Living Programs Jana Illingworth Health Facilities Surveyor Adult Services Bureaus Iowa Department of Inspections and Appeals Must be completed prior to date of hire Valid for 30 days If initial check results in a hit evaluation by DHS must be completed ID: 788577
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Trending and Best Practices in Assisted Living Programs
Jana IllingworthHealth Facilities SurveyorAdult Services BureausIowa Department of Inspections and Appeals
Slide2Must be completed prior to date of hireValid for 30 daysIf initial check results in a “hit”, evaluation by DHS must be completed.
Background Checks-67.19
Slide3Cognitive, Functional, and HealthPrior to admission, within 30 days, annually, and/or significant change
Cognitive-when the tool indicates moderate cognitive impairment and risk, GDS will be used for all subsequent cognitive evaluationsEvaluations-69.22
Slide4Develop based on evaluationsPrior to signing of OA, within 30 days of admission (if personal and/or health related care), with significant change, and at least annually.
If no significant change and after nurse review, can add minor discretionary changes without evaluations and signatures. If significant change relates to recurring or chronic condition, a previous evaluation and service plan can be utilized without new signatures. Service Plans-69.26
Slide5Contain: tenant needs and preferences, services and care, service providersPlanned and spontaneous activities for those who are unable, including tenants with dementia (GDS 4 or higher)
Service Plans
Slide6Wound care and treatmentHospice ServicesBehavioral issues and interventions
Exit Seeking and interventionsFalls and interventionsGeneral lack of specificity with caresService Plans
Slide7Medications should be administered as prescribed by the tenant’s physician, advanced registered nurse practitioner, or physician assistant.Transcription errors from the order to the MAR
PRN medication given for reason other than the order indicatedFailure to document medications as givenFailure to document desired effect of PRNPhysician Orders 67.5(6) d.
Slide8Failure to wash hands/sanitizerFailure to wear and remove gloves
Medication-Infection Control
Slide9Identify and implement interventionsBeyond medication change or doctor visit
Other interventions for staff to followLook at level of careTenant on Tenant Aggression
Slide10Basic Human NeedIndependenceChoices
Privacy, dignity, respectPolicies to facilitate safe sexual expressionSexuality
Slide11DHS vs DIAThefts-medication, money, belongingsFalls with Fractures
MistreatmentNotification to the Department
Slide12Elopement-March 2017-March 2018
*Data collected from DIA Facility Self Reporting SystemNotification to the Department
Slide13Door Alarms in ALP/D 69.32 (2)
An operating alarm system shall be connected to each exit door in a dementia-specific program.Safety and AutonomyOptionsDually certify the Program when current certification expiresInstall alarms on all exit doorsSeptember 1, 2018
Slide14Determination is made in the office EvaluationsService Plans
ACUDetermination of Dependent Adult
Slide1567.7 (1) Time-limited waiver. Upon receipt of a Program’s request for waiver of the criteria for retention of a tenant, the Department may grant a waiver for a time-limited basis. A waiver of the criteria for retention of a tenant is limited to a period of six months or less.
Waiver of Criteria for Retention
Slide1630 days notice in writing Reason for dischargeLTCO contact information
Copy to the LTCOInternal appeals process (not with the Department) Involuntary Discharge from the Program
Slide17Implementation of interventions for tenants with dementia and behavioral issues-aggression, agitation, exit seeking, redirection and activities-staff training of such interventions
Identify level of care issues and assistance with seamless discharge processInvestment in staff to encourage retention and tenureBest Practices
Slide18Cameras in hallways and common areasAttendance at meals
Best Practices
Slide19Linda Kellen, Bureau Chief (515) 281-7624
linda.kellen@dia.iowa.govCatie Campbell, Program Coordinator (A-L) (515) 281-3759 catie.campbell@dia.iowa.govDeb Dixon, Program Coordinator (M-Z) (515) 281-4081 deb.dixon@dia.iowa.gov
Tamara Brockob, Administrative Assistant (515) 281-5721
tamara.brockob@dia.iowa.gov
Contact Info
Slide20Iowa Administrative Code (IAC) (2016). 481-67.5(6)d.,67.19, 69.22, 69.26.
Office of the State Long-Term Care Ombudsman. Disability Rights Iowa (2016) Sexual Expression Policy Development, A Guide for Long-Term Care Facilities & Assisted Living Programs, (p.3)References