Rights and Safeguards for Consumers
Living in Housing With Services
Minnesota Department of Human Services
Video Conference
July 9, 2009
1
Presenters
• Natasha Merz, Regional Ombudsman
• Sherilyn Moe, Ombudsman Specialist
• Sandra Newbauer, Regional Ombudsman
Office of Ombudsman for Long-Term Care
Minnesota Board on Aging
(800) 657-3591
(651) 431-2555
2
LTC Ombudsman Role
• Minnesota LTC Ombudsman Statute
256.9741 Definitions
Client means an individual who requests, or on whose
behalf a request is made for, ombudsman services and
is….an individual reserving, receiving or requesting a
home care service.
Home care services means health, social or supportive
services provided to an individual for a fee in the
individual’s residence and in the community to promote,
maintain or restore health or maximize the individual’s
level of independence, while minimizing the effects of
disability or illness.
3
LTC Ombudsman Role
Minnesota Statutes and Rules for home care licensure:
144A.44 Home Care Bill of Rights: copy shall contain the
address and phone number of the office of ombudsman
for long-term care; this info must also be included in
notices of changes in client fees and notices where
home care providers initiate transfer or discontinuation of
services.
4668.0075 Orientation to Home Care Requirements:
Employees (direct care, supervision, management)
orientation must include the services of the ombudsman
for long-term care
4
LTC Ombudsman Role
Minnesota Statutes 144D.04 HWS
Contracts:
Subd. 2 Contents of contract:
(10) A description of the establishment’s complaint
resolution process available to residents
including the toll-free complaint line for the
Office of Ombudsman for Long-Term Care
5
Overview of HWS
Minnesota Statutes 144D
Registration of Housing With Services
(Currently over 1400 registrants)
Required registrants:
Establishments/settings/residences in which
• 80 percent or more age 55 & older
• Offers for a fee one or more health-related
service or two or more supportive services
provided by the HWS or arranged provider
• Consumer safeguards:
~ 17 point contract with each tenant
~ Related housing and other laws apply
6
Housing With Services
Settings may include:
• Apartment buildings, public or market rate
• Buildings in which tenants have own bedroom
and rest of living space is shared (own or shared
bathroom)
• Corporate adult foster care homes
• Section of nursing homes converted to HWS
Except for corporate AFC, no limit to # of tenants
7
Housing With Services
• Health-related services are licensed home care
services such as: nursing, assistance with
personal care and medications and central
storage of medications.
• These services must be delivered through a
Class A Professional Home Care Agency or
Class F Home Care Provider either by the HWS
entity having the home care license or by the
HWS contracting/arranging for these services
with a home care licensee.
8
Overview of Class A & Class F
Home Care Licenses
Minnesota Statutes 144A.43-144A.47
Class A Professional Home Care Agency
This hc license can provide services in HWS and
other home settings.
Class F Home Care Provider
This license is solely for HWS settings.
Delegated nursing services to “unlicensed personnel” who
provide assistance with personal cares and med delivery.
Can provide central storage of meds & trained unlicensed
personnel may give insulin injections.
9
Assisted Living Services
Minnesota Statues 144G
• Assisted living services are offered through a
Class A or F license only in a registered HWS.
There is no “assisted living license.”
• Minimum health-related services:
assistance with self-administration of med or
med admin and assistance with at least 3 ADLs:
bathing, dressing, grooming, eating, transferring,
continence care & assistance with toileting.
10
Assisted Living Services
Key requirements:
• A system for delegation of health care services
by an RN
• Staff access to an on-call RN 24/7
• Means for clients to request assistance for
health & safety needs 24/7 (awake staff exemption)
• System to check each AL client daily
• Uniform Consumer Info Guide available to
current and prospective AL clients
11
HWS Tenants/AL Clients
Termination of HC Services &Tenancy
• Home care bill of rights requires a 30 day notice for
terminating home care services for assisted living
clients (3 exceptions.)
• In addition to consumer safeguards in the 17 point
HWS contract and existing housing and other
related laws, HWS that offers assisted living
services must issue a written notice of termination
of the housing contract with certain criteria.
12
Consumer Safeguards
Home Care
• Health-related services are regulated
through the Minnesota Department of
Health through a home care license or
Medicare certification
• Vulnerable Adult Act
• Home Care Bill of Rights
13
Home Care Bill of Rights
1.
2.
3.
4.
5.
Five types of home care rights
Rights are attached to the type of service delivered
Minnesota licensed-only provider
Medicare-certified (& Class A licensed) provider
Assisted living services from a licensed only provider
(Class A or Class F)
Assisted living services from a Medicare-certified
provider
Services from a provider who is exempted from home
care licensure
There are two hospice bills of rights
1. MN hospice licensed only 2. Licensed & Medicarecertified hospice
14
Home Care Bill of Rights
Locate these rights in regular or large print and
in 6 languages on the
Minnesota Department of Health website:
www.health.state.mn.us/divs/fpc/consinfo.html
This site also gives provider survey, licensure,
certification and HWS registration information, a
provider directory and OHFC investigative reports.
15
Home Care Rights
• Rights must be given in writing at the time the
client and provider agree to the service
agreement/service plan or before services are
initiated, whichever is earlier.
• Provider must obtain & retain written
acknowledgement from the client/rep that the
client received the rights.
16
Home Care Rights
In addition to the text of the rights, a statement,
printed prominently in capital letters:
IF YOU HAVE A COMPLAINT ABOUT THE AGENCY OR
PERSON PROVIDING YOU HOME CARE SERVICES,
YOU MAY CALL, WRITE OR VISIT THE OFFICE OF
HEALTH FACILITY COMPLAINTS, MINNESOTA
DEPARTMENT OF HEALTH. YOU MAY ALSO CONTACT
THE OMBUDSMAN FOR LONG-TERM CARE.
Must include telephone number, mailing & street address of OHFC &
telephone number & address of OOLTC; licensee’s name, address,
Telephone number, name or title of person to whom problems or
complaints may be directed.
17
Home Care Rights
Brief Summary of Rights
 Receive written rights
 Receive services/care via a suitable, up-to-date
plan created with client/rep input; client/rep
notified of changes & have a say in the change
 Available services, disciplines that provide them,
choices & consequences including right to
refuse services or treatment
 Limits to available services & grounds for
termination of services.
18
Home Care Rights
 Availability of coverage of services by health
insurance, medical assistance or other health
programs, charges not covered by Medicare and
charges the client may have to pay; and the
charges regardless of who pays the bill
 Availability of other services, where to locate
them, choice of providers & change of providers
within limits of the payor.
19
Home Care Rights
 Privacy of personal, financial & medical info &
provider policies for their disclosure
 Access to (home care) records (MN statutes 144.291-8)
 Properly trained, competent, courteous &
respectful staff (also respectful to property)
 Free from physical and verbal abuse
20
Home Care Rights
 Reasonable, advance changes in services or charges,
including at least 10 days advance notice (30 days for
assisted living) of termination of services (2 exemptions for
licensed or Medicare cert only; 3 exemptions for assisted living)
 Coordinated transfer when change of provider
 Voice grievances, how to contact the staff who is to
investigate and attempt to resolve problem
 Name & address of state or county agency for more
information or assistance
 Assert rights personally or client’s rep may assert them.
There are some additional rights for clients getting Medicare home care
21
Consumer Issue
Home Care in HWS
Summary of 3 rights issues with consumers.
Participation in planning/changing service
plan/service agreement
Charges for services
Termination of services
22
Sources of Laws & Regulations
Applicable to HWS
•
•
•
•
•
•
•
•
•
•
MN Statutes 144D (HWS registration)
MN Statutes 144G (assisted living)
MN home care licensure & Medicare certification requirements
Standards of practice
MN Landlord Tenant Law
Federal Fair Housing Law
Americans with Disabilities Act
MN Statutes 157 (food, beverage & lodging establishments)
MN Rules 9555.5105-955.6255 (Adult Foster Care)
Minnesota’s human rights act; zoning, building &fire codes;
consumer laws; Vulnerable Adult Act, Nurse Practice Act;
employment laws
23
HWS contract requirements
1. All HWS providers are required to have a
written housing contract
2. MN statutes 144D.04 lists required content of
HWS contracts, including:
• Services provided in the base rate to be paid
by resident/tenant;
• Services including home care services
available for an additional fee (directly from or
arranged by HWS) and a schedule of fees
charged for these services;
24
HWS 17 point contract continued
• The building’s complaint resolution process including
OOLTC toll-free phone number;
• Requirements of residency to determine who may reside
or continue to reside there;
• Billing and payment procedures & requirements;
• The ability of tenants to receive services from service
providers with whom the HWS does not have an
arrangement;
• A statement about the availability of public funds for
payment for residence or services in the bldg. and
availability and contact information for long-term care
consultation services in the county where the HWS is
located
• This document may or may not include lease provisions.
25
HWS Regulations
2. Minnesota Statues 144D.065
Training in Dementia Care
requires direct care staff and their
supervisors (in HWS) to be trained in
dementia care.
26
3. Disclosure of Special Care Status
(Dementia Disclosure)
Minnesota Statutes 325F.72:
HWS that secure, segregate or provide a
special program or special unit for
residents with a diagnosis of probable
Alzheimer’s disease or a related disorder
or that advertise, market or otherwise
promote the building as providing
specialized care for Alzheimer’s disease or
related disorder are considered a “special
care unit.”
27
Dementia Disclosure criteria
• Must be provided to resident (or representative),
Ombudsman for LTC, and commissioner of health (upon
request)
• Disclosure must state in terms particular to memory
care:
- philosophy of care
- criteria for residency
- describe assessment process
- staff credentials and training
- building security features
- family involvement opportunities
- activities and programming
- fees for additional services and
-statement that residents will be given notice 30 days prior to changes in the
fee schedule
28
Uniform Consumer Information Guide or
Consumer Information Guide to Assisted Living
in Minnesota
Minnesota Statutes 144G.06
Guide to consumers to gather information about:







Home Care Provider information
Building Features
Staff Availability
Payment for Rents and Services
Supportive Services & Personal Care Assistance
Health Care Related Services
Legal Rights
29
Landlord/Tenant Law
• Minnesota Statutes 504B et. Seq.
• Applies to HWS providers
• Minnesota Statute 504B.181, subd. 2(b) (2004)
requires landlords to notify residential tenants
about the availability of the Office of the Minnesota
Attorney General handbook titled:
Landlords and Tenants:
Rights and Responsibilities
30
Landlord Tenant law continued
• If landlord has more than 12 units, a
written lease is required (504B.111)
- this may or may not be included in the HWS
contract
• Termination of residency provisions
- Month-to-month tenancy (rental notice period
plus one day)
- Fixed term lease (based on terms of lease)
31
Federal Housing Laws
& Related Federal Laws
• Federal Fair Housing Act (FHA) applies to HWS establishments
• FHA prohibits discrimination in terms or conditions of housing based
on:






Race/Color
Religion
Gender
National origin
Family status
Disability
 FHA requires owners of housing facilities to make reasonable
exceptions in their policies & operations to afford people with
disabilities equal housing opportunities.
 Individuals may file a housing complaint with the Department of
Housing & Urban Development or file a lawsuit in state or federal
court.
 See also http://www.ada.gov/cguide.html
32
Americans With Disabilities Act
Title III
• Applies to “Public Accommodations” including private
entities who own, lease, lease to, or operate facilities…
• Resident must have a qualifying disability to invoke ADA
protection
- Substantial limitation in a major life activity
• ADA prohibits exclusion, segregation and unequal
treatment based on disability.
• Requires architectural standards for new & altered
buildings (ramps, elevators, etc.)
• Requires reasonable accommodations to policies,
practices and procedures.
• Section 504 of Rehabilitation Act: applies to providers
receiving federal funding and has anti-discrimination
provisions similar to ADA
33
Consumer Issues in HWS
• Termination of Tenancy




Termination of residency agreement for various reasons
HWS not accepting tenant from hospital or nursing home
Home care service termination
Home care service termination notice different from
housing notice
 Billing/charges
 mixing rent with home care/health-related services
 Confused billing charges
34
Consumer Resources
• Office of Health Facility Complaints
(800) 369-7994
www.health.state.mn.us/divs/fpc/consinfo.html
• Office of Ombudsman for Long-Term Care
(800) 657-3591
www.mnaging.org
• Stratis Health ~ addresses quality of Medicare
services
(877) 787-2847
www.stratis.health.org
• Medicare
www.medicare.gov/HHCompare/home.asp offers
information about Medicare certified home health
agencies
35
Consumer Resources
• Common Entry Point to report adult maltreatment
(800) 333-2433
• Linkage Lines for information about community
resources:
Disability Linkage Line™ (866) 333-2466
Senior LinkAge Line® (800) 333-2433
www.MinnesotaHelp.Info
Veterans Linkage Line™ (888) 546-5838
www.minnesotaveteran.org
• Minnesota Statutes & Rules www.leg.state.mn.us
36
Descargar

Home Care Bill of Rights for Consumers in Housing With