Rights and Safeguards for Consumers Living in Housing With Services

1. Rights and Safeguards for Consumers Living in Housing With Services Minnesota Department of Human Services Video Conference July 9, 2009

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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.

9. Overview of Class A & Class F Home Care LicensesMinnesota 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.

10. Assisted Living ServicesMinnesota 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.

11. 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

12. 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.

13. Consumer SafeguardsHome 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

14. Home Care Bill of Rights 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 & Medicare-certified hospice

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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

21. 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

22. Consumer IssueHome Care in HWS Summary of 3 rights issues with consumers. • Participation in planning/changing service plan/service agreement • Charges for services • Termination of services

23. Sources of Laws & RegulationsApplicable 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

24. HWS contract requirements • All HWS providers are required to have a written housing contract • 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;

25. 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.

26. HWS Regulations • Minnesota Statues 144D.065 Training in Dementia Care requires direct care staff and their supervisors (in HWS) to be trained in dementia care.

27. 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.”

28. 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

29. 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

30. 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

31. 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)

32. 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

33. Americans With Disabilities ActTitle 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

34. 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

35. 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

36. 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