California’s governor and legislature continue to push a “master plan” agenda, and that “plan” will alter the structure of the RCFE industry. The intent of the plan is to change the care model from social to medical, so the state spends less money caring for its aging population, especially the cost of long-term i.e., skilled nursing. The plan will create a “private pay medical model” for RCFEs.
DSS’ upcoming changes to Title 22, especially the dementia regulations, will pressure facilities to hire nurses to create “safety assessments” and to better assess residents’ behaviors and need for specialized services. That would lead to better outcomes for residents, right? Better outcomes, but at what cost for residents and facilities? The state has devalued its growing elderly population, now totaling 19% of the state’s adult population.
When you read the new regulations, due January 1, you decide if I am someone in the desert crying “wolf.”
The January regulations will ultimately force RCFEs into hiring or consulting with medical professionals to assess and diagnose a resident’s “behavioral expression,” then create a “behavior plan and a safety plan” to address a resident’s “fear, perceived threat, boredom” and “wandering tendencies.” The new regulations will also force facilities into ascertaining if prescription and/or nonprescription medications are the cause of behavioral expressions, truly a medical assessment made by who exactly? Caregivers? Administrators? Nursing staff? Home health?
Is California endeavoring to have its Department of Health Services take compliance control of RCFEs away from DSS, then change its “social models of care,” dating to 1973, into medical models? Is it too late or is it better late than never? Is the state trying to catch up with the rest of the nation?
The new regulations will also force facilities to brush up on the language contained in residents’ legal documents to ascertain who, other than the resident, has the personal responsibility or liability to pay for care. DSS’ revised definition of “representative” could allow family members to weasel out of paying monthly fees. The revised regulation states, “…acting as a resident representative does not mean that the individual assumes personal responsibility or liability for payment of any charges incurred by the resident.”
Do you envision collecting monthly fees from dementia residents?
A new regulation will address a client’s “significant change in condition.” That is fine. However, the current Title 22 regulation requires a corresponding change in a facility’s plan of operation if a facility must significantly change resident services to meet a resident’s need (section 87208). This would require submitting a new plan of operation to an evaluator for approval or making an amendment to a plan of operation to meet a subjective and probable unpublished standard set by an evaluator. The Reappraisals section has been “gutted” that is likely to be the table setting for the creation of “care plans” and increases in staffing with corresponding staffing ratios.
Bedridden will come into the spotlight again with the legal definition of bedridden placed into the Medical Assessment section, 87458, but DSS continues its refusal to define “appropriate and sufficient care staff” so it can continue its subjective evaluation of facility staffing and residents’ physical condition. This leaves evaluators in the role of diagnosing bedridden which is unlawful under the California Business and Professions Code 2052.
Lastly, for now, the dementia regulations will be rewritten to reflect changes in law and the updating of the new regulations.