Or. Admin. Code § 411-054-0037 - [Effective 12/27/2024] Acuity-Based Staffing Tool
(1) CHOICE OF
ACUITY-BASED STAFFING TOOL: Every facility shall adopt an acuity-based staffing
tool (ABST) to determine appropriate staffing levels for the facility . Each
facility may choose to adopt the Department 's ABST or may choose to adopt a
different ABST. Regardless of the ABST the facility selects, all requirements
set forth in this rule, in OAR
411-054-0034 (Resident
Evaluation), and in the ABST Provider Guide must be met.
(2) START DATE: All facilities must select an
ABST by February 1, 2022. By July 1, 2022 facilities must fully implement the
ABST selected and complete an ABST assessment for each resident .
(3) FREQUENCY OF UPDATES: No later than July
1, 2022, an ABST assessment must be completed for each resident . Following this
deadline, facilities must review the ABST tool for each resident :
(a) Before a resident moves in, with
amendments as appropriate within the first 30 days to address a resident 's
needs.
(b) Whenever there is a
significant change of condition as defined in OAR
411-054-0005.
(c) No less than quarterly, preferably at the
same time the resident 's service plan is updated, as required by OAR
411-054-0034.
(4) MAINTAIN UPDATED STAFFING PLAN: Each
facility should use the results of an acuity-based staffing tool to develop and
routinely update the facility 's staffing plan. The ABST must convert evaluated
care needs of residents into staff hours to generate a facility staffing
plan.
(5) ABST ELEMENTS: Each ABST
must address activities of daily living and other tasks related to care, as
outlined in OAR 411-054-0030 and
411-054-0034. Each ABST must
address all the following activities of daily living (ADLs) for each resident
and the amount of staff time needed to provide care:
(a) Personal hygiene such as shaving and
mouth care, as described in OAR
411-054-0030(1)(e)(C)
and OAR 411-054-0034(5)(g)(B).
(b) Grooming, such as nail care and brushing
hair, as described in OAR
411-054-0030(1)(e)(E)
and OAR 411-054-0034(5)(g)(B).
(c) Dressing and undressing, as described in
OAR 411-054-0030(1)(e)(D)
and OAR 411-054-0034(5)(g)(B).
(d) Bowel and bladder management , as
described in OAR 411-054-0030(1)(e)(G)
and OAR 411-054-0034(5)(g)(A).
(f) Transferring in or out of bed or a chair,
as described in OAR 411-054-0030(1)(e)(A)
and OAR 411-054-0034(5)(g)(C).
(g) Repositioning in bed or chair, as
described in OAR 411-054-0030(1)(e)(A)
and OAR 411-054-0034(5)(g)(G).
(h) Ambulation, escorting to and from meals
or activities, as described in OAR
411-054-0030(1)(e)(F) and
(G), and OAR
411-057-0160(2)(a).
(i) If multiple staff are required to assist
with transferring and completing tasks in previous question, how much
additional time is needed, as described in
411-054-0070(1)(a).
(j) Supervising, cueing , or supporting while
eating, as described in
411-054-0030(1)(e)(F)
and 411-054-0034(5)(a)(g)(D).
(k) Medication administration, passing out
medications, as described in
411-054-0030(1)(f),
OAR 411-054-0055(2),
and OAR 411-054-0070(1).
(l) Providing non-drug interventions for pain
management , as described in
411-054-0034(5)(c)(C)
and OAR 411-054-0055(6)(c).
(m) Providing treatments (e.g., skin care,
wound care, antibiotic treatment), as described in OAR
411-054-0034(5)(l)
and OAR 411-054-0055(1).
(n) Cueing or redirecting due to cognitive
impairment or dementia , as described in OAR
411-054-0034(5)(d),
OAR 411-057-0160(2)(a) and
(e), and OAR
411-054-0030(1)(e)(H).
(o) Ensuring non-drug interventions for
behaviors, as described in OAR
411-054-0030(1)(e)(l)
and OAR 411-054-0055(6)(c) and
(d).
(p) Assisting with leisure activities, as
described in OAR 411-054-0005(27)(b),
OAR 411-054-0030(1)(c),
and OAR 411-054-0034(5)(a)(B).
(r) Monitoring behavioral conditions or
symptoms, as described in OAR
411-054-0040(1)(2)(a) and
(b).
(s) Assisting with communication, assistive
devices for hearing, vision, speech, as described in OAR
411-054-0034(5)(f).
(t) Responding to call lights, as described
in OAR 411-054-0070(1).
(u) Safety checks, fall prevention, as
described in OAR 411-054-0034(5)(n)(A).
(v) Completing resident specific housekeeping
or laundry services performed by care staff, as described in OAR
411-054-0005(96)
and OAR 411-054-0070(1)(a).
(w) Providing additional care service, such
as smoking assistance or pet care, as described in OAR
411-054-0034(5)(n)(H)
and OAR
411-054-0070(1).
(6) DETERMINE TIME TO MEET STAFF LEVELS: The
ABST must inform facilities as they develop a staffing plan to specify the
total number of weekly minutes required to meet the 24-hour scheduled and
unscheduled needs of residents.
(7)
REVIEW BY DEPARTMENT .
(a) The Department is
required to assess facility staffing levels each time the Department conducts a
survey, license approval or renewal, or an investigation into a complaint
regarding:
(A) Abuse of a resident ;
(B) Injury to a resident ;
(C) Resident safety; or
(D) Staffing levels.
(b) Each time the Department assesses a
facility 's staffing levels, the facility is required to provide the Department
with the current acuity-based staffing tool data.
(8) REGULATORY ACTION REQUIRED. The
Department will impose corrective action or sanctions as defined in OAR
411-054-0110 (Conditions) and
according to Oregon Laws 2021, chapter 588, section 2, if the Department
determines the facility is:
(a) Not using an
ABST.
(b) Not meeting the scheduled
and unscheduled needs of all residents 24 hours a day, seven days a
week.
(c) Using an ABST but is not
consistently staffing to the levels, intensity and qualifications indicated by
the tool.
(d) Not determining
facility staffing requirements with an ABST as required by
rule.
Notes
Statutory/Other Authority: ORS 410.070, 443.450 & 443.738
Statutes/Other Implemented: ORS 443.400 - 443.455, 443.738, 443.991 & 678.710
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