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Home My WebLink AboutAgenda - 02-16-1993 - IV-C 1 ORANGE COUNTY BOARD OF COMMISSIONERS Action Agenda Item No. .rV_C, ACTION AGENDA ITEM ABSTRACT Meeting Date: February 16, 1993 SUBJECT A Resolution on Critical Domiciliary Care Issues DEPARTMENT: DOA/DSS/DHCAC PUBLIC HEARING YES: NO: X ATTACHMENT(S) : INFORMATION CONTACT: Randy Brantley, DHCAC Chair ( 1) Facts Related to Critical Jerry Passmore, DOA Director Issues Concerning Domiciliary Marti Pryor-Cook, DSS Director Homes . (2 ) Original Resolution drafted by TELEPHONE NUMBER- Region J' s Domiciliary Home Hillsborough - 732-8181 Community Advisory Committees Chapel Hill 968-4501 ( 3) Revised Resolution drafted by Mebane - 227-2031 Aging and Social Services Boards Durham - 688-7331 PURPOSE : To consider adoption of a Resolution on critical Domiciliary care issues for submission to the general assembly and state agencies . BACKGROUND: During the summer of 1992 the Domiciliary Home Community Advisory Committees (DHCAC) in the Triangle J Region prepared a resolution based on facts related to critical issues concerning domiciliary homes . Before submitting the resolution to the County Commissioners for action, a Domiciliary Homes Quality Care Forum was held November 11th inviting comments on the proposed resolution from community groups such as local domiciliary home operators, Social Services licensing staff, Regional Ombudsman for Long Term Care and other citizen groups . The Forum was sponsored by the Orange County Domiciliary Community Advisory Committee the Orange County Department on Aging and the Department of Social Services . Input from the Forum resulted in the Advisory Board on Aging and the Social Services Board adopting a revised resolution which clarified issues and stressed maintaining the diversity of homes sizes as new regulations are developed. (Changes from the original resolution are underlined. ) RECOMMENDATION(S) : Manager recommends the adoption of the revised Orange County Resolution and submit it to Triangle J Council of Governments and appropriate state agencies . 2 FACTS - Related to Critical Issues Concerning Domiciliary Homes 1. North Carolina depends heavily on domiciliary care as a prindpal means of long term care. There are approximately 1,339 free-standing domiciliary homes with some 24,945 beds. These numbers exceed the bed count in nursing homes. An additional 3,336 domiciliary care beds are licensed in units affiliated with nursing homes. 2. North Carolina has the second highest domiciliary bed to older adult population ratio in the nation and provides the fourth highest domiciliary care payment rate in the country. It has the fourth highest average payment of all state supplements. 3. It is estimated that 66% of domiciliary residents have physical disabilities; over 50% have mental disabilities,and less than 7% have no physical or mental disability. 4. There are no specific formal training regulations for personal care staff(aides)who provide approximately 80% of resident care. 5. Staff turnover is high;among aides it reaches more than 200%per year. 6. North Carolina domiciliary regulations require no medical assessment of residents beyond occasional and incidental medical are. 7. Most domiciliary residents have multiple prescription/medical needs and they do not man- age their own medications or self medicate. There are no requirements for formal training in drug management for staff. This is in contrast to nursing homes where only licensed profes- sional staff may manage drugs and administer them. 8. Domiciliary hakes_remain asssnpt hum registration under the North Carolina Controlled Substance Act j 9. Except for r e:for developmentally disabled adults,no mental health training is required rest homes and family care homes where the number and variety of men- tal health are increasing. Some homes have a population entirely of younger mental health residents;others have significant numbers,alongside frail older persons. There is very limited access to mental health services by domiciliary home residents. 10. Rules and regulations governing Medicare/Medicaid in acute care hospitals result in patients being discharged to domiciliary homes in fragile medical conditions. 11. A resident on a state/county assistance program receive only$34 a month for all personal needs -from tissues to shoes. Medicare/Medicaid does not fund domiciliary care. 4 ORIGINA A Resolution Requesting Action on Critical Domiciliary Care Issues WHEREAS, North Carolina has the second highest dornidliary bed to older adult population ratic in the nation; and North Carolina has the fourth highest Domiciliary reimbursement rate in the nation; and has never conducted an independent fiscal audit with which to establish an actual reimbursement rate;and WHEREAS, it is estimated that 66% of domiciliary residents have physical disabilities;over 50% have mental disabilities; and less than 7% of the resident population have no physical or mental disability; and WHEREAS, N.C. domiciliary care regulations require no on-going medical status review,relying only on occasional and incidental medical care for residents;and WHEREAS, there currently are no specific formal training requirements for domiciliary home personal care staff in North Carolina's regulations and standards; and WHEREAS, most domiciliary residents have multiple prescription/medical needs and they do not manage their own medications or self medicate; and WHEREAS, there are no requirements for formal training in drug management practice for domidliary staff, and medications are given to residents by untrained staff; WHEREAS, domiciliary homes remain exempt from registration under the N.C.Controlled Sub- stances Act; and NOW THEREFOIE IT RESOLVED THAT: 1. A formal resident assessment procedure,induding an ongoing level of care review, be established for all N.C. domiciliary residents. 2. Regulations be developed to require professionally trained medication technicians per each 30 domiciliary residents in a facility. 3. Domiciliary homes be removed from exemption under the North Carolina Controlled Substances Act. (nvPr 5 4. Laws and regulations establishing a consistent state certified training program for all personal care staff in North Carolina's domiciliary homes be enacted and enforced. 5. North Carolina conduct an independent fiscal audit to establish a basis for setting sound domiciliary reimbursement rates. 6. Future fiscal increases from public funds for the State/County Special Assistance Program be directly allocated for certified staff training and specifically identified personal care services to be provided. 7. Action be taken by all appropriate state/county officials to ensure and enforce the protection of the health,safety,and welfare of North Carolina's older adults dependen upon the present domiciliary care system. FURTHER BE IT RESOLVED that a copy of this Resolution, prepared by the Domiciliary Home Community Advisory Committees in the Triangle J Region , be forwarded to members of the Gen- eral Assembly, the State Social Services Commission, Secretary of the Department of Human Re- sources, Director of the Division of Facility Services, and Director of the Division of Aging. Attest Adopted this Day of ,1992. • f ORANGE COUNTY COMMISSIONERS P.O. Box 8181 HILLSBOROUGH, N.C. 27278 Moses Carey,Jr. 732-8181 Alice M. Gordon 968-4501 Stephen H. Halkiotis 688-7331 Verla C. Insko 227-2031 Don Willhoit 644-3004 (Fax) March 8, 1993 Triangle J Council of Governments' Attn: Sharon Wilder 100 Park Drive P.O. Box 12276 Research Triangle Park, NC 27709 Dear Ms. Wilder: Attached to this letter is the resolution which the Orange County Board of Commissioners approved at their meeting held on February 16, 1993 . This resolution is a followup to extensive meetings held and comments received from local domiciliary home operators, Social Services licensing staff, Regional Ombudsman for Long Term Care and other citizen groups. The resolution clarifies issues and encourages maintaining the diversity of the size of these homes as new regulations are developed. Copies of this resolution will be sent to appropriate state agencies. If this office can be of further service, please do not hesitate to contact me. Sincerely, Xj,e,e4, 40 Beverly A. Blythe, Clerk Board of Commissioners cc: Appropriate State Agencies • YOU COUNT IN ORANGE COUNTY 1 to«t /1,4" ,7-/4 - A RESOLUTION REQUESTING ACTION ON CRITICAL DOMICILIARY CARE ISSUES WHEREAS, North Carolina has the second highest domiciliary bed to older adult population ratio in the nation; and North Carolina has the fourth highest Domiciliary reimbursement rate in the nation; and has never conducted an independent fiscal audit with which to establish an actual reimbursement rate; and WHEREAS, it is estimated that 66% of domiciliary residents have physical disabilities; over 50% have mental disabilities; and less than 7% of the resident population have no physical or mental disability; and WHEREAS, N.C. domiciliary care regulations require only an annual review with no ongoing medical status review, resulting in only an occasional and incidental medical care review for each resident; and WHEREAS, there currently are no specific formal training requirements for domiciliary home personal care staff in North Carolina's regulations and standards; and WHEREAS, most domiciliary residents have multiple prescription/medical needs and they do not manage their own medications or self medicate; and WHEREAS, there are no requirements for formal training in drug management practice for domiciliary staff, and medications are given to residents by untrained staff; and WHEREAS, domiciliary homes remain exempt from registration under the N.C. Controlled Substances Act; and WHEREAS, N.C. domiciliary homes vary in size from small family care homes with under seven residents to large institutional facilities with 200 residents or more; NOW, THEREFORE BE IT RESOLVED THAT: 1. A formal resident assessment procedure, including an ongoing level of care review, be established for all N.C. domiciliary residents. 2 . Regulations governing the procedures for procuring, storage, handling, and administration of prescription and over-the-counter medicines (drugs) be reviewed and strengthened as needed. 3 . Regulations be developed to identify the level of specialized training requirements for the staff responsible for handling and administering all medicines. 4 . Domiciliary homes should be included under the North Carolina Controlled Substances Act. 5. Laws and regulations establishing a consistent state certified training program for all personal care staff in North Carolina's domiciliary homes be enacted and enforced. 6. North Carolina conduct in independent fiscal audit to establish a basis for setting sound domiciliary reimbursement rates. 7. The adequacy and use of personal allowance funds received by residents on state/county assistance program needs be reviewed and revised. 8 . Future fiscal increases from public funds for the State/County Special Assistance Program be directly allocated for certified staff training and specifically identified personal care services to be provided. 9. Action be taken by all appropriate state/county officials to ensure and enforce the protection of the health, safety, and welfare of North Carolina's older adults dependent upon the present domiciliary care system. 10. New strategies and regulations for improved quality should maintain the diversity of domiciliary home sizes for consumer choice. FURTHER BE IT RESOLVED that a copy of this Resolution, prepared by the Domiciliary Home Community Advisory committees in the Triangle J Region with underlined modifications, be forwarded to members of the General Assembly, the State Social Services Commission, Secretary of the Department of Human Resources, Director of Facility Services, and Director of the Division of Aging. Adopted this 16th day of February, 1993 . uS , / , Craig, Board of Commiss 'tin-' Attest: J■ Y i s\ /( � ue/ J l �+ ' 1 "Vii, �so-ti r1 � �,