Ch. 12, § 10. Secure Dementia Units

(a) Level 2 assisted living facilities require adherence to all Level 1 requirements with the following additional criteria for a Level 2 Assisted Living Facility License. (i) Level 2 Core Management requirements. (A) The facility manager shall have at least three (3) years experience in working in the field of geriatrics or caring for disabled residents in a licensed facility; (B) Certified as a residential care/assisted living facility administrator or have equivalent training. (I) Certification requirements include a training program covering topics referenced in the regulations. The course work must take place in a college, vocational training, state or national certification program, which is approved by the Department of Health. Licensed nursing home administrators, for the purpose of these rules, meet the qualifications. (II) Administrators must complete at least sixteen (16) hours of continuing education annually. At least eight (8) of the 16 hours of annual continuing education shall pertain to caring persons with severe cognitive impairments. (III) A full time manager with the above qualifications must be on duty, on the premises. (ii) Level 2 Staffing Requirements. (A) Nursing Staff. (I) The facility shall ensure adequate numbers of qualified nursing staff are available to meet the routine and emergency needs of residents. (II) A licensed nurse shall be on duty, and in the facility, for a minimum of eight (8) hours during a daily 24-hour period. The eight (8) hours are not required to be consecutive. (1.) May be an LPN if an RN is available on premises or by telephone. (2.) To administer P.R.N. medications. (3.) To perform ongoing resident evaluations in order to ensure appropriate, timely interventions. (III) At least one (1) licensed nurse or CNA shall be on duty and in the secure dementia unit at all times. (iii) Level 2 Direct Care Staff. In addition to meeting all other requirements for direct care staff stated in this Chapter, assisted living Level 2 direct care staff must receive additional documented training in: (A) The facility or units philosophy and approaches to providing care and supervision of persons with severe cognitive impairment; (B) The skills necessary to care for, intervene, and direct residents who are unable to independently perform activities of daily living; (C) Techniques for minimizing challenging behaviors: (I) Wandering; (II) Hallucinations, illusions, and delusions; and (III) Impairment of senses; (D) Therapeutic programming to support the highest level of residents function including: (I) Large motor activity; (II) Small motor activity; (III) Appropriate level cognitive tasks; and (IV) Social/emotional stimulation; (E) Promoting residents dignity, independence, individuality, privacy, and choice; (F) Identifying and alleviating safety risks to residents; (G) Recognizing common side effects and reactions to medications; and (H) Techniques for dealing with bowel and bladder aberrant behavior. (I) At least one staff member with this specialized training must be available on the unit at all times to provide supervision and care to the residents, as well as to assist the residents in evacuation of the facility. (J) Staff must have at least twelve (12) hours of continuing education annually related to care of persons with dementia. (iv) Level 2 additional core services. In addition to the previously listed Core Services increased assistance may be required with activities of daily living depending upon assessed resident functional and cognitive ability: (A) Assistance as needed with dressing, grooming, bathing, mobility, toileting; (B) Assistance as needed to maintain nutrition and hydration status based individual assessed needs: (C) Services necessary to maintain the highest continence level and skin integrity; and (D) Activity program developed by an activities professional, at least on a consultation basis, who has been trained in dementia specific activities. The program must be evaluated and revised as needed to meet the needs of the unit residents. (v) Level 2 Admission Requirements. In addition to all other required assessments, Level 2 facilities must perform a placement assessment for each resident to determine if placement in a secure dementia unit is appropriate. The results of the assessment must show that the resident exhibits one (1) or more of the following on a continual basis: (A) The resident requires cueing to find their way or they will get lost; (B) The resident wanders and requires an appropriate and safe place to wander; (C) The resident's cognitive and behavioral status requires staff with specialized training. (vi) Assistance Plans for residents of secure units must address, at a minimum, the following: (A) Memory; (B) Judgment; (C) Self-care ability; (D) Ability to solve problems; (E) Mood and character changes; (F) Behavioral patterns; (G) Wandering; and (H) Dietary needs. (vii) Level 2 Discharge Requirements. In addition to Level 1 discharge criteria residents of Level 2 facilities must be discharged when one or more of the following situations exist: (A) When it has been determined that intermittent nursing care has become ongoing; or (B) When the resident requires more than limited assistance to evacuate the building.