ADULT DAY CARE

ADULT DAY CARE A. Definition and Purpose Adult Day Care is a place for aged and disabled individuals with serious health problems or impairments to go during the day for recreational activities, personal care supervision, nutrition, limited health care and the opportunity to interact socially with other people in group or individual activities. The purpose of day care is to: (1) provide care, supervision and services to individuals who are capable of only limited self-care; (2) meet health maintenance, prevention/intervention, and rehabilitation needs; and (3) promote a maximum level of independent functioning. B. Eligibility Qualification - Persons age 60 and older with scores ranging from level II through III on the Consumer Information Form. Spouses of clients are eligible if under 60 and disabled. Contributions - Clients shall be allowed the opportunity to contribute to the cost of service. The Center director shall assure that no one is denied service because he/she cannot or will not voluntarily contribute to the program. C. Unit of Service One unit of service equals a client's attendance for at least four (4) hours but less than twenty-four hours at the center. The day begins when the client enters the facility and ends when he/she leaves unless the center provides transportation. If the center provides transportation, the unit starts when the client is picked up. It is recommended that participants be transported not more than sixty minutes without the opportunity for rest stop. At a minimum, clients should be scheduled for a full day two (2) to five (5) day a week, with scheduled attendance based on a full day of services. For fiscal reimbursement purposes, unit cost can be prorated based on the number of hours the client is in attendance. (i.e. if the unit cost is $45 per client per day, and the client could not stay the full day, then the reimbursement for three hours would be $16.89 rounded up $17.00). If fraction is less than .50, it would be rounded down to the next whole number. D. Minimum Program Requirements Each service provider of Adult Day Care under Title III of the Older Americans Act or through contractual agreement with an Area Agency on Aging must adhere to the following requirements: All clients are to be entered into the State Approved Client Tracking System no later than 10 working days. 1. Service Activities Adult day care components include but are not limited to: a. Personal care service such as assistance with walking, grooming, eating and toileting. The adult day care program shall provide assistance and supervision needed with activities of daily living. b. Nutrition - A minimum of one mid-morning snack, one nutritious noon meal and one mid-afternoon snack shall be provided at the center. Modified diets shall be provided to meet participants' needs. Snacks shall be offered as appropriate to meet the participants' nutritional needs. Fluids shall be available as needed by participants. Nutrition education and counseling shall be an integral part of the day care program. The participant's total dietary intake is not the center's responsibility. The center is responsible only for meals served at the center. c. Client Activities - The day care program shall provide recreational and social activities suited to meet the needs of the participants and designed to encourage physical exercise to prevent deterioration and to stimulate social interaction. Social services are provided to participants and their families to help them with personal, family, and adjustment problems that interfere with the effectiveness of the treatment plan. They are an essential part of care management. The social worker may serve as a consultant or may be a part- time or full-time staff member. The planning of activities shall reflect professional understanding of the recreational needs and abilities of the participants. Activities shall emphasize the individual participant's strengths and abilities rather than impairments and shall contribute to participant feelings of competence and accomplishment. Activities shall be designed in a manner to promote personal growth and enhance the self-image and/or to improve or maintain the functioning level of the participants. Activities offered to participants may focus, but are not limited to, the following: 1) Maintaining lifelong skills; 2) Learning new skills and gaining knowledge; 3) Challenging and tapping the potential abilities of participants; 4) Participating in activities for independent functioning; 5) Improving capacity for independent functioning; 6) Developing interpersonal relationships; 7) Developing creative capacities; 8) Improving physical and emotional well being; 9) Being exposed to and involved in activities and events within the greater community; 10) Experiencing cultural enrichment; and, 11) Having fun and enjoyment. Planned activities shall be available whenever the center is in operation. A monthly calendar of activities shall be prepared and posted in a visible place. Calendar may be distributed to family/caregivers and other interested individuals. Group daily activities shall be posted in a prominent, convenient, visible place. The activities schedule shall be coordinated with other services offered at the center and with other staff. d. Transportation Services - The day care program shall provide transportation, when needed, for participants to and from their homes and to other community facilities utilized in implementing the participants' plan of care. Handicapped accessible transportation will be provided. All contracted transportation systems shall meet local, state and federal regulations. It is recommended that participants be transported no more than sixty minutes without the opportunity for a rest stop. e. Nursing Services - Registered nurse (RN) services such as physical assessment, preparing and administering medications, observing drug reactions, carrying out treatments, changing dressings and rehabilitative nursing shall be provided. Nursing services may vary in intensity, depending on the needs of the participants. Intensity is determined by both the number of participants requiring nursing services and the type of nursing service needed. The nurse may serve as a consultant or may be a part-time or full-time staff member. Delegation of some nursing services, such as personal care, to program aides who are trained and supervised by the nurse, is part of the nursing service. Nursing services shall be offered by all adult day care centers. According to participant needs as identified in the nursing assessment, inter-disciplinary plan of care and physician orders, the nursing service may include a configuration of the following, depending on the level of intensity needed. All of the following shall be carried out: 1) Assess participants' health status; 2) Monitor vital signs and weight; 3) Provide health education and counseling, including nutritional advice, to participants and families; 4) Develop policies and procedures for personal care and train staff in the implementation; 5) Provide liaison with the participant's personal physician, notifying him/her of any changes in participant's health status; 6) Coordinate the provision of other health services provided outside the center; 7) Train staff and supervise the use of standard protocols for communicable diseases and infection control; and, 8) Coordinate and oversee participant health records. The following shall also be added to the above if they are needed by participants and if there is a full-time nurse or provision for professional care: 1) Administer and document medications and observe for possible adverse reaction; 2) Supervise the provision of modified and therapeutic diets or supplemental feedings; 3) Provide observation, monitoring and intervention for unstable medical conditions; 4) Provide training in self-administration of medications; 5) Provide restorative or rehabilitative nursing including bladder and bowel retraining and the supervision of, or provision of, maintenance therapy procedures; 6) Provide supportive nursing such as general maintenance care of colostomy and ileostomy, changing dressings, prophylactic skin care to avoid skin breakdown, foot and nail care, and routine care of incontinent participants, including incontinence supplies; 7) Provide emergency care including notification of physician or ambulance; 8) Provide for regular inspection of drug storage conditions; and, 9) Any other direct nursing service requiring skilled nursing treatment. f. Emergency Services - Instructions for dealing with emergency situations shall be established in writing. Such instructions must include name and telephone number of a physician on call, written arrangements with a nearby hospital for inpatient and emergency room service, and provision for ambulance transportation. A contact name and telephone number shall be maintained for each participant in case of emergencies. An evacuation plan diagram and documentation of evacuation drills must be posted. g. Emergency Plan - A written procedure for handling emergencies shall be posted in the center and in all center vehicles. The emergency plan shall include the following: 1) A written agreement with the participant or family regarding arrangements for emergency care and ambulance transportation; 2) Written procedure for medical crises, and an easily located file for each participant; 3) Listing of identifiable information (physician's name and telephone number, family's name, and hospital needed in emergencies); 4) Staff training to ensure smooth implementation of the emergency plan; and, 5) Plan for handling emergencies during transportation. h. Pre-admission Assessment - A pre-admission assessment shall be conducted either in the participant's home or at the center. This includes: 1) Review of intake information; 2) Review of medical forms; 3) ADL's/IADL's; 4) Signing of all consent forms (release of information, emergency information); and, 5) Signing of application. As part of the assessment process, the applicant and family members or other caregivers shall have at least one personal interview with a program staff member. i. Enrollment Agreement - It is highly recommended that there be a signed enrollment agreement that includes the following: 1) Scheduled days of attendance; 2) Services and goals of center; 3) Transportation agreement; 4) Emergency procedures; 5) Releases from liability (e.g., field trips); and, 6) Conditions for termination from service or discharge. The participant and/or caregiver should receive a copy of the enrollment agreement and a copy of the center's grievance procedures. j. Inter-Disciplinary Team Assessment - A comprehensive written assessment shall be completed in order to collect sufficient information to develop the individual=s plan of care. The assessment shall be completed within eight days (8) of attendance in the program or within no more than 30 calendar days. The level of detail shall depend upon the level of care to be provided. The assessment may include the person's health profile (medical records, medical history, verification of medical regime, primary physician and other specialists, and physician's restrictions), social history, formal and informal support systems, including caregiver information and assessment of caregiver stress, activities of daily living skills, mental and emotional status, community and financial resources. k. Medical Report - A current medical report (based upon an examination completed within six (6) months prior to admission) including diagnosis, medication, other treatment recommendations, and verification of the absence of communicable disease (including tuberculosis screening) shall be obtained from the physician prior to enrollment unless exception is necessary. Each participant shall provide a name and number of a physician to contact in the event of an emergency and for on-going care. l. Written Individualized Plan of Care - The goal of the plan of care is to increase the functioning of the participant to the optimum level and maintain it at that level. The written plan of care shall reflect the individual's strengths, needs and problems and shall be developed by an inter-disciplinary team through a team conference. It shall include realistic, specific, verifiable and achievable objectives, which are both long-term and short-term. Also to be identified are the services to be provided and responsible staff. m. Service Documentation - Progress notes on each participant shall be written quarterly and shall reflect at least the plan of service, goals and objectives, and the participant's status in regard to the services. Treatment notes and notes on significant events shall be recorded according to professional standards, when appropriate. n. Discharge Plan - Many participants take part in adult day care on a long-term basis. However, discharge plans are necessary and appropriate for those who will leave the program because of changes in need and functional status. o. Evaluations - Evaluations provide information concerning the effectiveness in reaching established goals and objectives. Evaluation is a process whereby information is secured by the agency for making appropriate program or structural changes. Evaluations include an analysis of data collected, and a comparison to the planned expectations and actual achievements, based on prevailing community standards of care. The administrator of the adult day care program is responsible for seeing that the program evaluation is done on a regular basis with reporting to the governing body. The governing body must ensure that evaluations result in positive and constructive actions for improving agency effectiveness. The program evaluation may be conducted either internally or externally. It is recommended that internal evaluation include individuals not directly affiliated with the center. For external evaluations, it is recommended that composition of the multi-disciplinary team include persons having expertise with the specialized populations being served. The evaluation process selected by the agency shall examine the adult day care program on three levels: the caregiver/participant/staff level; the agency program level; and the community level. The evaluation shall include resources invested, the productivity of performance, and the resulting benefits. Each adult day care program shall have a written plan for the evaluation of its operation and services. The program's goals and objectives shall be reviewed at least annually, but not all evaluation components need to be done that often. The plan shall include: 1) The purpose and reason for the evaluation; 2) The timetable for initiating and completing the evaluation; 3) The parties to be involved; and, 4) The areas that will be addressed. 2. Location of Service a. A day care center for adults should be located close to the population it serves. b. A telephone shall be readily available to staff in emergencies. c. The center shall use rooms that are appropriately ventilated, with proper lighting. d. The center must meet all applicable handicapped accessibility standards. e. There must be adequate heating and cooling to maintain a comfortable temperature. All heating and cooling equipment must be adequately protected so that participants cannot come in direct contact with equipment. f. Drinking water from a source approved by the Mississippi State Department of Health Department (MSDH) and supplied by sanitary means must be located in or near the rooms usually occupied by participants. g. Adequate bathroom facilities, including hand washing basin, must be readily accessible from the areas where most of the center activities take place. Paper towels must be available in all bathrooms. h. Isolation space must be available in which a sick or upset participant can be cared for temporarily. i. Floors and walls must be free from dampness and odors and must be kept clean. j. The building must be approved by the local fire department to be free from fire hazards; the facility must also be approved by the MSDH for sanitation and for other health protective measures. Certification of approval must be visibly located in the center. k. There must be at least two (2) exits and the exit doors must open outward. 3. Access to Service The client may enter the service system through an appropriate referral. 4. Delivery Characteristics a. Each client record must include: 1) Emergency contact person's name and telephone number; 2) Approval/termination for services; 3) Consumer Information Form which contains Confidentiality and Authorization Release; 4) Medical health, special dietary needs, and impairments; and, 5) A plan of care. b. Services shall be provided a minimum of five (5) days a week and at least four to eight hours a day. c. The adult day care center will develop with the client a mutually agreed upon plan of care based on assessment of the client's need and resources. d. All staff shall participate in each individual's plan of care, established during the assessment and reassessment to achieve the goals set for individual through planed objectives. e. There shall be one staff member assigned to provide care for every ten adult day care participants, depending upon the physical capabilities of the clients. {Preferably the ratio is a minimum of one (1) six (6)} f. The adult day care center shall have access to nursing services if a registered nurse is not on staff at the center. Access to nursing services can be attained through contractual agreements, the use of volunteers (retired registered nurses) or the use of nursing school supervisors. 5. Staffing a. There must be a person designated to be responsible for the day-to-day operations of the center. b. There must be adequate staff to accomplish the purpose of the program. c. All staff members must be emotionally and physically fit to care for persons who have physical and/or mental limitations. d. All persons employed by the center must provide evidence of a current or annual physical/medical examination. e. The staff shall be qualified by demonstrated competence, specialized background, education and experience as outlined in specific job descriptions. f. Volunteers must be trained and must meet minimum requirements established by the provider. g. All staff shall have completed First Aid, CPR, and Heimlich Technique class, or definite plans must be made for this training to be included as part of an in- service program. h. The adult day care provider shall check the references on all employees and volunteers. i. A minimum of eight hours per year in-service training shall be provided, preferably quarterly, and must be appropriate to staff job function and participant care needs. j. Personnel files shall contain a copy of a current license or certification if applicable to the staff position, and certification of CPR and First Aid training. k. Employee background check is required, due to the increase in adult abuse, child abuse, terrorist acts and false or inflated information supplied by job applicants. 6. Prohibited Service Activities Only a licensed health care professional can provide nursing care, medical services, or medication, as long as these activities are part of the client's approved plan of care. 7. Qualifications Qualifications outlined in the Adult Day Care 1990 Proposed Standards will apply to anyone hired after October 17, 1990. A waiver of exception can be requested from the Division of Aging and Adult Services. a. Program Director - (also known as center manager, site manager, center director, center coordinator) Under the direction of the Administrator, the Program Director organizes implements and coordinates the daily operation of the Adult Day Care program in accordance with participants' needs and any mandatory requirements. The Program Director shall have a Bachelor's Degree in health, social services, or a related field, with one year's supervisory experience (full-time or equivalent) in a social or health service setting. Sample duties may include supervision of, or direct responsibility for, the following: 1) Planning the day care program to meet individual needs of the participants, liaison with community agencies, and provision of services to individuals and families when necessary. 2) Coordinating the development and on-going review and monitoring of participants' individual plan of care, and making necessary program adjustments. 3) Establishment, maintenance and monitoring internal management systems to facilitate scheduling and coordination of services, and for the collection of pertinent participant data. 4) Recruitment, hiring and general supervision of all staff, volunteers, and contractors. 5) Training and utilization of volunteers with consideration of their individual talents and program activities to work effectively with the day care program. b. Social Worker - Shall have a Master's Degree in social work and at least one year of professional work experience (full-time or the equivalent) or a Bachelor's Degree and three years experience in a health or social service setting. (All social workers must be licensed by the Mississippi State Board of Examiners for Social Workers and Marriage and Family Therapists.) c. Nurse - Shall be a licensed registered nurse or hold a Bachelor's Degree in nursing (BSN) with valid state credentials and a minimum of one year applicable experience (full-time or equivalent) in working with the aged and disabled. d. Activities Coordinator - Shall have a Bachelor's Degree plus one (1) year of experience (full-time or equivalent) in social or health services. e. Program Assistant/Aide - Shall have one(1) or more years of experience in working with the aged and disabled in a health care or social service setting. f. Secretary/Bookkeeping - Shall have at least a high school diploma or equivalent and skills and training to carry out the duties of the position. Preferably a Bachelor's Degree in Accounting or high school diploma and five (5) years experience in Accounting. g. Driver - Shall have a valid and appropriate state driver's license, a safe driving record and training in First Aid and CPR (cardiopulmonary resuscitation.) h. Custodian - Shall be knowledgeable and experienced in maintaining a service facility. i. Volunteers - Shall be individuals or groups who desire to work with Adult Day Care participants and shall take part in program orientation and training. The duties of volunteers shall be mutually determined by volunteers and staff. Duties shall either supplement staff in established activities or provide additional services for which the volunteer has special talents. 8. Personnel Management a. There shall be a description of behaviors that will not be allowed, the number of infractions that constitute reasons for termination of services, and hearing procedures for the Center. b. There shall be a termination and grievance procedure outlining conditions under which staff will be removed from the Center's services. 9. Monitoring The Mississippi Department of Human Services, Office of Monitoring shall monitor the Adult Day Care Program three (3) times a year and at least every six (6) months.