DRAFT – Lockable Doors and Privacy in Provider owned or controlled settings Information Bulletin

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.21.XXX DRAFT

Purpose:

This Information Bulletin outlines requirements for residential providers in the Developmental Disabilities waivers. Providers must ensure that individuals who reside in provider owned or controlled settings have the means to lock/unlock their homes and bedroom doors so that they have privacy in their residential living spaces.

Background:

The Centers for Medicare and Medicaid Services (CMS) has specific requirements for provider-owned or controlled residential settings in the HCBS waiver where services are delivered. Among those requirements is the expectation that waiver participants are assured privacy within their homes and bedrooms.

Details of the specific requirements may be reviewed at 42 CFR §441.301(c)(4)(i-v) and include:

  1. In a provider-owned or controlled residential setting, in addition to the qualities at §?441.301(c)(4)(i) through (v), the following additional conditions must be met:
  2. Each individual has privacy in their bedroom.
    1. Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.

Definitions:

Provider-owned or controlled setting

A provider-owned or controlled setting is a physical setting in which the individual resides and also meets one of the following criteria:

  1. that is owned, co-owned, leased or rented by a provider of HCBS and is providing services onsite; or
  2. that is owned, co-owned, leased or rented by a third party that has a direct or indirect financial relationship with a provider of HCBS; or
  3. in which receipt of support services is limited to a specific provider while living at the site.

A setting that meets this definition is a provider-owned or controlled setting, regardless of whether a residency agreement is signed by the individual and guardian, if applicable. The existence of a residential agreement does not transfer ownership or control of the residential setting from the provider to the individual and/or guardian.

Policy:

Right to Privacy in Homes and Bedrooms

Individuals have the right to privacy within their homes (house, apartment, condominium, etc.) and bedroom unless there is an identified and documented health or safety concern. In such cases, the health and safety concern must be based on individually assessed needs and documented in the Personal Plan and Implementation Strategy, as indicated in the Modification section of this bulletin.

No provider may have a policy or practice that prohibits the right of an individual to lock the doors of their homes and bedrooms unless there is a documented health or safety concern. In which case the provider must follow the Human Rights Committee rules and regulations for rights restrictions.


Providers should afford individuals they support the same respect and dignity as a person not receiving HCBS and as such, the individual must have:

  1. The option for a lockable front door to their home.
  2. Access (through keys, key fobs, codes, key cards and any other devices used to gain access through any door lock mechanism) to their bedroom and/or home.
  3. Bedroom door that is lockable from the inside and the outside if the home is shared with others not related to the individual that is lockable by the individual with only appropriate staff having access to bedroom.


Staff Access to Homes and Bedrooms

  1. Access to the individual's home and bedroom should be limited to individuals who reside in the setting and identified staff, based on circumstances and/or purposes, described in the Personal Plan and Implementation Strategy.
  2.  All staff entering an individual's bedroom must knock and receive permission prior to entering.
  3. In an emergency, health, or safety situation, it may be appropriate for staff to enter an individual's locked room without permission. The Personal Plan and Implementation Strategy should address the circumstances in which this might happen. The Implementation Strategy must document staff that can have access to a person's home and room. (Designation of staff may be by title rather than name.) Notice of such "emergency" access must be provided to the individual and guardian, if one has been appointed, as soon as feasible following the access but no later than 24 hours following emergency access. The provider will retain a written record of access and associated notification for at least 12 calendar months.

Bedroom Locking Mechanisms and Egress

  1. All bedroom door locking mechanisms and systems must allow the door to be easily unlocked/opened simply by turning the doorknob from within the room for purposes of egress. Physical accessibility accommodations can be made for individuals who have identified needs.
  2. No additional locks may be placed inside the room. (Chain locks, slide bolts, hasps, and other locks that prevent emergency access from outside the room are prohibited.)
  3. Doors may have a key, fob, code pad, keycard, etc. that will allow the door to be unlocked from outside the room by room occupant(s) and other authorized persons.
  4. The door may not require a key, tool, or special knowledge (i.e. code) to unlock the door from inside the room. Occupants of the room must have full egress from the room with a turn of the doorknob at all times.

Modification of the Locked Door Requirement

A. Modifications are considered a deviation from the individual's right to privacy within their homes (house, apartment, condominium, etc.) and bedroom including access to keys and privacy in their bedrooms. It must be supported by a specific, individually assessed need and justified in the Personal Plan. Modifications also must be reviewed by the Human Rights Committee (HRC) or Behavioral Management Committee (BMC) and must comply with the process outlined in Rules 115 and 120. The HRC Manual details the process for HRC reviews. The Personal Plan and Implementation Strategy should include the following:

  1. Specific and individualized assessed need for which the modification is required.
  2. Less restrictive interventions and supports attempted without success prior to imposing any modifications.
  3. Data collection and review of less restrictive interventions and supports. In addition, if the modification is needed due to the presence of behaviors that pose a risk to the individual or others, include collection and review of data related to the effectiveness of methods used to reduce the undesired behavior.
  4. Schedule of periodic reviews of data as outlined in the Behavior Intervention And Treatment Implementation And Billing for a rights restriction.
  5. Assurance that interventions and supports pose no harm to the individual.
  6. Informed consent of the individual and the individual's guardian, if applicable.

B. The prospective, or current residential provider agency, is responsible for providing items 1-6 above and documenting these items in the Implementation Strategy. In addition, the Implementation Strategy must address the specific supports that will be provided to assist the individual to have access to their locked home and bedroom. 

Responsibility of the Independent Service Coordination (ISC) Agency

  1. The Independent Service Coordination agency (ISC) is responsible for ensuring that the Personal Plan and Implementation Strategy documents the modifications at the time of initial modification and are updated as appropriate per periodic review.
  2. The ISC will work with the residential provider agency to provide available supporting documentation in the Personal Plan that reflects the need for modifications.

Costs

The service provider is responsible for all costs associated with initial implementation and ongoing maintenance of locking mechanisms required for compliance with this IB. If an individual needs an accommodation to ensure physical accessibility, they can utilize home modification funding.

Effective Date:

Upon Final Posting

Provider agencies must ensure the requirements outlined in this IB are implemented by July 1, 2022.