October 13th Assisted Living Forum

On Tuesday, October 13^th, the Bureau of Assisted Living (BAL) hosted a virtual version of their Quarterly Forum.

As usual, a recording of the forum and the materials will be posted to the BAL website in the coming weeks.

Here are the updates and overviews of the information that was shared during the meeting, for more details view the recording and materials once they are posted on the BAL website:

Updates from Ken Brotheridge – Bureau Director:

• DHS/DQA Provider Portal – if you have questions or need to troubleshoot, reach out to the number on their DHS website.
• DHS 88 Adult Family Homes Administrative Rule Rewrite – Achieved certain milestones over the summer, held a hearing, received responses as part of the hearing process. Bureau is continuing to review the comments and will be responding in some way, with no updates on where the rulemaking process is going next. There will be updates in the future, so stay tuned and make sure you’re on the email list for updates.
• Calendar Year 2027 Assisted Living Forums – This is the last 2026 Assisted Living Forum. There will be more forums in 2027, and the first one will likely be in February, but keep an eye out for updates.
  • In 2026 we held 4 in-person forums, they received positive feedback on continuing in-person forums and they are looking to repeat in-person opportunities in 2027.

Jerry Riederer – FOCUS 2026 – Registration is open if you haven’t already registered.

• There is more Assisted Living content than in years past as there are more Assisted Living providers attending. Included in the breakout sessions, there will be the usual surveyor panel and a presentation on RN delegation.

Kathy Teske – Survey Documents:

• Access to Records Memo – Hoping to work collaboratively to transition to using electronic records during the survey process. Giving surveyor access to read-only records has resulted in a faster survey process and experience.
• DQA/Provider Relationships During the Survey Process – “Shared Expectations Tool”
• Survey Readiness Guide – Information that BAL staff had input on and information that they think is helpful for providers to develop their own survey readiness plans. This includes a number of questions that surveyors will likely ask your staff, so they can be prepared to answer those questions.

Emergency Responses in Assisted Living/Emergency Preparedness: Kelly Haugen NW Region Director, Jessica Gross Relocation Coordinator with DMS, Nancy Studt BOALTC

• AFH Codes:
  • 88.05(4) Fire Safety – requires written plan for fire response, staff and resident training, and semi-annual drills. Requires evaluation of resident evacuation abilities and encourages local fire department coordination.
• RCAC Codes:
  • 89.23(2)(c) Emergency Assistance – requires written plans for a variety of emergencies, staff must be available to provide assistance 24/7 and the plan must be developed in consult with local emergency services.
• CBRF Codes:
  • 83.47(2) Emergency & Disaster Plans – requires written emergency plans that include responses to a variety of situations, emergency shelter plans, transportation to the emergency shelter location, and meal/medication assistance when at the emergency shelter location.
  • Requires review and practices and encourages local collaboration.

After your initial response – notify all appropriate parties that haven’t been made aware of the situations, develop and implement contingency plans, and analyze/revise emergency response plans.

Relocation:

• Chapter 50 relocation process.
• Relocation team purpose in emergency response
  • Resident roster, MCO information, and current location of residents.
  • Team consists of DMS, BAL, Facility, Ombudsman, MC
• Manual and information on Resident Relocation

Transfer Stress Syndrome or Transfer Trauma

• Emotional and physiological impacts of sudden transfer.
• Symptoms before, during, after include:
  • Agitation, fear, delirium, increased falls, changes in self-care, weight loss, withdrawal from activities.
  • Look for changes of baseline.
• Factors that can magnify symptoms:
  • Unpreparedness or surprise at the need to relocate. Keep residents informed as things go.
  • Consider known physical and mental states beforehand, will they experience more pain and anxiety during the move.
  • Lack of a social support network can magnify symptoms.
  • Consider the residents’ history, impacting previous trauma and issues.
• Strategies for successful outcomes:
  • Right to be notified
  • Keep people informed as things change and be flexible.
    • Keep residents more prepared and feel more involved in the process.
    • Let residents and family know how they will be contacted.
  • Provide information on where belongings are being stored and how to access them.

Lisa Hassenstab – Disability Rights Wisconsin – Resident Voting Rights in Residential Care Settings

• Federal regulation states that residents in long-term care facilities who are eligible voters have the right to vote and facilities must help facilitate the exercise of that right.
• Eligible voters retain the right to vote unless it is removed by a judge.
• You can check your registration status, register, and update voter registration and more at myvote.wi.gov.
• Tips for Assisting residents with voter registration:
  • Include a question about registration during your intake process.
    • If they want to register online, via mail, or in-person at the polls.
      • State photo ID.
      • Proof of residence
    • How can residents vote?
      • Absentee ballots
      • In-person absentee (early voting)
      • In-person on election day
      • With a Special Voting Deputy (SVD) (Only certain facilities eligible)
        • At least 5 registered electors of the municipality as residents of the facility.
        • At least 1 has requested an absentee ballot.
        • The facility has 10 or more residents.
        • This is determined by the local town, village, or city clerk, so communicate with them on eligibility and process.
      • SVD (process is the responsibility of the Clerk)
        • Requires 2 visits to the facility.
        • Family may be present when the SVDs are present.
          • Can assist resident with voting, only at the request of the resident.
        • Family can request SVD dates and times from the facility; it is also posted publicly.
        • There may be election observers in the facility, this is allowed since it is a public voting process, typically the SVD will work in a common area and the SVDs will ensure that the election observers follow requirements.
          • Observers need to be pre-registered with the clerk.
          • Observers cannot enter a resident room without permission.
        • Staff cannot assist a resident with voting while an SVD is in the facility, the SVD can assist the resident with voting.
      • Tips for assisting residents with absentee ballots:
        • Resident can vote from prior address if they intend to return to that address.
        • You can assist in requesting absentee ballot.
        • Staff may assist a resident with completing a ballot upon the resident request if SVDs are not coming to the facility.
      • Voting locations on election day are required to have curbside voting and accessible voting equipment.
    • Residents with a guardianship do not automatically lose their right to vote in that process, that information is included on the form and determined by the judge.

Home and Community Based Services Setting Rule Updates – Chrstine See – DMS

• HCBS Settings Rule Overview
  • Established by CMS in 2014.
  • “ensures that people who receive services through Medicaid’s HCBS program have full access to the benefits of community living and are able to receive services in the most integrated.
  • The rule protects the resident’s individual autonomy and decision making.
• HCBS Settings Rule applies to IRIS, FamilyCare, Family Care Partnership and CLTS
  • Locations include adult day cares, group supported services, AFH, CBRFs and RCACs.
  • Does not apply to SNF, IMF, ICF/IDD, or Hospitals.
• Modifications:
  • An HCBS modification is an agreed upon restriction that is implemented by the provider to limit one or more of the resident’s rights to address an identified need or risk to health and safety. They must follow the HCBS Settings Rule Modification process.
    • MCO or IRIS Consultant leads and documents the process.
  • Only the following rules can be modified:
    • Privacy in sleep and living units:
    • Entrance door lockable with only appropriate staff having keys.
    • If rooms are shared, the individual has a choice of roommates,
    • Freedom and support to control their own schedule and activities
    • Freedom to furnish and decorate within lease agreement guidelines
    • Access to food at any time
    • Can have guests, including overnight
  • Modifications may only be made due to a health and safety, behavioral, or other risk to the individual, must be in relation to one or more of the HCBS settings rule rights, must be justified and documented in the individual’s plan.
  • Home and Community Based Services (HCBS) Settings Rule Modifications: Residential Provider Support Tool for Family Care and Family Care Partnership Members
• The DQA survey process looks for benchmarks in HCBS rules, there are additional benchmarks for heightened scrutiny providers. (Connected to nursing home, under same roof)
• Code is still available through MCOs for free training, reach out to your MCO for that code.