Title of Rule: Sections of Title 484 WAC dealing with the operation of state veterans homes.

     Purpose: To redefine sections of Title 484 WAC clarifying that the department may operate a state veterans home in eastern Washington in a manner similar to the operation of the other existing state veterans homes and to allow a designated representative of the superintendent to carry out some functions.

     Statutory Authority for Adoption: RCW 43.60A.070 and chapter 72.36 RCW.

     Statute Being Implemented: Chapter 4, Laws of 2001 2nd sp. sess.

     Summary: Current rules need to be modified to allow the agency to comply with recently changed state law. The changes will further clarify the department's authority to maintain and operate a veterans home in eastern Washington. Additional changes will clarify that the superintendent may designate a representative to carry out some functions at the veterans home.

     Reasons Supporting Proposal: Changes must be made to Title 484 WAC because of changes made by the state legislature during the 2001 2nd sp. sess.

     Name of Agency Personnel Responsible for Drafting: Heidi Audette, P.O. Box 41150, Olympia, 98504, (360) 725-2154; Implementation and Enforcement: Lourdes Alvarado-Ramos, P.O. Box 41150, Olympia, 98504, (360) 725-2155.

     Name of Proponent: Washington Department of Veterans Affairs, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: This will modify existing rules to allow the agency to comply with changes in state law as a result of SHB 2227, which passed during the 2nd sp. sess. of the 2001 legislature and clarify that a designated representative of the superintendent may assist in the performance of some functions.

     The effects of the rule are that consistency is maintained between state law and agency rule and practices.

     Proposal Changes the Following Existing Rules: WAC 484-20-010 (5)(a): Change will include the eastern Washington veterans home in the definition of daily rate.

     WAC 484-20-010(9): Redefines "facility" to include the eastern Washington veterans home.

     WAC 484-20-010(22): Redefines "state veterans home" to include the eastern Washington veterans home.

     WAC 484-20-080(1): Adds the superintendent's designated representative as a person to whom the residents may provide their annual statement of income and expenses.

     WAC 484-20-086 (2)(c): Adds the superintendent's designated representative as a person to whom alleged violations of mistreatment, neglect or abuse and misappropriation of resident property may be reported.

     WAC 484-20-090 (1)(c) and (g) and (2)(c): Adds the superintendent's representative as a person to whom residents may request permission to use electrical appliances or have/feed animals and to request exceptions to the overnight and leave privileges policy.

     WAC 484-20-095: Adds the superintendent's designated representative as a person who may establish supplementary procedures for the state veterans homes consistent with federal and state statutes and standards.

     WAC 484-20-135 (1) and (3): Clarifies that transfers can occur between any of the state veterans homes and that the superintendent or administrator shall be contacted for additional information.

     WAC 484-20-140: Clarifies that former residents may reapply to any veterans home.

     WAC 484-20-145: Clarifies that residents may be buried in a state veterans home cemetery, if the veterans home has a cemetery.

September 5, 2001

Heidi Audette

Public Relations

and Legislative Manager

     (1) Admission team - A team consisting of a designated veterans benefit specialist and designated medical or nursing staff.

     (2) Adjudicative proceeding - In accordance with RCW 34.05.010(1), an adjudicative proceeding is a proceeding before an agency in which an opportunity for hearing before that agency is required by statute or constitutional right before or after the entry of an action by the agency.

     (3) Administrative action - An act (as defined in RCW 34.05.010(3)) taken by the agency or state veterans home which implements or enforces a statute, applies an agency rule or order, or imposes sanctions or withholds benefits.

     (4) Comprehensive care plan - A plan which outlines details of health care for Medicaid certified nursing facility residents.

     (5) Cost of care.

     (a) Daily rate - The maximum daily cost (rate) to provide care and services to a Medicaid recipient. The daily rate is set annually by the department of social and health services and applies to all Medicaid certified nursing facility residents. A different daily rate is established for the Washington veterans homes and, the Washington soldiers home, and the eastern Washington veterans home (also known as the Spokane veterans home).

     (b) Private rate - The daily cost (rate) to provide services to state veterans home residents who have resource levels exceeding standards in WAC 484-20-040. There is a different private rate for nursing care and domiciliary care. The private rate is based on actual operating costs.

     (c) Resident contribution - The monthly amount a resident pays to the state veterans home as partial payment of the cost of care. If the resident is a Medicaid recipient, the resident contribution is determined by the appropriate community service office. If the resident is not a Medicaid recipient, the resident contribution is determined by the facility. The resident contribution is recalculated with any change in the resident's monthly income.

     (6) Department - The department of veterans affairs.

     (7) Director - The director of the department of veterans affairs or his/her designee.

     (8) Domiciliary care - Is the provision of a home, with necessary ambulant medical care. To be entitled to domiciliary care, the applicant must consistently have a disability, disease or injury which is chronic in nature and produces disablement of such a degree and probable persistency as will incapacitate from earning a living for a prospective period.

     (9) Facility - Refers to either the Washington veterans home, or the Washington soldiers home, or the eastern Washington veterans home (also known as the Spokane veterans home), but does not include the Medicaid certified nursing facility.

     (10) Furlough - An approved absence for facility residents.

     (11) Grievance - An oral or written statement of any difficulty, disagreement, or dispute relating in any way to a facility, a resident or facility staff.

     (12) Grievance investigator - State veterans home social service staff or another appropriate person requested by the resident who investigates a grievance.

     (13) Income - The receipt by an individual of any property or service which he/she can apply either directly, by sale, or conversion to meet his/her basic needs for food, clothing, and shelter.

     (a) Earned income - Gross wages for services rendered and/or net earnings from self-employment. Earned income received at predictable intervals other than monthly or in unequal amounts will be converted to a monthly basis.

     (b) Unearned income - All other income.

     (14) Medicaid certified nursing facility - Refers to those nursing care units of each state veterans home that are Medicaid certified as described under WAC 388-97-005(20).

     (15) Personal needs allowance - In accordance with RCW 72.36 the amount which a resident may retain from his/her income.

     (16) Rehabilitation leave - A period of time granted to permit a resident to attempt to reestablish independent living or other care arrangements in a community of his/her choice while retaining the right to return to the facility without reapplying for admission.

     (17) Rehabilitation plan - Describes individualized goals for professional treatment, counseling and/or guidance necessary to restore to the maximum extent possible the physical, mental and psychological functioning of an ill or disabled person.

     (18) Resources - Cash or other liquid assets or any real or personal property that an individual or spouse, if any, owns and could convert to cash to be used for support or maintenance.

     (a) When an individual can reduce a liquid asset to cash, it is a resource.

     (b) If an individual cannot reduce an asset to cash, it is not considered an available resource.

     (c) Liquid - Assets that are in cash or are financial instruments which are convertible to cash such as, but not limited to, cash in hand, stocks, savings, checking accounts, mutual fund shares, mortgage, promissory notes.

     (d) Nonliquid - All other property both real and personal shall be evaluated according to the price that can reasonably be expected to sell for on the open market in the particular geographical area involved.

     (19) Resident - An individual who resides at a state veterans home.

     (20) Resident council - A group of residents elected in accordance with RCW 72.36.150 by facility residents.

     (21) Social leave - An approved absence for residents of Medicaid certified nursing facility units.

     (22) State veterans home - Refers to either the Washington soldiers home and colony in Orting, or the Washington veterans home in Retsil, the eastern Washington veterans home (also known as the Spokane veterans home), or both all.

     (23) Staff - Any individual hired or contracted to provide care and services at the state veterans homes.

     (24) Superintendent - The licensed nursing home administrator appointed by the director to administer the day-to-day operations of a state veterans home.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-010, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-010, filed 8/14/92, effective 9/14/92; 85-20-099 (Order 85-01), § 484-20-010, filed 10/1/85; 80-09-069 (Order 80-01), § 484-20-010, filed 7/17/80; Order 7659, § 484-20-010, filed 7/28/77.]

     Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.

     Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 94-22-050, filed 10/31/94, effective 12/1/94)

WAC 484-20-080   Annual declaration of income and resources.   (1) Each resident shall promptly provide the superintendent or designated representative with a statement reflecting all income and resources:

     (a) Annually, at such time as determined by department policy;

     (b) Within fourteen days of any change in income;

     (c) Within fourteen days of receipt of any lump sum/back-award payment of benefits. The department shall provide forms for reporting of income and resources; and

     (d) If the resident is able to demonstrate good cause, exceptions may be made to the reporting deadlines in (b) and (c) of this subsection.

     (2) Each resident shall comply with any reporting requirements necessary to initiate/continue any benefits and/or pensions to which he/she is entitled.

     (3) Reports shall be made at intervals and on forms prescribed by the entity paying the benefits and/or pension. Copies shall be submitted to the facility's administration for filing in the resident's administrative file:

     (a) U.S. Department of Veterans Affairs benefits -- as prescribed by the U.S. Department of Veterans Affairs.

     (b) Social Security benefits -- as prescribed by the Social Security Administration.

     (c) Medicaid benefits -- as prescribed by the department of social and health services.

     (d) Other pensions and benefits -- as prescribed by the entity paying the pension/benefit.

     (4) When a resident is authorized to contribute to the support of a dependent under WAC 484-20-065, the dependent shall also be required to comply with any required reporting intervals, using the prescribed form(s).

     (5) The veterans benefit specialist and business office staff at each facility shall be available to assist residents to complete and submit appropriate reports in a timely manner and to resolve any underpayment or overpayment of benefits.

     (6) Failure to comply with all income and resource reporting requirements may result in overpayment or underpayment of the resident contribution. Underpayment of the resident contribution may be grounds to begin discharge proceedings in accordance with WAC 484-20-120. Notice of such administrative action shall be given in accordance with WAC 484-20-103.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-080, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 80-09-069 (Order 80-01), § 484-20-080, filed 7/17/80; Order 7659, § 484-20-080, filed 7/28/77.]

     Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 94-22-050, filed 10/31/94, effective 12/1/94)

WAC 484-20-086   Restraints/prevention of abuse -- Medicaid certified nursing facility.   (1) Restraints. In accordance with federal regulations at 42 CFR § 483.13, the resident has the right to be free from any physical or chemical restraints imposed for purposes of:

     (a) Discipline or convenience, and not required to treat the resident's medical symptoms; or

     (b) Preventing or limiting independent mobility or activity, except that a restraint may be used in a bona fide emergency situation when necessary to prevent a person from inflicting injury upon self or others. The Medicaid nursing facility shall obtain within seventy-two hours a physician's order for proper treatment resolving the emergency situation and eliminating the cause for the restraint.

     (2) Abuse. The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

     (a) The Medicaid certified nursing facility shall develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse of residents and misappropriation of resident property.

     (b) The Medicaid certified nursing facility shall:

     (i) Not use verbal, mental, sexual, or physical abuse, corporal punishment or involuntary seclusion; and

     (ii) Not employ persons who have been:

     (A) Found guilty of abusing, neglecting or mistreating residents; by a court of law; or

     (B) Have had a finding entered into the state nurse aide registry concerning abuse, neglect, mistreatment of residents, and misappropriation of their property; and

     (iii) Report any knowledge it has of actions by court of law against an employee, which would indicate unfitness for services as a nurse aide or other medicaid certified nursing facility staff to the state nurse aid registry or licensing authorities.

     (c) The Medicaid certified nursing facility shall ensure that all alleged violations involving mistreatment, neglect or abuse including injuries of unknown source, and misappropriation of resident property are reported immediately to the superintendent or designated representative of the Medicaid certified nursing facility and to other officials in accordance with state law through established procedures (including the state survey and certification agency).

     (d) The Medicaid certified nursing facility shall:

     (i) Have evidence that all alleged violations are thoroughly investigated; and

     (ii) Prevent further potential abuse while the investigation is in progress.

     (e) The results of all investigations shall be reported to the superintendent or his/her designated representative and to other officials in accordance with state law (including to the state survey and certification agency) within five working days of the incident, and if the alleged violation is verified, appropriate corrective action must be taken.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-086, filed 10/31/94, effective 12/1/94.]

     (1) Health and safety rules.

     (a) Emergency evacuation. Any time a fire or alarm is sounded, domiciliary residents must immediately evacuate the building and report to the designated evacuation area. Residents may not enter the evacuated building until designated staff indicate all is clear. Nursing care unit residents must follow the instructions of the nursing staff.

     (b) Community living skills. The condition of residents living quarters must meet existing fire, safety and health-sanitation codes. Residents shall accomplish and/or assist with maintaining their living quarters as defined in their comprehensive care plan. Vacated rooms shall be left in a clean condition.

     (c) Electrical appliances. Only low wattage household type electrical appliances such as television sets, electric clocks, electric razors, fans of 150 watts or less with acceptable finger guards, small refrigerators rated at not more than 1.5 amps and approved by the facility electrician, radios, audio and/or video recorders (VCRs), and disc playing machines may be used in resident's rooms. Use of any other electrical equipment requires the written approval of the superintendent or designated representative.

     (d) Repair of rooms. Residents shall not alter or repair their living quarters or other common use areas. This includes but is not limited to walls (e.g., for hanging pictures), other flat surfaces, electrical systems, television/cable hook-ups, phone hook-ups, heating systems, and plumbing. State veterans home staff shall assist residents in personalizing their rooms, including but not limited to hanging personal pictures and checking electrical appliances as authorized in (c) of this subsection. Requests for alterations and/or repairs shall be made to the state veterans home plant manager.

     (e) Alcohol - drugs. Possession or use of intoxicating beverages, narcotics, or controlled substances on the grounds of a state veterans home or during off-grounds activities sponsored by the state veterans home, without a physician's written prescription is prohibited. Drugs which were prescribed by a physician but which are no longer used by the resident to whom they were issued, shall be turned in to the state veterans home pharmacy.

     (f) Weapons. Possession of firearms, ammunition, explosives or dangerous weapons is prohibited.

     (g) Animals. Unauthorized possession or feeding of animals on state veterans home property is prohibited except when specifically sanctioned by the superintendent or designated representative.

     (h) Smoking. Residents may not smoke in bed or in any area in the state veterans home where no smoking signs are posted.

     (2) General facility rules.

     (a) Visiting hours. Normal visiting hours for guests are 8:00 a.m. to 10:00 p.m.

     (b) Program listening. Radios, TVs, and tape recording-playing devices such as video tape recorders (VCRs) and cassette players may be used in resident's rooms. Volume levels of such equipment must be kept at a level that does not disturb others. Between the hours of 10:00 p.m. and 7:00 a.m., volume on such equipment must be reduced to match reduced noise levels in the general surroundings so that others will not be disturbed. The use of headphones is strongly encouraged for those who wish to use such equipment after 10:00 p.m.

     (c) Leave. Pursuant to U.S. Department of Veterans Affairs census reporting requirements, residents leaving the grounds for any purpose must sign out at designated locations. Upon returning, the resident must sign in again. After returning from overnight pass, furlough or social leave, the resident must remain on the grounds overnight before permission to go on an additional overnight pass, furlough or social leave can be granted, except in the case of emergency. Leaving the grounds without proper authorization, or failure to return from overnight pass, furlough or social leave at the prescribed time without obtaining permission for an extension, may result in the resident being discharged in accordance with WAC 484-20-120. Residents being admitted to the facility must remain on the grounds overnight before overnight pass or leave privileges may be exercised unless an exception is granted by the superintendent or designated representative.

     (d) Respect for property. No person may deface or destroy walls, buildings, trees, shrubbery, fences, grounds, or any other property or possessions belonging to the state of Washington or to any other person. Appropriation of the property of another person, corporate entity or the state of Washington without permission is also prohibited. Residents are required to reimburse the state veterans home for theft and intentional or negligent injury to state property.

     (e) Vehicle registration. Vehicles kept on state veterans home property must be registered at least annually with the state veterans home administration. Residents who drive on the state veterans home property must: Possess a valid Washington state driver's license; provide proof of ownership and/or registration; and, show proof of at least minimal insurance as required by Washington state financial responsibility law. The requirement to register applies to vehicles owned by residents, owned by another and registered in the name of the resident, and/or any vehicle regardless of ownership that is regularly in the possession of the resident. Vehicles must have current license tags and they must display the state veterans home identification sticker. All traffic and parking control signs must be obeyed.

     (f) Personal conduct between residents and others. Residents are expected to refrain from obscene, sexually or racially demeaning, threatening language, or behavior, or physically assaultive behavior,. Such behavior, directed at another person, whether on the grounds or off the grounds during a state veterans home-sponsored activity, will be considered a violation of this rule.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-090, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-090, filed 8/14/92, effective 9/14/92; 85-20-099 (Order 85-01), § 484-20-090, filed 10/1/85; 80-09-069 (Order 80-01), § 484-20-090, filed 7/17/80; Order 7659, § 484-20-090, filed 7/28/77.]

     Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 92-17-046 [94-22-050], filed 8/14/92 [10/31/94], effective 9/14/92 [12/1/94])

WAC 484-20-095   Supplementary policies and procedures.   The superintendent or designated representative of each state veterans home shall establish supplementary policies and procedures consistent with the substance and intent of the rules in this chapter and applicable federal and state statutes and standards.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-095, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-095, filed 8/14/92, effective 9/14/92; Order 7659, § 484-20-095, filed 7/28/77.]

     Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 94-22-050, filed 10/31/94, effective 12/1/94)

WAC 484-20-135   Transfer from one state veterans home to another.   (1) A resident may apply for transfer to either any state veterans home or the colony located at Orting. Requests for transfer are to be forwarded to the admissions team.

     (2) All such requests shall be reviewed by the admissions team, using the admissions criteria.

     (3) In addition, the admission team shall contact the superintendent or designated representative of each state veterans home to obtain other information which may be pertinent to the transfer request.

     (4) The admission team shall make a recommendation to approve or deny the transfer.

     (5) The names of residents who are approved for transfer shall be placed on the waiting list for the program or service which the admission team has determined shall be most appropriate for their health care needs. The position on the waiting list shall be determined by the date on which the transfer was approved.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-135, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-135, filed 8/14/92, effective 9/14/92; Order 7659, § 484-20-135, filed 7/28/77.]

     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 94-22-050, filed 10/31/94, effective 12/1/94)

WAC 484-20-145   Burial in the state veterans home cemetery.   (1) To the extent practicable the remains of individuals who die at a state veterans home shall be disposed of in accordance with instructions given prior to death.

     (2) An individual or his/her survivors (in the line of succession as designated in RCW 68.50.160) may request burial in the state veterans home cemetery, if the state veterans home has a cemetery, when the deceased is a resident of the state veterans home at the time of death.

     (3) A nonresident spouse of a former resident who is buried in the facility's cemetery may request burial in the state veterans home cemetery, unless the spouse has remarried. If the spouse wishes to be buried in the facility's cemetery, he/she makes such a request with the knowledge that his/her remains will be cremated and buried in the same gravesite as the former resident.

     (4) Funeral arrangements and all burial costs shall be the responsibility of the deceased individual's estate or his/her survivors (or the county if there are no survivors) in accordance with RCW 68.50.160.

[Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 94-22-050, § 484-20-145, filed 10/31/94, effective 12/1/94. Statutory Authority: RCW 43.60A.070. 92-17-046, § 484-20-145, filed 8/14/92, effective 9/14/92; 80-09-069 (Order 80-01), § 484-20-145, filed 7/17/80; Order 7659, § 484-20-145, filed 7/28/77.]

     Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.

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