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Regulatory Guidance for Providers

Washington providers are charged with ensuring residents’ rights are protected. While skilled nursing facilities must comply with state and federal requirements, standards for assisted living are established in state law.

Here are links to WHCA Survey & Regulatory Update articles that provide helpful guidance on key issues:

Discharge and Transfer Notices- Skilled Nursing and Assisted Living Providers
  • Discharge Notice Guidance for Assisted Living and Skilled Nursing
    Issuing a discharge notice to a resident and his/her surrogate decision maker is never an easy task. Not only is it emotionally difficult for all involved parties, but it can also be time consuming to fulfill all requirements outlined in RCW 70.129.110. If not done carefully and thoroughly, issuing a discharge notice can quickly elevate from a mundane task on your to-do list to a contentious, relationship-ruining event.
  • Transferring Residents to Other Settings
    A resident transfer involves the temporary movement of a resident from a licensed or certified care setting to another licensed or certified care setting. This movement is short term and typically for medical or mental health treatment or rehabilitation, with an expected eventual return to the original facility. This article aims to delineate the differences between discharging a resident and transferring one.

 

Resident Meetings for Annual Inspections – Assisted Living Providers

 

Federal Requirements for Skilled Nursing Facilities

The CMS Rules of Participation detail federal standards for skilled nursing facilities.  The federal requirements do not apply to assisted living. Here is guidance about the CMS standards:

  • Transfer/Discharge Notice Requirements-Notification of the Ombuds: Requirements related to resident transfers and discharges are detailed in CFR 483.15, F622 through F626. While a number of the requirements mirror the Washington statute (RCW 70.129.110), there are some key additional requirements to ensure compliance.
  • Admission, Transfer, and Discharge Requirements: Detailed information regarding resident admissions, transfers, and discharges under the CMS Rules of Participation.
  • Room & Roommate Changes: What You Need to Know: Nursing facility residents have a right to share a room with whomever they wish, as long as both residents agree; this guidance describes the requirement.
  • Grievance System: Requirements for all skilled nursing facilities regarding management of grievances/complaints are outlined in section CFR 483.10. While F585 goes into greater detail regarding the facility responsibility for managing grievances, some key highlights are outlined in this article.
  • Resident Rights-Visitation: A skilled nursing facility resident has the right to receive visitors of his/her own choosing at the time of their choosing and in a manner that does not impose on the rights of another resident, and must provide IMMEDIATE access to a resident by immediate family, other relatives of the resident, and others that are visiting with the consent of the resident. This article provides additional information about the standard.
  • Resident Smoking: Smoking is still a topic that is fraught with personal opinions, safety hazards, resident rights, and multiple regulations. Every facility needs to remain hypervigilant related to smoking, whether the facility “permits” resident smoking. Included in the Centers for Medicare & Medicaid Services (CMS) State Operations Manual (SOM) Appendix Q-Guidelines for Determining Immediate Jeopardy are triggers that include unsupervised resident smoking with known safety risks (failure to prevent neglect) and smoking in high risk areas (failure to provide safety from fire, smoke and environment hazards). This guidance provides information about the CMS requirements related to resident smoking.
  • Resident Rights- Substance Use Disorders: CMS is increasing scrutiny on the care for residents with substance use disorder (SUD). This article will help providers understand a residents rights related to this issue.

 

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