Webinar Responses

During the course of the webinar on the Operational Guide for Sudden Closure of Adult Residential Care Facility, participants had the opportunity to submit comments and questions.  Below is a response to this input prepared by personnel of the Divisions of Aging and Adult Services, Health Service Regulation, and Mental Health, Developmental Disabilities and Substance Abuse Services.  This will remain a work-in-progress, meaning that additional information may be posted from time to time on this web page as the need arises.  We also welcome ideas, the sharing of tools, and any other measures that will help us prepare for any future sudden closures.   To aid those who may have further questions, we have provided email links.

Questions

  1. Who takes care of the residents in the event of a sudden closure?  Who takes care of the residents’ physical needs (personal hygiene, medication administration, etc.) if facility staff are not available to provide care, give meds, meals etc...?
  2. Has a tool been developed to help the lead agency in accessing what is needed for relocation of the residents?
  3. What items are needed to assist in resident relocation?
  4. What resident records need to be sent or copied to accompany resident to new location?
  5. Who is responsible for retrieving and safeguarding each resident’s records that need to follow the resident to their placement?
  6. When a move has to occur very quickly, and a resident has been in a facility for a long time, what are the requirements for an updated FL2 and TB skin test?
  7. How will we deal with obtaining PASRR in these situations?
  8. How long do we track individual residents affected by a sudden closure?
  9. Was the most current copy of Exhibit E (the Adult Care Home/5600 Discharge Tracking Log) used in the webinar?  How do we note the name of the new home/placement?
  10. What is the process for the host LME/MCO and/or host DSS contacting the LME/MCOs and/or DSSs for residents whose Medicaid originates in other counties?  What are the expectations for those “home” agencies to assist in relocating the residents and how will they be notified of their residents being in an out-of-area facility?  Will DSS be the lead for every consumer, including consumers with a primary diagnosis of mental illness?
  11. What happens when the facility closes without providing the required 30 day notice?
  12. What were the consequences for the Adult Care Home that gave only three days of notice?  How are the closure requirements enforced?  Did any criminal charges result in the three closures referenced in the presentation?
  13. Who are the primary contacts in case I have further questions?


  1. Who takes care of the residents in the event of a sudden closure?  Who takes care of the residents’ physical needs (personal hygiene, medication administration, etc.) if facility staff are not available to provide care, give meds, meals etc...?
    Several of the questions and comments submitted by webinar participants focused on “who takes care of the residents” in the event of a sudden closure, especially if the facility’s staff members are no longer available.  The simple answer, even if not simple to achieve, is that all of us must do our respective part to assure the health and safety of affected residents in such situations.  While in the previous cases many direct care workers of closed facilities have stayed on to assist out of concern for the residents, we know that we must be prepared if this were not the case.  This suggests the importance of advance planning locally to discuss roles as we have done at the state level with this Operational Guide.  We strongly recommend that similar discussions and contingency planning take place among the local partners, to include at least the county Department of Social Services, LME-MCO and Long Term Care Ombudsman Program.  We hope that what we have outlined in the Operational Guide will serve as an important starting place for this discussion.  Additional organizations that you might want to include would be Public Health, the local Food Bank, the County’s Public Affairs Officer and others whom you can imagine calling upon in the event of a serious situation.  You might even consider practicing your response through a simulated exercise.

    Again, in many cases, though the home is initiating closure without adequate notice, facility staff remain and provide services as residents are being placed.  In adult care homes, if all of the staff leave their jobs and the facility, then DSS would need to arrange for services until residents are placed.  This will create an urgency to find safe locations as soon as possible.  County DSS may need to work with other local organizations including public health, the LME-MCO, food pantry, etc. to ensure meals and medication administration remain timely.  Residents will need to be prioritized for placement activities based on their medical condition and care needs.  Family members may be able to provide care on a short-term basis.  For a medically fragile situation, home health services or emergency room treatment may need to occur.
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  3. Has a tool been developed to help the lead agency in accessing what is needed for relocation of the residents?
    For adult care facilities, please consult the Adult Care Abrupt Closure Process.  For Mental Health facilities, the LME/MCO would follow their internal procedures.


  4. What items are needed to assist in resident relocation?
    For residents residing in adult care homes, items normally needed are: gloves; hand sanitizer; gallon-size Ziploc bags (at least two for each resident) to hold resident medications, Medicaid card, etc.; heavy duty trash bags for packing resident possessions and clothes; adhesive labels; permanent markers; camera for any documentation needed; paper for copying, and if necessary, a portable copier (if available).  Based on the DSS’ knowledge of the facility and residents, other items may be identified. 


  5. What resident records need to be sent or copied to accompany resident to new location?
    Place in a resident-labeled bag: medications, original Medicaid card, insurance cards; documents regarding guardianship, Power of Attorney (POA), Do Not Resuscitate (DNR) orders and/or living wills; and any other documents that belong to the resident.

    Documents to be copied include: the resident’s medication administration records, controlled substance logs, TB screening and vaccination records; PASRR, Medicaid Personal Care Service (PCS) authorization for services, FL-2, Independent Assessment, DMA 3050-R or other care plan, the contact information regarding designated legally responsible party and the resident-designated individual to be notified of discharge.  Utilize a resident checklist to document each item or document placed in the bag.  Place a copy of it enclosed in the bag.  Maintain the original checklist for your records. 

    For an adult care home, the facility needs to maintain records in case of DMA audits, etc .  By rule, the facility is required to maintain records for three years after a resident leaves.  If the facility deserts the records, then either the county DSS or DSHR picks them. 

    For 5600 group homes, the LME-MCOs who have placement authority will follow their internal policies to ensure they have the records and documents needed for care coordination.


  6. Who is responsible for retrieving and safeguarding each resident’s records that need to follow the resident to their placement?
    For adult care homes, the facility’s record would be left in the facility unless the licensee and staff have deserted the facility.  In that case, the DSS staff should remove the resident’s record to their office.  This may not be determined until several days following the vacancy of the building.


  7. When a move has to occur very quickly, and a resident has been in a facility for a long time, what are the requirements for an updated FL2 and TB skin test?
    For residents living in adult care homes, the FL-2 should be updated annually.  The DSS worker would copy the current FL-2 in the closing facility as well as the TB screening documentation.  The receiving facility should obtain a new FL-2 as soon as possible if the FL-2 from the closing facility is older than 90 days.  Additionally, the receiving adult care home will need to immediately verify physician orders.  New TB screening is not necessary if the resident moved from one licensed adult care home to another.


  8. How will we deal with obtaining PASRR in these situations?
    The Preadmission Screening and Resident Review (PASRR) requirement will be reviewed on a “case by case” basis.  While it is the goal that everyone seeking admittance to an adult care home has a PASRR to facilitate appropriate community options and services, it is now a requirement for the reimbursement of Medicaid Personal Care Services in an adult care home.  However, circumstances during the response to a sudden closure may call for a temporary arrangement.  That would be done once official notification of the closing has been established and a status of the situation is known.  The determination regarding PASRR would be made by an appropriate official within the NC Department of Health and Human Services, Office of the Secretary/Policy Office Transitions to Community Living Section.


  9. How long do we track individual residents affected by a sudden closure?
    Each individual impacted by the sudden closure must be included on the training log.  The location of the new living environment must be identified.  During the debriefing meeting the tracking log will be reviewed.  Individuals identified as high risk or placed in inappropriate settings will require additional follow up until the situation is deemed locally to no longer require this (e.g., they are placed in the most appropriate community setting, or they self identify that they like where they are living and do not wish to move at this time).


  10. Was the most current copy of Exhibit E (the Adult Care Home/5600 Discharge Tracking Log) used in the webinar?  How do we note the name of the new home/placement?
    There are two versions of Exhibit E with only slight, intentional differences.  The official Operational Guide (PDF version) has an Exhibit E that does not include names of individuals in key roles (i.e., Chief of Adult Services for DAAS, and Housing Administrator for DMH/DD/SAS).  This was done so the document would not need constant revisions if staffing changes occurred.  The online version of the tracking log (XLS) has Suzanne Merrill and Ken Edminster identified to make notification of the appropriate person easier. As for names of the facility to which individuals may relocate, the online version of Exhibit E has a drop-down list for type of new living situation (Destination Category).  There were too many locations to list on a drop-down item, and facilities change names or cease operation which would require constant revisions to the document.  After the type of location has been identified, it is recommended that the name and address be included in the final column “comments”.  There is a specific column in which to list the ACH or 5600 group home, if applicable.  We recommend including both the name and address of the facility.  For other locations, you can add similar information in the final column ‘comments.’


  11. What is the process for the host LME/MCO and/or host DSS contacting the LME/MCOs and/or DSSs for residents whose Medicaid originates in other counties?  What are the expectations for those “home” agencies to assist in relocating the residents and how will they be notified of their residents being in an out-of-area facility?  Will DSS be the lead for every consumer, including consumers with a primary diagnosis of mental illness?
    At the point the Division of Health Service Regulation activates the Hub for Adult Care Homes, the Division of Aging and Adult Services (DAAS) runs a list of all Special Assistance/Medicaid residents in the facility.  That list has the resident’s name, Medicaid identification number, county of Medicaid origin, information about a guardian and/or representative payee and how to contact that person.

    The resident list is quickly shared with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH) and the county DSS where the facility is located.  DMH determines which of the residents on the overall list have a behavioral health diagnosis and provides that list to the “host” LME/MCO.  The “host” LME/MCO contacts the “home” LME/MCOs to let them know there are residents in the facility whose Medicaid originates in their catchment area and coordinates with them to relocate those residents.  The “host” and the “home” LME/MCOs are expected to work together to relocate residents with a behavioral health diagnosis.  The “host” LME/MCO coordinates these efforts with the DSS where the facility is located. 

    The DSS where the facility is located coordinates the overall response to the sudden closure, but as stated above, the ‘host” LME/MCO is responsible for relocating residents with a behavioral health diagnosis in conjunction with the “home” LME/MCOs.

    The DAAS field staff contacts each of the DSSs where the Special Assistance/Medicaid originates.  Those DSSs are asked to assist with the relocation of residents from their counties impacted by the sudden closure of the facility.  Those DSSs are to coordinate with the DSS where the facility is located to arrange for alternative placements/living arrangements for those residents. 

    While the LME/MCOs are taking the lead for residents with behavioral health diagnoses, the expectation is for LME/MCOs and DSSs to work together to assure the safe and timely relocation of all impacted residents.

    The process for a sudden closure of a 5600 Group Home licensed under GS 122C is similar to that of the sudden closure of an adult or family care home licensed under GS 131D.  At the point the Division of Health Service Regulation activates the Hub for 5600 Group Homes, DAAS runs a list of every Special Assistance/Medicaid resident in the home.  That list has the resident’s name, Medicaid identification number, county of Medicaid origin, information about a guardian and/or representative payee and how to contact that person.

    The resident list is quickly shared with DMH.  DMH provides that list to the “host” LME/MCO.  The “host” LME/MCO is the lead agency for relocating residents.  The “host” LME/MCO will contact the “home” LME/MCOs to let them know there are residents in the home whose Medicaid originates in their catchment area and coordinate with them to relocate those residents.  The “host” and the “home” LME/MCOs are expected to work together to relocate residents. 

    The DSS where the home is located is alerted to the sudden closure, but does not have a specific assigned role in this response as they are not directly involved with these homes.  The DSS can be contacted as a resource to the LME/MCOs and when there is a need for Adult Protective Services.


  12. What happens when the facility closes without providing the required 30 day notice?
    DHSR staff will utilize regulatory authority available in statute including fines and/or licensure action.  For homes licensed by  under Mental Health or Adult Care rules an onsite visit will be conducted to determine if the facility violated the requirement for  30 days notice and ensure all clients are appropriately placed and records transferred or secured.  The Department is reviewing potential changes to statute regarding consequences against the licensee.


  13. What were the consequences for the Adult Care Home that gave only three days of notice?  How are the closure requirements enforced?  Did any criminal charges result in the three closures referenced in the presentation?
    No action was taken to pursue criminal charges.  DHSR had suspended admissions and issued a revocation to the licensee prior to closure of one of the homes; no action was taken regarding the other homes.  Because the County DSS staff monitor for regulatory compliance, the DHSR staff did not go onsite during these closures.  In the future, because the county DSS staff are focused on placement activities, ACLS will be onsite to monitor regulatory compliance.


  14. Who are the primary contacts in case I have further questions?
    Division of Aging and Adult Services (DAAS)
    Suzanne.Merrill@dhhs.nc.gov, Chief of Adult Services Section
    Chris.Urso@dhhs.nc.gov, Special Assistance Program Administrator
    Sharon.Wilder@dhhs.nc.gov
    , State Long Term Care Ombudsman
    Dennis.Streets@dhhs.nc.gov, Division Director

    Division of Health Service Regulation (DHSR)
    Barbara.Ryan@dhhs.nc.gov, Chief of Adult Care Licensure Section
    Stephanie.Gilliam@dhhs.nc.gov
    , Chief of Mental Health Licensure & Certification Section

    Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS)
    Ken.Edminster@dhhs.nc.gov, Housing Administrator

Last updated: March 14, 2014