1 the afh journey begins - oregon.gov the afh journey begins rev april 2016 dhs-office of licensing...

THE AFH JOURNEY BEGINS1

REV April 2016 DHS-Office of Licensing and Regulatory Oversight

WELCOME

Welcome

Your journey towards opening or managing an Adult Foster Home begins today.

The purpose of the EQC training is to provide you with information and tools you need to provide:

Appropriate care; AND

Ready your house to support individual resident choice.

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EQC TRAINING

The EQC training covers a broad range of topics necessary to:

Understand the scope of what is expected from an adult foster home licensee and their caregivers;

Prepare your home for residents; and

Understanding your home is now also the home of each resident.

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Business basics;

Care planning;

Common chronic conditions;

Communication;

Dementia and challenging behaviors;

Documentation requirements;

Emergency preparedness;

Fire safety;

Food safety and handling

Infection control;

Managing your time;

Medication administration;

4 EQC TOPICS


Normal aging;

Nutrition;

Personal hygiene;

Privacy, HIPAA and security;

Problem solving and conflict resolution;

Resident rights;

Safety in the home environment;

Screening and admission process;

Taking care of yourself.

5 EQC TOPICS CONTINUED


ADDITIONAL TRAINING

Your participation in the EQC training is only the beginning. The EQC training does not cover all aspects of resident care. It is your responsibility to seek additional training such as:

Topics covered that you do not feel adequately prepared;

Prior to admitting a resident with a condition you are unfamiliar with;

Ongoing training as required by OAR 411-050-0625;

Operating a business.

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ADDITIONAL TRAINING

Resources and tools are available to help you find the right information and training:EQC additional tools and resources -

www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/Pages/EQC-Resources.aspx;

Safe Medication Administration -www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/Pages/safe-med-administration.aspx;

Adult Foster Home Training website -www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/APD-AFH/Pages/Training.aspx

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SCREENING PROCESS8


INTRODUCTION

Preparing for ongoing needs:

All residents have conditions that change overtime:

Normal aging process;

Changes in medication needs;

Changes in chronic health care needs;

Progression of degenerative conditions.

Be prepared to provide care according to the individual needs and preferences of each resident.

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WHOSE HOME IS IT?

Once your home is licensed, your house is also each resident’s home:

Accommodations need to be made reflecting, within reason, their expectations. Residents, have a say in:

Activities;

When and where they can eat;

When the resident goes to bed and gets up in the morning; and

Who their visitors are and when they can visit.

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WHOSE HOME IS IT? CONTINUED

Imagine how you would feel if you could not:

Arrange your furniture and decorate your room as you like;

Lock your bedroom door for privacy;

Access snacks when you want;

Provide input into the food offered or your mealtimes;

Decide when and who you have visit.

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WHAT IS AN AFH?

Adult Foster Homes are highly regulated businesses and must be run in accordance with:

All applicable state and federal Medicaid/Medicare laws and regulations;

Applicable federal and state business regulations;

Oregon State OARs for Adult Foster Homes;

Fair housing rules;

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WHAT IS AN AFH? CONTINUED

An adult foster home is also a place of employment:

Must follow all applicable employment laws, BOLI (Bureau of Labor and Industry):

Wage and Hours.

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WHAT IS AN AFH? ONGOING UPKEEP

There are additional responsibilities of an AFH provider, such as:Routine maintenance of the interior and

exterior of the home:

Painting;

Yard maintenance and debris removal;

Electrical and plumbing;

Keeping exits and walkways clear and accessible;

Ensuring adequate supplies;

Electrical and plumbing in good working order.

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WHAT IS AN AFH? ROUND-THE-CLOCK TASKS

Owning and running an adult foster home is not an 8 AM to 5 PM job. For example, it requires significant time involving more than one person to manage:Maintenance of home and property;Resident care and service needs;Nighttime care needs;Laundry;Nutritional needs;Financial records;Resident and facility records.

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SCREENING16


SCREENING PURPOSE & KEY TERMS

Assist the learner in understanding:

What information needs to be shared with the prospective resident;

What information must be gathered during the screening process;

Behavior management;

License classification;

Screening;

Medication management.

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SCREENING INTRODUCTION

Referrals come from a variety of sources:

Prospective residents, their family or friends;

Healthcare practitioners;

Nursing facilities and hospital discharge planners;

Local Aging and People with Disabilities or Area Agency on Aging:

Case manager; or

Diversion coordinator

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SCREENING FINDING THE RIGHT MATCH

Before accepting a prospective resident:Visit the person in their current setting; and

Gather information to make an informed decision.

The decision to admit a person to an AFH often results from a crisis:Discharge planners, healthcare practitioners,

families, or case managers may try to push for an immediate decision;

It is vital that you take time and gather information from as many sources as possible before deciding to admit a resident.

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You are the only one who can determine if you are qualified, willing and able to care for a new resident;

Taking in a resident without adequate information:

Leads to turmoil for the resident, his or her family, the other residents in your AFH and you;

May result in corrective actions, including sanctions, for admitting a resident without being able to meet their needs.

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Once admitted, a resident can only be asked to leave for specific reasons as

allowed by Oregon administrative rules.

21 ALERT



Avoid unnecessary challenges by ensuring:

You can support the prospective resident’s needs and expectations;

Prospective residents, families, or the resident’s representative understand your home’s policies, residency agreement, and resident’s rights;

As a licensee you have completed a thorough screening of each resident prior to admission;

As a licensee you aware of the limitations of the AFH and staff.

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SCREENING SDS 0902

Use the mandatory SDS 0902 form to identify required information including, but not limited to:Medical diagnosis, medications and nursing care;

Personal care needs including night care needs;

Cognitive and communication needs;

Nutritional needs;

Activities and lifestyle preferences; and

Other data to assure you can meet care needs:Refer to OAR 411-050-0655 and OAR 411-015-0006.

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SCREENING SDS 090224


SCREENING SDS 034025

Use the AFH Care Plan, SDS 0340, during your screening process. It will provide you with a better understanding of the residents needs:


SCREENING PROCESS

Ask as many questions as possible over the phone. The answers will help determine your next action:

Have a list of questions or a copy of the Screening and General Information form, SDS 0902, near the phone;

Determining if the caller needs a placement for a man and you only have a shared room with an existing female resident; or

You could be a nonsmoking home and the potential resident is a smoker.

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SCREENING PROCESS

The information gathered will focus on the potential resident’s ability to participate in activities of daily living (ADLs): Bathing/personal hygiene;

Grooming;

Eating/nutrition;

Dressing;

Transfer/mobility;

Toileting;

Behavior management.

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SCREENING PROCESS

Determine how much help the potential resident requires through:

Interviews with the potential resident;

Interviews with family, previous caregivers and medical professionals involved;

Documentation from previous healthcare settings; AND

Your own observations during your face-to-face visit.

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SCREENING ACTIVITIES OF DAILY LIVING (ADLs)

Document the person’s ability to perform ADLs without help. For definitions refer to OAR 411-015-006:

Independent: Can manage the ADL without assistance or cueing;

Assistance: Is able to do the task but cannot do it alone;

Full Assistance: Cannot do any part of the task and it must be done entirely by another person.

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SCREENING EVACUATION

Evacuation: It is the licensee’s responsibility to ensure all occupants can be safely evacuated within the time allowed:

Refer to OAR 411-050-0650(5);

Consider and plan how you will evacuate all residents including family members if you only have one person on duty at any one time:

If you have anyone requiring a two-person assist, you will need two people available at all times.

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The licensee must consider the potential resident’s ability to:

Transfer: for example, assistance getting out of bed, up from a chair or toilet;

Evacuate without assistance;

Follow instructions:

Residents with cognitive deficits may not be able to follow directions in an emergency.

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The layout of the home and property must be considered when evaluating the evacuation plan: Evaluate the ability of prospective resident and

all other occupants to evacuate to the final point of safety, which is at least 50 feet away from the AFH. For example, consider:

A resident who can only walk 12 feet without resting, would not be able to independently evacuate to the final point of safety;

A resident who requires portable oxygen or other assistive devices.

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SCREENING CARE NEEDS

The licensee must be able to support the prospective resident’s care needs in addition to current residents. Consider: Medical diagnosis;

Dementia and other behavioral needs;

Medications and treatments;

Nurse consultation or RN delegation services;

Communication needs;

Special diets; and

Lifestyle choices and activities.

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SCREENING COLLECTING DATA

Document the source of the information gathered. Common sources of information:

The potential resident;

Family/friends;

Physician, nurse practitioner or office nurse;

Case manager or diversion /transition coordinator;

Pharmacist.

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Medical sources of information include: Hospital or nursing facility:

Discharge planner/social service worker;

Patient/resident chart:

Admission information;

Current medication administration record;

Nurses’ notes, includes care needs, sleeping habits and behavioral issues;

Social service notes on previous living arrangements, contact people, other personal information;

Dietitian notes;

Physical, occupational or speech therapy notes.

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If moving from an ALF or RCF setting:

Interview the primary caregivers;

Obtain copies of the resident’s records:

Service plan describing what services are provided for the resident based on the resident’s individual capabilities and preferences;

Narratives/notes regarding care provided and response to care;

Current physicians’ or nurse practitioners’ orders including medications, treatments and therapies.

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If moving from an AFH:

Interview the primary caregiver;

Obtain copies of the resident’s records:

General information form;

Most recent physicians’ or nurse practitioners’ orders: Medication, treatments, therapies;

Narratives/incident reports: indicating resident’s current condition;

Instructions from other members of the health care team: RN, physical, occupational, speech or mental health therapist, social worker, etc.

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If the prospective resident was living in their own home:

Talk with community supports:

Friends;

Church;

Support groups;

Service groups the person has been involved with: Lions Club, Shriner’s, Elks, Moose, American Legion, Eagles, Odd Fellows, military service organizations.

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SCREENING GUIDELINES

Effective screening and assessment requires sensitivity, good communication skills and a professional attitude.

Each piece of information fills in the puzzle enabling you to make an informed decision:

You do not need nor should you have access to all information;

Out of respect for privacy, confine your research to information that is reasonably related to your ability to provide care.

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Listen and show you care: Potential residents and their family members

are often under tremendous stress;

Be understanding as it may be difficult for prospective residents or their family to talk about problems without being emotional;

Be reassuring;

Prepare the resident and the family for a period of adjustment that may take more time then expected;

Encourage questions.

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Avoid making promises you cannot keep: “Don’t worry, we won’t let anything happen to

your mother.”

You can’t guarantee that a medical event will not occur.

“Don’t worry, your father will never have to move.”

You can’t guarantee the resident’s care needs may increase and exceed the abilities or the license level of the AFH.

“Sure, we can take your father fishing every weekend.”

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SCREENING ADMISSION PACKET

Develop an admission packet:

Provide information about your AFH to clarify expectations for residents and families:

Qualifications of you, your staff, and consulting RN;

Your license classification;

The types of residents you serve;

Daily routine, including children, visitors and pets;

Nearby resources (churches, senior center, shopping, transportation services, etc.);

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Residency Agreement: House policies;

Resident Rights;

Services you can/cannot provide;

Rates and related issues:

Notification of rate increases;

Billing procedure (when payment is due);

Refund policies;

Whether you are enrolled as a Medicaid provider.

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Policy/procedures:

Confidentiality and HIPAA;

Safety and emergency evacuation procedures;

Notification of emergencies or other urgent issues;

Notification of involuntary move-out;

Social activities within/outside of home;

How roommates are selected;

Personal possessions;

Food brought in by family or others.

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Resident’s medical needs:

Arrangement for medical and personal appointments;

Replacement of/payment for medications;

Procedures for care needs beyond your skills/license level;

Procedures for a medical emergency and when death occurs.

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SCREENING PROCEDURES

These procedures will facilitate the screening process:

Be familiar with the Screening Information and General Assessment form (SDS 0902) and complete it as you talk with the potential resident, initial caller and other contact people;

Discuss your criteria for admitting new residents and providing care. Briefly outline your qualifications, your license classification and the type of resident you serve;

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Arrange to meet with prospective resident and family. If the person making the inquiry is interested in placement, stress how important it is for all parties to meet and talk together;

A face-to-face interview with the potential resident is vital. You must gather your own information and consider information given to you by other people;

Invite the potential resident to your home to meet a potential roommate, and other housemates;

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Talk with the prospective resident. It is essential to involve the person as much as possible in the decision-making process;

Review the admission packet together:

It is important for you to explain the admission process and what it is like to live in your home;

Review the house policies, residency agreement, services provided and fees:

Determine who will make payment and when.

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Review and explain the Resident’s Rights;

Advise the potential resident or the representative that you must have signed written orders from the physician or nurse practitioner before giving medication and doing treatments.

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SCREENING LEGAL DOCUMENTS

If the person may be admitted, obtain copies of any legal documents such as:Advance Health Care Directive;POLST;Power of Attorney:

You must clearly understand the POA’s legal authority and responsibility regarding medical decision making.

Letters of Guardianship or Conservatorship: You must clearly understand the guardian or

conservators legal authority and responsibility regarding medical decision making.

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Discuss expectations of the prospective resident and family:

What kind of care and services do they expect you to provide? Thoroughly discuss differences between what they expect and what you can provide;

Determine who will be responsible for caregiving decisions;

Be sure everyone involved has a clear understanding before admitting to your home.

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Set a time for the resident to visit:

Inviting a potential resident for a meal gives both of you valuable information:

The resident gets to see how, where and what you serve at meal times;

They are able to socialize with current residents;

The resident can view the available room; and

Meet their potential roommate.

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You can observe and note several things:

Was the resident able to travel in a standard car? If not, how did she or he arrive?

Did the person require help getting in and out of the car?

Did the individual use mobility aids (cane, walker, wheelchair, etc.) to walk into your house?

Was the person able to walk up steps to the door, if necessary?

Did he or she seem to tire easily?

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While in the house, did the person get up and down from chairs without assistance and, if help was needed, what type of help was required?

Did the individual need help with toileting or mobility while there? What help was needed?

Could the person eat independently and cut food, and did he or she have problems chewing or swallowing?

Did the person seem alert and oriented?

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If a potential resident is in the hospital or is unable to visit, do a face-to-face screening where they reside: Was the person able to come to the door?

Were they alone or was a caregiver with them?

Do they have a caregiver? How many hours/day are they with them? What tasks do they perform?

Did the person use mobility aids? Was the person able to get to a standing position on their own?

Does the home smell of feces or urine?

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Can the potential resident show you and tell you about their medications?

Observe family interactions during the visit:

Does a family member answer the questions for the person?

Does one person speak for the whole family?

Do family members respect one another, or do they argue or show other signs of communication problems?

How does the prospective resident react to family members?

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Encourage ongoing communication:

Conducting a thorough screening takes time;

Individuals might want to share additional information forgotten during the initial contact;

Often prospective residents and family feel overwhelmed;

Let them know you are available for additional meetings or further discussion by telephone.

Talk to members of the prospective resident’s care team.

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Gather information from additional sources. Family members may not be able to give you a realistic picture of the person’s current condition, or behavior:

They may not have spent time with the person on a regular basis or, they have dealt with the relative’s behavior for years, and it no longer seems unusual.

They may look for the best and ignore the concerns, find talking about problems difficult, or fear you will refuse to admit their relative.

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Be honest with yourself and others

If at any point in the screening process you determine that you will not be able to provide care, let the potential resident or their family

know so they can look elsewhere for a placement.

59 ALERT


SCREENING ANALYZING DATA

Once you have gathered all the data, you need to assess what you have collected:

Take your time to consider all aspects of the data you collected;

Some data should cue you to:

Seek additional information;

Carefully consider if you can meet the potential resident’s needs.

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Additional information may be needed when there is a history of:

Frequent moves from one care setting to another:

This could mean there are hidden care issues you need to be aware of before making a decision;

Consider the potential resident’s and the family’s reasons for the move, but seek information from current or past caregivers.

61 SCREENING ANALYZING DATA


Noncompliance with recommended care:

You cannot change a lifetime of habits;

Bathing/hygiene issues become important when the person refuses to bathe or change clothes and their appearance and odor is offensive to you and others;

Refusal to follow a diet or take medications ordered by their doctor.



Not following a bathing routine, sleep schedule or other activities is not a valid reason for a involuntary

move-out.

63 ALERT


Be aware of dynamics between the resident and their family:

You cannot change a lifetime of family dynamics;

You must help the resident exercise his or her rights according to OAR 411-050-0655 (9).



Nighttime care needs:

AFHs must meet the night needs of residents. Consider how the resident will notify the caregiver when they need assistance at night:

All residents may have some nighttime needs;

Some residents have regular nighttime needs.



One caregiver cannot provide care during both the day and night on a regular basis:

If you identify the potential resident has regular nighttime care needs, and you are unable or unwilling to hire additional nighttime staff, you cannot admit.

Residents requiring regular nighttime assistance cannot be asked or required to use (for the convenience of the AFH):

Incontinence supplies; or

A bedside commode.



Residents with dementia or challenging behaviors may require routine cueing or redirection and may require additional staff:

Use of psychotropic medications or physical restraints for the convenience of the AFH is not allowed;

Residents with nighttime behaviors need to have caregiving staff available for appropriate cueing or redirection.



Before accepting a new resident consider:

The needs of the potential resident as well as the needs of the current residents in your home:

The current resident has the right to choose his or her roommate.

You must consider:

All caregiver’s qualifications, and their willingness and ability to provide care for the residents; and

All information and data gathered in your pre-admission packet.

68 SCREENING PRIOR TO ADMISSION


SCREENING PRIOR TO ADMISSION

Discuss sensitive caregiving issues and decisions including:

Procedures to follow if the resident dies in your home.

Obtain the name and telephone number of the resident’s funeral home, or information regarding funeral plans;

Each county may have different rules regarding what to do in case of a death. Prior to admitting any residents:

Contact your local sheriff’s office, EMS, or county medical examiner’s office for requirements in your area.

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If the resident does not want medical intervention in the event of cardiac or

respiratory arrest they must have a written and signed POLST or other legal

medical documentation.

You cannot require a POLST

70 ALERT


Arrange for caregiver training:

How to properly use all resident equipment;

How to properly provide transfer assistance;

On RN delegation for tasks of nursing that can be delegated;

On any administration of non-oral medications such as eye drops (if caregivers are unfamiliar with proper eye drop administration).



The resident cannot be admitted before caregivers have received proper

training.

72 ALERT


Can I provide care based on the classification level of my license?

What is the resident’s current health condition?

What are the resident’s healthcare needs?

Classification license level expectations.



Equipment needs:

Make arrangements to access medical equipment prior to admission (wheelchair, walker or other assistive devices):

If your home is not wheelchair-accessible, you cannot take residents who use a wheelchair;

Residents who are not independent in mobility can only be placed on the ground floor:

If equipment is not available prior to admission, the resident cannot be admitted.



Class 1 license: Provider may only admit residents who need

assistance in up to four activities of daily living;

Residents cannot have: Complex medical conditions:

For example, Parkinson’s disease.

Newly acute medical conditions:

For example, a resident being discharged from the hospital to a community-based setting following surgery requiring significant wound care;

Newly diagnosed insulin-dependent diabetes.



Class 2 license:

Provider may provide care to residents who require assistance in all activities of daily living, but require full assistance in up to three of the activities.



Class 3 license:

Provider may provide care for residents who require full assistance in all activities of daily living;

Limited to only one resident who requires bed-care or full assistance with all activities of daily living, not including cognition or behaviors.



Only the licensee may approve or deny admissions to the AFH and the licensee

is held responsible for their decision.

78 ALERT


The licensee must be able to answer “Yes” to each of the following questions before admitting a prospective resident:

Can the resident’s needs be met within the classification of the home?

Can the licensee and all caregivers meet the resident’s needs?

Can all of the AFH staff meet the needs of the prospective resident and the current residents?



Can the prospective resident and all occupants of the AFH, including family members, be evacuated as required?

Do you have written physician orders for the resident’s medication, therapies and treatments?

Are all supplies and equipment available?

Is the RN consultant available to assist with evaluating the medical needs of the resident?

Is the RN available to delegate tasks of nursing to caregiver prior to the task?



You are required to offer the resident or their representative a copy of the completed screening and assessment documentation, regardless of your decision to admit:

If the resident is admitted to your AFH, a copy must be placed in the individual’s resident record:

Completed screening forms must be maintained for a minimum of 3 years if prospective resident is not admitted to your home.



ADMITTING82


Admitting the new resident indicates you:

Have determined the care needs of the new resident are within your license classification;

Are able to meet the new resident’s needs and the needs of the current residents;

Can evacuate all occupants of the AFH, including family members, as required; and

Have written orders for the new resident’s medication, therapies and treatments.

83 ADMISSION INTRODUCTION


Set a day and time for the move-in:Schedule a time that assures you, the resident

and family members do not feel rushed.

Encourage the resident to personalize their room with:Favorite pictures and other decorative items;

Arranging furniture to suit their personal taste:Must comply with fire and safety rules;

If resident does not have furniture, AFH must provide before resident is admitted. See OAR 411-050-0650 (4).

84 ADMISSION MOVE-IN


Document personal possessions:

Discuss labeling personal possessions.

Suggest clothing the resident should bring:

Ideally clothing and other personal items should be washable:

If resident has non-washable clothing discuss cost of dry cleaning in advance.

Clothing should be comfortable and easy to put on and take off.

85 ADMISSIONS MOVE-IN


Encourage relatives or friends to help the new resident move in:

On move-in day make the new resident your priority:

You may need additional staff on the day when a new resident moves into your home.

Show the new resident around your home, how to find the bathroom, where meals are served, where common areas are located.

Introduce the new resident and family to other residents;

86 ADMISSIONSMOVE-IN


Respect privacy of all residents during the move-in activities;

Review emergency evacuation procedures within 24 hours of admission:

You must show all new residents how to respond to a smoke and carbon monoxide alarm, how to participate in a fire drill, and how to exit the home in an emergency.

Expect to spend extra time with the new resident in the first few days.

87 ADMISSIONSMOVE-IN


During the first 14 days, after a resident is admitted, the licensee begins a written assessment of the resident. See OAR 411-050-0655 (4):

This requires continuing to observe the resident’s abilities to perform activities of daily living (ADLs);

Document the resident’s preferences directly onto the care plan;

The care plan must be completed within 14 days of admission.

88 ADMISSIONS FIRST 14 DAYS


Recognize the resident’s feelings:Anger, loneliness, resentment and depression

are common;

Do not dismiss the residents feelings by saying “you shouldn’t feel that way”

The adjustment process involves three stages: Shock;

Anger or depression; and

Acceptance.

89 ADMISSIONS ADJUSTMENT PERIOD


You can assist residents and their families through the adjustment process by:

Keeping them informed; and

Involved:

If you notice the resident’s anger or depression persists for more than two months, it may be appropriate to request a medical evaluation.



Be a model for the new resident:

Visit with residents and encourage socializing;

Make mealtime pleasant;

Respect privacy:

Knock before entering a resident’s room; or

The bathroom.



Be patient with the new resident and family:

Reassure the family that someone is always in the home to meet the resident’s needs;

If family members or others find it hard to reach you by phone, problems can arise:

Explain that when you are busy with a resident, you may not be able to answer the telephone;

Reassure them you’ll call them back as soon as possible.



QUESTIONS93


1 the afh journey begins - oregon.gov the afh journey begins rev april 2016 dhs-office of licensing...

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