Assisted Living in Wisconsin

Agency: Department of Health Services, Division of Quality Assurance, Bureau of Assisted Living
Phone: (608) 266-8598
Website: http://dhfs.wisconsin.gov/bqaconsumer/AssistedLiving/AsLivindex.htm

CBRF: Provides care, treatment, and other services to five or more unrelated adults who need supportive or protective services or supervision because they cannot or do not wish to live independently yet do not need the services of a nursing home or a hospital. CBRFs are limited to those who do not require care above intermediate nursing care or more than three hours of nursing care per week unless there is a waiver approved by the department. CBRFs are categorized by size, the resident's ability to evacuate, and disability/condition or status (e.g. advanced age, irreversible dementia, mental illness, developmental disability, alcoholism, physical disability, AIDS). CBRFs provide a living environment that is as homelike as possible and is the least restrictive of each person's freedom and is compatible with the person's need for care and services. Residents are encouraged to move toward functional independence in daily living or to continue functioning independently to the extent possible. RCAC: Provides each tenant with an independent apartment in a setting that is homelike and residential in character; makes available personal, supportive, and nursing services that are appropriate to the needs, abilities, and preferences of individual tenants; and operates in a manner that protects tenants' rights, respects tenant privacy, enhances tenant self-reliance, and supports tenant autonomy in decision-making, including the right to accept risk. RCACs consist of five or more independent apartments, each of which has an individual, lockable entrance and exit; a kitchen, including a stove; individual bathroom, sleeping, and living areas; and provide residents up to 28 hours per week of personal, supportive, and nursing services. AFH: Three or four adults not related to the licensee receive care, treatment, or services above the level of room and board. No more than seven hours per week of nursing care may be provided. Residents are defined as adults unrelated to the licensee who live and sleep in the home and receive care, treatment, or services in addition to room and board.

Facility Scope of Care:
CBRF: Provides general services, client-specific services, and medication administration and assistance. General services include supervision, information and referral, leisure time activities, transportation, and health monitoring. Client-groupspecific services include personal care, activity programming for persons with dementia, independent living skills, communication skills, and up to three hours of nursing care per week (unless hospice is involved). RCAC: Provides services that are sufficient and qualified to meet the care needs identified in the tenant service agreements, meet unscheduled care needs of its tenants, and make emergency services available 24 hours per day. At a minimum, facilities must provide supportive services, including meals, housekeeping, access to medical services, personal services, including assistance with all activities of daily living; and nursing services, including health monitoring and medication administration. AFH: Provides supportive and personal care services to individuals who are defined as having one or more of the following disabilities, conditions, or statuses: a functional impairment that commonly accompanies advanced age or irreversible dementia such as Alzheimer's disease; a developmental disability; an emotional disturbance or mental illness; alcoholism; a physical disability; pregnant women who need counseling services; a diagnosis of terminal illness; or AIDS.

Move-In/Move-Out Requirements:
CBRF: Must ensure that residents of different ages, development levels, or behavior patterns, as identified in their assessment and individual service plans, are compatible and meet the license classification of the facility. Facilities may not admit persons who are confined to bed, destructive to property or self, or have physical, mental, psychiatric, or social needs that are not compatible with the CBRF client group or with the care, treatment, or services offered by the CBRF. Persons requiring more than three hours of nursing care per week or restraints may be admitted only if the licensing authority is satisfied that granting a waiver will meet the best interests of the resident or potential resident. Residents may not be involuntarily discharged without 30 days' notice and have appeal rights. RCAC: Unless residents are admitted to share an apartment with a competent spouse or other person who has legal responsibility, facilities may not admit persons who have a court determination of incompetence and are subject to guardianship; have an activated power of attorney for health care; or have been found by a physician or psychologist to be incapable of recognizing danger, summoning assistance, expressing need, or making care decisions. Facilities may discharge residents for the following reasons: their needs cannot be met at the facility's level of services; the time required to provide services to the tenant exceeds 28 hours per week; their condition requires the immediate availability of a nurse 24 hours per day; their behavior poses an immediate threat to the health or safety of self or others; they refuse to cooperate in a physical examination; fees have not been paid; or they refuse to enter into a negotiated risk agreement. AFH: New residents must have a health screening within 90 days prior to admission or within seven days after admission. The facility is required to have a service agreement with each resident that specifies the names of the parties to the agreement; services that will be provided and a description of each; charges for room and board and services and any other fees; a method for paying fees; and conditions for transfer or discharge and how the facility will assist in the relocation. A facility may terminate a resident's placement upon 30-day notice to the resident, the resident's guardian, if any, the service coordinator, and the placing agency. The 30-day notification is not required for an emergency termination necessary to prevent harm to the resident or other household members.

Resident Assessment:
CBRF: Prior to admission, each person is assessed to identify needs and abilities. Based on the assessment, an individualized service plan is developed. RCAC: A comprehensive assessment is performed with the active participation of the prospective resident prior to admission. Regulations identify components of the assessment but do not specify format. AFH: Within 30 days of admission a written assessment and individual service plan are completed for each resident. The assessment identifies the person's needs and abilities. Although the assessment is required, the format is developed by each facility

Medication Management:
CBRF: Medication administration and management are performed by licensed nurses or pharmacists unless medications are packaged by unit dose. All direct-care staff and administrative personnel must complete an eight-hour approved medication administration and management course. RCAC: Medication administration and management must be performed by a nurse or as a delegated task to unlicensed staff, under the supervision of a nurse or pharmacist. AFH: All prescription medications must be securely stored in the original container. Before a licensee or service provider dispenses or administers medication to a resident, the licensee must obtain a written order from the prescribing physician. The order must specify who by name or position is permitted to administer the medication and under what circumstances the medication is to be administered.

Physical Plant Requirements:
CBRF: Facilities must comply with all local building codes, ordinances, and zoning requirements. In addition, CBRFs must comply with DHS 83, Subchapters IX, X, & XI relating to physical environment and safety, structural requirements, and additional requirements. The minimum number of beds in a CBRF is five. Minimum sleeping room size is 60 to 100 square feet depending on the license classification (ambulatory, semiambulatory or non-ambulatory), existing vs. new construction, and single vs. private occupancy. Construction requirements, fire protection, and accessibility are all predicated on the size of the facility and the class. Ambulating and the ability to be mentally and physically capable of responding to an electronic fire alarm and exiting the facility without assistance or verbal or physical prompting defines class. RCAC: All resident units must be independent with lockable entrances/exits and provide a minimum of 250 square feet of interior floor space, excluding closets. They must meet building codes required for multi-family dwellings. Multiple occupancy of an independent apartment is limited to a spouse or a roommate chosen at the initiative of the resident. AFH: Must be located so that residents can easily get to community activities and support services. They are to be safe, clean, and well maintained and provide a homelike environment. The home must be physically accessible to all residents. There must be at least 60 square feet per person in a shared bedroom and 80 square feet in a single occupancy room. For a person in a wheelchair, the bedroom space is 100 square feet.

Residents Allowed Per Room:
CBRF: Resident bedrooms in a CBRF shall accommodate no more than two residents. RCAC: A maximum of two residents is allowed per unit (limited to a spouse or a roommate chosen at the initiative of the tenant). AFH: A maximum of two residents is allowed per room.

Life Safety:
Different fire safety standards apply to Wisconsin's three types of assisted living. At a minimum, all CBRFs must determine the evacuation ability of each resident, develop an emergency plan, be inspected by the local fire authority, maintain a minimum of two exits, maintain a fire extinguisher on each floor, and have an interconnected smoke and heat detection system. Based on the type of residents the facility serves and the residents' ability to evacuate the facility, other fire safety requirements may be required. The additional requirements include: an externally monitored smoke detection system, vertical smoke separation between floors, a sprinkler system, and 24-hour awake staff. RCACs must comply with Wisconsin Department of Commerce codes for multifamily dwellings and with local fire and building codes. Every AFH must be equipped with one or more fire extinguisher and one or more single station smoke detector on each floor. Smoke detectors are required in each habitable room except kitchens and bathrooms and are also required in other specific locations. The first floor of the home must have at least two means of exiting. The licensee must have a written evacuation plan and conduct semi-annual fire drills.

Alzheimer's Unit Requirements:
CBRF: Must identify the client group(s) it can serve. Two categories are persons with functional impairments that commonly accompany advanced age and persons with irreversible dementia such as Alzheimer's. A full description of residents' special needs and how those needs will be met are provided as part of the licensing process. Structured activity programming must be integrated into the daily routines of residents with irreversible dementia. RCAC: None specified. AFH: Functional impairments that commonly accompany advanced age and irreversible dementia such as Alzheimer's disease are two 'types' of conditions that are served. As part of the licensing process, the proposed AFH must develop a program statement that describes the number and types of individuals the applicant is willing to accept and how the entity will meet the needs of the residents.

Staff Training for Alzheimer's Care:
CBRF: If a facility serves persons with dementia, staff must receive training within 90 days of employment. This training is specific to the client groups served by the CBRF and includes, but is not limited to, the characteristics of the client group served by the facility such as group members' physical, social, and mental health needs; specific medications or treatments needed by the residents; program services needed by the residents; meeting the needs of persons with a dual diagnosis; and maintaining or increasing social participation, self direction, self care, and vocational abilities. RCAC: None specified. AFH: None specified.

Staffing Requirements:
CBRF: The ratio of staff to residents must be adequate to meet the needs of residents as defined in their assessments and individual service plans. At least one qualified resident care staff person shall be in the facility when one or more residents are in the facility. Staffing ratios vary based on the residents' ability to evacuate during an emergency and their care needs. There must be awake staff at night in facilities with one or more residents requiring continuous care. RCAC: Staffing must be adequate to provide all services identified in the residents' service agreements. A designated service manager must be available on short notice. AFH: The licensee or service provider must have a sufficient number of staff to meet the needs of the residents. Additionally, the licensee or service provider must be present and awake at all times if any resident is in need of continuous care. Residents have the right to prompt and adequate treatment.

Staff Education Training:
CBRF: Employees need to have orientation training before they can perform any job duty. Minimum initial training consists of department-approved training in medication management, standard precautions, fire safety, and first aid. In addition, all staff must have training in resident rights, the client group, and challenging behaviors. Resident care staff involved in certain tasks must have training in needs assessment of prospective residents; development of service plans; provision of personal care; and in dietary needs, menu planning, food preparation, and sanitation. RCAC: Resident care staff must have documented training or experience in the needs and techniques for assisting with activities of daily living; the physical, functional, and psychological characteristics associated with aging; and the purpose and philosophy of assisted living, including respect for tenant privacy, autonomy, and independence. All staff are required to have training in fire safety, first aid, standard precautions, and the facility's policies and procedures relating to tenant rights. AFH: Service providers must be at least 18 years of age; responsible, mature, and of reputable character; and exercise and display the capacity to successfully provide care for three or four unrelated adult residents. The licensee and each service provider must complete 15 hours of training related to the health, safety, and welfare of residents, resident rights, and treatment appropriate to residents including fire safety and first aid. They must have a clean criminal background check.

Medicaid Policy and Reimbursements:
CBRF: Community Option Program (COP) and COP-Waiver funds may be available, depending on eligibility and waiting lists. Wisconsin also has a program called Family Care that provides public funding. RCAC: Certification is required for a facility to receive Medicaid waiver reimbursement. COP and COP-waiver funds may be available, depending on eligibility and waiting lists. Wisconsin also has a program called Family Care that provides public funding. AFH: COP and COP-waiver funds may be available, depending on eligibility and waiting lists. Wisconsin also has a program called Family Care that provides public funding. The state has begun an initiative to expand managed long-term care options in Wisconsin. See: http://dhs.wisconsin.gov/LTCare/.