February 10th Bureau of Assisted Living – Assisted Living Forum
Yesterday, the Bureau of Assisted Living (BAL) hosted their quarterly Assisted Living Forum covering a number of topics and updates. A recording of this forum will be posted, previous forums, and the schedule for 2026 forums can be found here.
Here is a summary of the topics discussed:
BAL & DQA Updates – Eugene Janke has been hired and started as the new Deputy Administrator for the Division of Quality Assurance. Eugene comes to DQA following time as a Division Administrator with the Department of Employee Trust Funds (ETF) with the State of Wisconsin. In addition, Kelly Haugen, a former surveyor in the Northwest Region is the new Regional Director, following Bill Gardner’s retirement last year.
Lastly, an update was provided on the new DQA Provider Portal which allows providers to interact with DQA in numerous ways, including submitting initial applications, pay required fees, track feedback from DQA, and to view licensing, certification, or registration decisions in the system.
Survey Overview and Helpful Hints – Kathy Teske, BAL Deputy Director and Kelly Haugen provided some updates on the survey process and helpful hints.
Following a series of meetings with providers in October and November of last year, BAL is working on several projects and efforts to improve the survey process for assisted living facilities and surveyors. They are in the process of creating a “shared expectations” document, similar to the one for nursing homes so that both surveyors and facility staff have a shared set of guidelines and what to expect during the survey process.
A main issue raised by BAL is the use of electronic records and surveyor direct access to these records. Reports from BAL are that surveyors often have to spend significant time waiting for facility staff to print or provide records. This extends the time it takes for surveyors to complete their work and can extend the survey into additional hours and days. Some facilities have allowed surveyors to directly access records through various options with records platforms, whether a guest ID, a surveyor-specific account, or some other read-only access. Kathy would like to hear from providers on their experiences in an effort to increase comfort, increase awareness amongst providers, and to increase the efficiency of the survey process. If you use electronic records, have allowed surveyor access to records, and are willing to share your experience, please provide feedback either to Kathy directly at Kathleen.teske@dhs.wisconsin.gov or you can share the feedback with Eric Koch, Sr. Vice President of Government Relations & Regulatory affairs with WHCA/WiCAL at ekoch@whcawical.org, and he will facilitate relaying comments and feedback to BAL.
Kelly provided some helpful hints on how to make a survey a successful and efficient process. Including, ensuring staff are prepared and know what to expect; being generally prepared for unannounced surveys, especially regarding your records; and creating a survey binder, like many members use in nursing homes, compiling needed information in one place where anyone at the facility is able to quickly find and provide information. Survey binders should contain information like addressing corrections of previous SODs, evacuation and safety plans, activity calendars, menus, staff schedule, and staff/resident rosters. More information on the survey process can be found in BAL’s Survey Guide.
Northwoods Technical College Gerontology Program – Jennifer Ellis-Gajda provided an update on the work that they are doing, having established a gerontology program with a 2 year associate’s degree, a pathways certificate, and single courses. Northwoods Technical College is continuing to work on other programming including CBRF director
Pharmacy Updates – Doug Englebert from DHS provided reminders that facilities need to ensure that they have a plan in place for medications when a resident leaves, when medications can be sent with the resident and when they need to be disposed/how to dispose of them. Survey issues have come up when facilities do not have a system to dispose of medications or do not follow them, with instances of diversion of the medications and the problem areas are medications after discharge, death of a resident, and with controlled substances.
Questions are being raised by providers on the use of naloxone. Naloxone is available both over-the-counter and by prescription. If a facility has this on hand, staff need to ensure they are trained and have the ability to administer the Naloxone.
CBD is another common issue that comes up in facilities. Facilities are setting up policies regarding the use of products with THCa or Delta-9 THC, ensuring that drug interactions are accounted for and dosage is known. A thing to watch is that under the federal budget bill last year, the hemp loophole in the Farm Bill has been closed which will become effective November 2027 whereby the sale of any hemp-derived products (CBD, THCa, Delta-9 THC) will be illegal.
Delegation is another issue that current comes up frequently. Delegation is not training; the RN needs to ensure that the staff are not only trained but capable to doing the delegated task. When an RN leaves, the delegation is removed. So make sure you take steps to find new nursing coverage who can delegate tasks.
Freedom of choice is another issue that comes up with assisted living providers. This freedom includes that residents may choose which pharmacy they want to use, and fees for using a different pharmacy must not be so high so as to restrict choice.
HCBS Q&A Session – Christine See & Jerry Riederer from DQA answered questions submitted from providers on HCBS. Review the recording of the forum to find those questions and answers. Christine shared information on the HCBS setting rule information from DHS. Christine also shared information on training on the HCBS Setting Rules, MCOs are not required to train providers on the rule, but there is a training at UWGB on this. There is a cost to the training, but you may receive a code by reaching out to an MCO you work with to receive a code for free access. This document explains how to register for HCBS Setting Rule Mircrocredential Course using your promo code. Additionally, many MCOs have developed their own trainings for internal or external partners, you may wish to reach out to them to see if they have trainings available. Training is not required for all staff in assisted living facilities unless you are a heightened scrutiny facility, where initial training and annual review is required for staff directly overseeing residents’ care.
Wrap Up – Bureau Director Ken Brotheridge gave a few reminders and updates, including that the June Assisted Living Forum on June 16th from 10am-Noon will have information on survey process improvements and efforts.
