Legal Issues forLegal Issues forSocial WorkersSocial Workers

October 5, 2007October 5, 2007

By: Susan M. VoigtBy: Susan M. Voigt

VOIGT, KLEGON, and RODVOIGT, KLEGON, and RODÉ É Law FirmLaw Firm

(651) 209-6161(651) 209-6161

Increase in Responsibility for Social Increase in Responsibility for Social Services in L-T-CareServices in L-T-Care

How many residents do you serve?How many residents do you serve? What happens when you drop the ball?What happens when you drop the ball? Why is the licensing Board calling you?Why is the licensing Board calling you? Why do you need legal advice before you Why do you need legal advice before you

speak to the family?speak to the family? Who wants to be conservator?Who wants to be conservator? Where is the resident going?Where is the resident going? Another new regulation?Another new regulation?

ADMISSIONADMISSION

Admission pressuresAdmission pressures Financial informationFinancial information Assessment – care and financialAssessment – care and financial PPS and payment on admission PPS and payment on admission

issuesissues Predatory offender law changesPredatory offender law changes DNR/DNI policies, PSDA DNR/DNI policies, PSDA

procedures/Advance directivesprocedures/Advance directives

LEGAL AND PRACTICAL LEGAL AND PRACTICAL ASPECTS OF ASPECTS OF

DOCUMENTATIONDOCUMENTATION New documentation requirementsNew documentation requirements

- resident advocate/psycho social - resident advocate/psycho social services, activitiesservices, activities

Changes in nursing home rules and Changes in nursing home rules and regs and areas of survey focus:regs and areas of survey focus:- activities, unnecessary meds, - activities, unnecessary meds, anxiety, family and physician anxiety, family and physician notification of significant change, notification of significant change, F323, OHFC incidents/accidents; F323, OHFC incidents/accidents; psycho-social requirementspsycho-social requirements

DOCUMENTATION CONTINUEDDOCUMENTATION CONTINUED

Resident and family interview relied upon for Resident and family interview relied upon for deficiencies (F241) Dignity; MI issuesdeficiencies (F241) Dignity; MI issues

New social service staff – no such response as New social service staff – no such response as “I don’t know.”“I don’t know.”

Progress notes critical – follow up after psych Progress notes critical – follow up after psych eval and recommendations must be timely’eval and recommendations must be timely’

New focus on suicidal ideation and safety New focus on suicidal ideation and safety plansplans

Medication review and effectiveness Medication review and effectiveness documenteddocumented

KNOW THE REGULATIONS KNOW THE REGULATIONS AND USE TERMINOLOGYAND USE TERMINOLOGY

Appendix PP in state operations Appendix PP in state operations manual at manual at www.cmswww.cms website website

MDH website at MDH website at www.health.state.mn.uswww.health.state.mn.us

Know your residents and families and Know your residents and families and connect with nursingconnect with nursing

F323 – “identify risk”; “evaluate”; F323 – “identify risk”; “evaluate”; “implement interventions”; “monitor “implement interventions”; “monitor and modify” magic words and modify” magic words

THE VULNERABLE ADULTS THE VULNERABLE ADULTS ACTACT

Unexplained incidents – bruising – Unexplained incidents – bruising – determine a reasonable explanationdetermine a reasonable explanation

Falls elopements, smoking risks new focusFalls elopements, smoking risks new focus Reporting requirements – is it abuse or Reporting requirements – is it abuse or

neglect? Is it an error? An accident? Is it neglect? Is it an error? An accident? Is it financial exploitation?financial exploitation?

OHFC appeals increasing due to more OHFC appeals increasing due to more investigations and serious level investigations and serious level deficienciesdeficiencies

Vulnerable adult neglect and abuse are Vulnerable adult neglect and abuse are connected to wrongful death casesconnected to wrongful death cases

HEALTH CARE DIRECTIVESHEALTH CARE DIRECTIVES

DNR/DNIDNR/DNI Comfort care measures policyComfort care measures policy Directive for Health Care and POA for Directive for Health Care and POA for

financial are not the samefinancial are not the same Informed consent and patient right to Informed consent and patient right to

refuserefuse Medication administration issuesMedication administration issues Risk management vs. legal decision Risk management vs. legal decision

makingmaking

DISCHARGE AND DISCHARGE AND TRANSFER TRANSFER

REQUIREMENTSREQUIREMENTS Social service documentation regarding Social service documentation regarding

discharge and transfer - guidelinesdischarge and transfer - guidelines Commitment process for behaviorsCommitment process for behaviors New conservator/guardianship process New conservator/guardianship process

for behaviors and nonpaymentfor behaviors and nonpayment Role of Ombudsman and Adult ProtectionRole of Ombudsman and Adult Protection Medical Assistance application and social Medical Assistance application and social

service roleservice role

Predatory Offender ChangesPredatory Offender Changes

2006 – You can decide NOT to admit 2006 – You can decide NOT to admit an offender or violent personan offender or violent person

Abuse Abuse prevention/assessment/individual prevention/assessment/individual plansplans

Notification requirementsNotification requirements HIPAA releaseHIPAA release To admit or not admit?To admit or not admit?

Why do you do this?Why do you do this?

Grace momentsGrace moments Mission and paycheckMission and paycheck For the residentsFor the residents Because you can – and you do it wellBecause you can – and you do it well

Legal Issues Legal Issues UpdateUpdate

Social WorkersSocial WorkersOctober 5, 2007October 5, 2007

By: Susan M. VoigtBy: Susan M. Voigt

Attorney Attorney

Voigt, Klegon and Rode Law Voigt, Klegon and Rode Law firmfirm

(651) 209-6161(651) 209-6161