ORD) at (916) 657-2586 or visit their website at www.dss.cahwnet.gov/ord/default.htm . Please note that depending on the version of software that you are currently using, it might be necessary to press your control key to activate the hyperlinks found throughout this document.
Records Removal and Reproduction Regulations: The Records Removal and Reproduction Regulations were approved by the Office of Administrative Law and became effective on June 8, 2005. The following are the major provisions of the regulations:
- Facility and resident/client records must be made available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying.
- CCLD representatives cannot remove any current emergency or health-related information for current residents/clients or personnel unless the same information is otherwise readily available in another document or format at the facility. Specific documents that cannot be removed are identified in the regulations.
- Prior to removing any records for copying, a licensing representative must prepare a list of the records to be removed. The list must be signed and dated upon removal of the records. A copy of the list must be left with the administrator or designee. The LIC 809 (Facility Evaluation Report) would generally be used for this purpose, although any names of residents/clients should be listed on the LIC 811 (Confidential Names). The list would generally include the type of file; the date of the file; the name of the resident/client, if applicable (on the LIC 811); and any other necessary identifying information.
- CCLD representatives must return the records undamaged and in good order within three business days following the date the records were removed.
The actual changes to the regulations, which cut across facility categories, may be reviewed at www.dss.cahwnet.gov/getinfo/pdf/f080318r.PDF .
Category Consolidation for Adult Day Programs: The applicable General Licensing Requirements, Adult Day Care and Adult Day Support Center regulations are being consolidated into a single category called Adult Day Programs to comply with Senate Bill 1982, Chapter 773, Statutes of 2002. The public hearing for these regulations was held on August 17, 2005. Comments from the public hearing will be reviewed to determine if any changes need to be made to the regulations before submitting them to the Office of Administrative Law (OAL) for final review.
Age and Postural Support Exceptions for Adult Residential Facilities: These proposed regulations will eliminate the need for exceptions in Adult Residential Facilities (ARF) when clients reach 60 years of age and exceptions for the use of postural supports in all adult categories. ARF licensees will no longer be required to obtain exceptions to retain clients who turn 60, as long as these clients do not exceed 50% of the census in facilities with a capacity of six or less; or 25% of the census in facilities with a capacity of over six. Exceptions will still be required to admit new clients over the age of 59 into an ARF regardless of the facility's capacity or census. This regulation package will also remove the approval/exception requirements for the use of postural supports in adult facilities if the licensee meets the same conditions currently required to receive an approved exception. These requirements are listed in the proposed regulations. The public hearing for these regulations occurred on May 18, 2005. No amendments needed to be made as a result of these hearings. The package will be submitted to OAL for final review and signature in early September 2005.
ASSISTANCE WITH MEDICARE PRESCRIPTION DRUG PLAN COSTS
Beginning January 1, 2006, a new program will provide prescription drug coverage under Medicare to beneficiaries with limited income and resources. People may qualify for assistance if they meet the following criteria:
- Income below $14,355 for an individual or $19,245 for a married couple living together. There are some exceptions to these limits, such as for people who support other family members who live with them, or who have earnings from work.
- Resources below $10,000 for an individual or $20,000 for a married couple living together. There are some exceptions to these resource limits, such as for cars, houses and burial expenses.
To learn more about the Medicare prescription drug program and eligibility requirements, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov . For applications, contact the Social Security Administration and ask for the Application for Help with Medicare Prescription Drug Plan Costs form (SSA-1020). Applicants may also apply online at www.socialsecurity.gov .
CALIFORNIA DEPARTMENT OF HEALTH SERVICES (DHS) GUIDELINES FOR WEST NILE VIRUS (WNV)
WNV is a virus transmitted to people through the bite of an infected mosquito. The elderly and those with underlying chronic diseases are at greater risk of serious complications and death as a result of being infected by WNV. In mid-August 2005, the deaths of three elderly men from WNV (in San Joaquin, Butte and Riverside counties, respectively) brought the total number of people in California to die of WNV to six. As of August 18, 2005, 49 counties in California had reported WNV activity this year - and 208 individuals from 21 counties had been infected with WNV. (For the most recent statistics on the spread of WNV, please see the DHS web site at www.dhs.ca.gov .) Many counties are now engaged in widespread spraying of pesticides in an effort to control WNV.
For updated WNV guidelines prepared by DHS for long-term care facilities, please visit the CCLD web site at www.ccld.ca./res/pdf/WestNile2005.pdf . In addition, the following are general WNV prevention tips for licensees and residents/clients:
- Use an effective mosquito repellent containing ingredients such as DEET, Picaridin or oil of lemon eucalyptus.
- Repair tears in door and window screens.
- Drain standing water. Mosquitoes can hatch in as little as a half-inch of water.
- Wear long pants and sleeves outdoors when practical.
- Avoid being outside at dawn and dusk, when mosquitoes are most active.
Symptoms of WNV may include fever, aches and fatigue, although about 80 percent of people who get WNV have no symptoms.
THE ALZHEIMER ASSOCIATION'S DEMENTIA CARE PRACTICE RECOMMENDATIONS
The Alzheimer's Association ( www.alz.org ) is launching a campaign for quality residential care to improve the quality of life of people who suffer from Alzheimer's disease or other dementia related disorders. Last July, the recommendations to accomplish this goal were formally presented to attendees at the association's Dementia Care Conference in Chicago. The recommendations are evidence-based and have been endorsed by 25 organizations representing consumers, providers and workers. Copies of the Alzheimer's Association Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes can be obtained either online at www.alz.org/careconference/08/overview.asp , or in hardcopy (form # CR 946C) by calling the Alzheimer's Association Distribution Center at 1-800-223-4405.
Over the next few months, the Association will be conducting training sessions based on these recommendations at several professional conferences in California. If you would like to schedule a session for your staff, organization or members; you may contact Jackie McGrath, State Policy Director, at (916) 447-2741.
BLOOD-GLUCOSE TESTING IN LONG-TERM RESIDENTIAL CARE FACILITIES
Performing blood-glucose monitoring without following universal precautions can lead to the spread of hepatitis B in care facilities, according to a report released by the Federal Centers for Disease Control (CDC) in the March 11, 2005 issue of its Morbidity and Mortality Weekly Report ( www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm ). Hepatitis B is a serious disease that causes liver inflammation and related complications. It is spread by the hepatitis B virus in infected blood and other body fluids. Most people get a short infection, known as an "acute" case of hepatitis B, and are rid of the virus within six months. However, people can die from acute or chronic (long-term) hepatitis B.
Part of the CDC report looked at diabetic residents of an assisted-living facility in California. Of nine residents who had daily fingerstick tests performed by nursing staff, eight had acute hepatitis B, compared with none of the seven residents who mainly performed their own fingerstick tests. The nurses said facility staff discouraged them from wearing gloves when performing the fingerstick tests so that the facility would not seem too "clinical." The nurses also reportedly did not wash their hands between procedures, and sometimes re-used certain fingerstick devices. The CDC report concluded that this relatively lax approach to universal precautions led to the spread of hepatitis B among residents who relied on nursing staff to perform their fingerstick tests.
To prevent the spread of hepatitis B when fingerstick tests are performed, licensees are reminded that:
- Nursing staff who perform fingerstick tests should wear gloves. (Direct care staff who assist residents in self-administering fingerstick tests should also wear gloves.) Gloves should be changed between residents.
- Hand washing facilities should be available to everyone who provides care in the facility. Hands should be washed frequently, including between procedures.
- Certain fingerstick devices, including the caps of pen-like fingerstick devices and glucometers, should never be shared between residents/clients because the devices may become contaminated with hepatitis B.
If you have any questions, please contact your local health department. At DHS, contact Jon Rosenberg, M.D. ( jrosenbe@dhs.ca.gov ), or Chris Cahill ( ccahill@dhs.ca.gov ) either by e-mail or at (510) 540-2566.
ASSISTED LIVING WAIVER PILOT PROJECT (ALWPP)
Assembly Bill 499 (Aroner, Statutes of 2000) requires DHS to test the feasibility of assisted living as a Medi-Cal benefit. The ALWPP was created for this purpose. For the first time in California, this pilot project will allow Medi-Cal funds to be used to pay for care for eligible persons in a Residential Care Facility for the Elderly (RCFE) (or in publicly subsidized housing with care rendered by a home health agency). The ALWPP is part of a larger trend to allow people who need facility care to choose to remain in home and community-based settings.
To participate in the ALWPP, a person must be both nursing-home eligible and Medi-Cal eligible. The ALWPP will be conducted in Sacramento, San Joaquin and Los Angeles counties, and will have a capacity of 1,000 participants over its three-year life span. Participating RCFEs must be in good standing with CCLD and meet the following criteria: 24-hour awake staff; private-room occupancy (or shared by choice); private or semi-private full bathroom (to be shared by not more than two residents); kitchenettes; and, as necessary, licensed nursing staff to meet the skilled nursing needs of residents. RCFEs with a licensed capacity of fewer than seven beds do not have to have awake staff at night or provide kitchenettes (as long as residents have access to a common kitchen area at all times).
It is anticipated that the ALWPP will begin enrolling residents January 1, 2006. For more information on how your RCFE can participate in the pilot, please see the following web site: www.californiaassistedliving.org . If you have questions, please contact Mark Mimnaugh at DHS at (916) 552-9379.
THE HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM (HICAP)
HICAP is a consumer-oriented health insurance counseling and education program. This program provides three primary services: (1) community education to Medicare beneficiaries regarding Medicare, Medicare supplement insurance, and long-term care insurance; (2) individual health insurance counseling and advocacy services regarding Medicare and other health insurance claims; and (3) legal referral and, in some geographic areas, legal assistance. HICAP community presentations enhance the community's knowledge of Medicare benefits, coverage and out of pocket expenses; beneficiary rights including appeal procedures; and how to choose Medicare supplement and long-term care insurance. Eligibility for HICAP services is limited to persons eligible for Medicare. Registered Counselors are available to the public by calling the HICAP toll-free number at 1-800-434-0222. Additional information on HICAP services is available at local Senior Centers, the statewide Area Agency on Aging Information and Assistance toll-free line at 1-800-510-2020, and the California Department of Aging's web site at www.aging.ca.gov .
UNITED STATES DEPARTMENT OF LABOR FACT SHEET # 16
The United States Department of Labor, Wage and Hour Division (WHD) is responsible for the administration of the Fair Labor Standards Act in the area of wages and compensation. In a joint effort with WHD, each of our updates feature one in a series of fact sheets providing general information on various topics. Enclosed is Fact Sheet #16 entitled, "Deductions From Wages for Uniforms and Other Facilities Under the Fair Labor Standards Act (FLSA)." You can review this fact sheet at the following address: www.dol.gov/esa/regs/compliance/whd/ca_main.htm . Additional information can be obtained from the Department of Labor by calling their toll-free information service number, (866) 889-5627, or through their website at www.wagehour.dol.gov .
SENIOR CARE PROGRAM STAFF CHANGES
The Senior Care Program is pleased to announce the appointment of Pam Gill as Licensing Program Manager in the Central California Senior Care Licensing Office. Prior to her appointment, Pam was a Licensing Program Analyst. Pam assumed her new position in June 2005.
RESIDENTIAL CARE STATISTICS
All of the statistics for licensed Adult and Senior Care facilities are now available online. When you visit the CCLD home page, click on the link on the left side of the page that is titled, "Licensing Overview." Then click on the first bullet that says, "Number of State Licensed Facilities, by County." Scroll to the end of the document for the statewide totals. Further breakouts by category and location are still available. Please direct your requests to Sarah Fernandes, Central Operations Branch, at (916) 327-2406. Directories can also be obtained from your local licensing office.
SUMMARY
If you have questions about items included in this Update or suggestions for future topics, please contact Barbara Rooney, Acting Chief of the Technical Assistance and Policy Branch at (916) 324-4312. Also, please visit our website at www.ccld.ca.gov to obtain copies of Updates, office locations, provider letters, regulations, or to learn more about licensing services.
Sincerely,
Original Signed by Jo Frederick
JO FREDERICK
Deputy Director
Community Care Licensing Division
Enclosures