Theresa's Law aims to protect seniors living in Adult Foster Care (AFC) facilities currently being neglected, abused emotionally and physically, and exploited due to deficiencies in education of Direct Care Workers (DCWs), transparency: residents' rights and AFC designation, oversight and enforcement of existing regulations, staffing standards, and accountability by AFC facilities.

Unfortunately, Public Act 218 does not do enough to ensure residents are treated with the dignity and respect they deserve nor does it ensure they receive exemplary care to promote quality of life.  Theresa's Law is the first step at solidifying Public Act 218 to a level that will make a real difference in the quality of care our precious seniors receive in AFC facilities. It will also benefit DCWs, as it will provide them with the necessary education and resources to be successful. Below are the proposed changes outlined in Theresa's Law.  Please know that some of the wording may change once an official bill is written and introduced.

Staff Educational Requirements

DCWs must be properly trained and educated to understand the physical, emotional, and social needs of the population they are hired to care for in AFC facilities.

• Licensee must keep a written training plan for all workers and keep a record of all training & education requirements, including details of course completed (where, when, how, date, instructor) and documentation of passed written and performance based competency tests. This information must be provided at the next license renewal period.
• Unsupervised resident contact is prohibited prior to completion of all required Continuing Education (CE) classes.
• In addition to on-the-job training, all DCWs must complete the following CE courses within 60 days of hire and staff must demonstrate understanding by passing both a written and competency based performance test:
• Empathy - simulation of the aging process. Course must provide staff the experience of sensory challenges related to the aging process and the emotional challenges that come with the loss of independence, home, and relationships. This class must be in-person every 2 years.
• Dignity & Sensitivity - Course must include basic techniques for effectively and compassionately communicating with the elderly, how to handle and defuse difficult situations in a respectful manner. This class must be in-person and completed every 2 years.
• Resident Rights - Course must instruct staff of all rights granted to the resident. Must be completed yearly.
  
• Medication Administration - class must include appropriate medication handling, including avoiding the use of drugs for sedative purposes. Only staff members who have successfully completed a CE medication administration course that includes the passing of a performance based competency test may administer oral; topical; eye, nose, and ear drop prescription medications, and epinephrine injections for insect bites or other allergies, and insulin injections. ONLY EXCEPTION is for those staff members who are a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the state of Michigan. Must be completed yearly and in-person.
  
• Medication/Insulin - only staff members permitted to administer insulin injections must, in addition to the medication administration course, complete a Department approved diabetes patient education program that must be completed yearly and in-person.
• Understanding Dementia - must teach the fundamentals of dementia, including how to recognize signs of the disease, effects on resident, effective communication and proper care standards of residents with dementia. Class must be taken yearly (in-person or online).
• Death & Dying - course must provide basic understanding of end of life issues and the impact on the resident, including appropriate behavior and communication with the resident and resident's family. Course must be taken yearly and can be online.
• Yearly Training/Education Assessments - Facility must conduct yearly training assessments, separate from tests taken upon completion of a CE course, to ensure the staff members recall what they have learned during training & education courses and are implementing this knowledge appropriately while providing care.

Transparency:

• Prior to admission, each resident and/or designee shall be informed of the resident's rights and the right to lodge complaints without intimidation, retaliation, or threats of retaliation by the residence or its staff persons against the reporter. Notification must be both verbal and in written form.
• Resident and/or designee must receive a physical signed copy of rights and complaint procedures signed by both the resident and/or designee AND the licensee (facility)
• Notification of rights and complaint procedures shall be communicated in an easily understood manner and in a language understood by the resident and/or resident's designee.
• The licensee/residence must post the residents' rights and complaint procedures in a conspicuous and public place within the residence.
• Licensee must have a structured and documented internal complaint policy and process.
• Prior to admission, residence shall inform resident and/or designee of the right to file a complaint, and procedures for doing so, with the following reporting/protective agencies, which shall include respective phone number, websites, and contacts:
• Residence or Licensee Complaint Office/Department
• Local Ombudsman
• Michigan's Department of Licensing and Regulatory Affairs (LARA)
• Local Law Enforcement
• Licensee shall permit and respond to oral and written complaints from any source regarding alleged violation of resident rights, quality of care or other matter without retaliation or threat of retaliation.
• Violation of resident's rights will result in a financial penalty.
• Waiver of any resident right shall be void.
• Contact information for all reporting/protective agencies shall be posted in large print in a conspicuous place within the residence.
• Nothing in this section may affect in any way the right of the resident to file suit or claim for damages.
• Residence shall ensure investigation and resolution of complaints. Residence shall designate the staff person responsible for receiving complaints and determining the outcome of the complaint. Residence shall keep a log of all complaints and outcomes to be reviewed by LARA at next licensing renewal.
• Prohibition against deprivation of rights:
• A resident may not be deprived of his/her rights
• Resident's rights may not be used as a reward or sanction
• Updates to existing rights:
• The 'Right to refuse' must include the right to request meals to be delivered to resident's room. Resident is not to be forced to go down to the dining room, especially if they are ill or have been injured; however, illness or injury is not a prerequisite.
• Resident and/or designee must be made fully aware of all facility rules prior to admission both verbally and in written form. Sixty days prior to the effective date, notice must be given to all residents of any new or changes to existing facility rules.
• Prior to admission, the resident and/or designee shall be informed of all current active violations the facility has been​ cited.
• All residents and/or designee shall be notified when a facility has been cited for a violation, regardless of who filed the complaint.
  

• Adult Foster Care (AFC) facilities must identify themselves as Adult Foster Care facilities and not as "Assisted Living" in all legal and marketing materials.
• AFC must notify resident and/or designee of AFC designation and that they are governed by the rules of Public Act 218, both verbally and in written form PRIOR to admission.

• At a minimum, a Licensed Practical Nurse (LPN) must be on duty 24/7.
• At least 1 staff member certified in CPR must be on duty 24/7.
• Must have a social worker on staff with a minimum availability for 1 hour per week with each resident.
  

• Violations cited against an AFC must remain on their record for public disclosure for a minimum of 7 years. This gives future residents and families the important information necessary to make an informed decision. Current rule is only 3 years due to record retention policy. (Note: A speeding ticket stays on a driver's record for 7 years.)
  
• A financial penalty must be assessed for each cited violation. Fine will be increased for each repeated violation up to 3 times in a single year, after which the licensee is to be placed on disciplinary review to determine if license should be revoked. Monies collected from these fines should go towards ensuring adequate staffing to conduct and oversee inspections and investigations in a timely manner.
• All financial penalties must be paid within 30 days of date citation was issued or incur a late fee.
• For all cited violations, Licensee (AFC) must submit a SMART (Specific, Measurable, Achievable, Realistic, Time-bound) Corrective Action Plan (CAP) that clearly:
• Describes the problem
• Establishes what caused the problem
• Determines and implements action to prevent the problem from reoccurring
• Provides a method for measuring compliance and effectiveness of plan
• The Licensing and Regulatory Affairs (LARA) must follow-up with CAPs no later than 30 days of the implementation date. Currently, no standard procedures or timeline exists for doing so and can be as late as the next license renewal, which could be 2 years or not at all.
• Failure by the licensee (AFC) to fully comply and complete the CAP by the due date will result in an additional financial penalty or suspension of license.
• The LARA complaint process must include:
• Clear and concise overview of the complaint process procedures including how to file, the steps in the process, and information on how the complainant will be kept informed of the progress of each step of the process.
• Escalation procedures if complainant is not satisfied at any point within the process.
• Complainant satisfaction survey at conclusion of completion/closure of complaint/investigation, including the administrative review process.
• Appeals process for complainant if unsatisfied with the outcome of an investigation.
• Ability for complainant to participate and give verbal input into each step of the complaint process, including the administrative review.
• All complaints for all license types (AF,AG,AL,AS,AM,AL) and related investigation results, including violations cited, must be stored in a database for easy retrieval and statistical purposes, for a period of no less than 10 years.
• Internal Quality Control procedures must be implemented to ensure all steps, actions, and deliverables of a formal complaint are carried out in a timely manner. (Our mother's Special Investigation Report was not uploaded to the LARA website for almost 4 months from date of issuance and likely wouldn't have been at all had we not brought it to their attention.).
• Resident and/or Resident Designee Satisfaction Surveys:
• Must be given on 30 days, 6 months, and 1 year intervals from admission date, and yearly thereafter and upon discharge, AND must be capable of being anonymous.
• All surveys must be kept on file at the AFC for review at next licensing renewal.
• Surveys must measure, at a minimum, the following:
• Satisfaction with physical environment (resident's room, dining facilities, social gathering places, outside, etc..).
• Staff competency, kindness and empathy.
• Physical and emotional needs being met?
• Feeling safe and cared for in home?
• Feeling respected and honored?
• Satisfaction with quality of food (meals, snacks).
• Satisfaction with quality and quantity of available activities.
• Licensing renewal requirements: additions to the current 'Method of Inspection', LARA must validate and consider for renewal:
• DCW training plan and completion of training by each DCW.
• Successful completion of yearly training/education assessments for all DCWs.
• Is contact information for reporting/protective agencies posted in residence in a conspicuous place?
• Number of new and repeated violations since last renewal period.
• Any outstanding fines due?
• Any CAPs past due? If yes, temporary renewal until CAP is completed. After that time, if not completed, license is revoked.
• Survey results from residents and/or their designee
• Interviews with residents as well as family councils (where they exist).
• Licensee renewal and/or investigation "inspection team" shall include a Registered Nurse, dietician, and a licensed social worker.
• All cited violations must be posted on LARA website facility search in a conspicuous manner.
• Updates to existing LARA Facility Search to enhance the information provided in an intuitive manner. The current search feature is clumsy and does not display violations in a conspicuous manner. Also, the current search feature contains bugs (that have been reported) that make the search cumbersome and laborious.