Adult Day Care 525-05-30-10

(Revised 7/1/21 ML #3628)

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Purpose

Adult Day Care is a community-based service offered within a group setting designed to meet the needs of functionally impaired adults. It is a structured, comprehensive service that provides a variety of social and related support services in a protective setting during a part of the day. Adult Day care programs shall operate a minimum of three hours per day up to a maximum of ten hours per day. Individuals who participate in Adult Day Care attend on a planned basis during specified hours.  Adult Day Care assists its participants to remain in the community, enabling families and other caregivers to continue caring for an impaired member at home.

Adult Day Care emphasizes a flexible program of service activities designed to provide an individualized plan of care. It affords opportunities of personal enrichment and provides a setting for group involvements outside the home. Adult Day Care reduces isolation often associated with frailty and impairment as well as enabling the individual to remain in his or her home and community as long as possible.

Service Eligibility, Criteria for

The individual receiving Adult Day Care will meet the following criteria:

1. Must be eligible for the programs of Medicaid Waiver for Home and Community Based Services, SPED, or ExSPED.
2. The individual is able to function in an ambulatory care setting.
3. The individual is able to participate in group activities.
4. The individual requires assistance in Activities of Daily Living and Instrumental Activities of Daily Living as determined by the Comprehensive Assessment.
5. When the individual is not living alone, the primary caregiver will benefit from the temporary relief of caregiving.

Service Activities, Authorized

The service tasks/activities within the scope of this service chapter are identified on the authorization.

Unallowable Service Activities: Shopping, Housework, and Laundry, are tasks which are not authorized under Adult Day Care Services.

• Non medical transportation may be included as a part of this service and may already be included in the rate, contact a HCBS Program Administrator to determine if non medical transportation has been included the rate for an Adult Day Care Provider.
• Adult Day Care Unit - one unit equal 1/2 day.

Adult Day Care Enrollment (Provider)

Staff to Participant Ratio for Adult Day Care Centers

1. Adult Day Care Center providers shall meet a staff to participant ratio not to exceed a minimum of one to eight.
2. Full-time or full-time equivalent staff shall be considered as those who spend 70 percent of time in direct service with participants.
3. Each adult day care center that is conjointly located within another facility may consider a shared staffing arrangement, however, shared staff must meet specific adult day care staff standards.

Facility Standards for Adult Day Care Centers

1. Adult Day Care in Hospitals, Nursing Homes, and Basic Care Facilities

• Hospitals, nursing homes, and basic care facilities are considered to have met the standards contained in this section based upon their licensure status.
  

• 1915(c) Medicaid waiver funds cannot be used to provide adult day care that is located in a nursing home or hospital. Waiver recipients are not eligible to receive an HCBS service in an institutional setting regardless of the funding source. SPED & Ex-SPED recipients may receive adult day services in these settings.

2. Adult Day Care Centers

Adult day care center facilities shall meet the following standards:

1. The facility shall be designed and furnished with primary consideration given for the special needs and interests of the population to be served and the activities and services to be provided.

• A facility shall be architecturally designed, in conformance with the requirements of Section 504 of the Rehabilitation Act of 1973, to accommodate handicapped individuals and meet any state and local barrier-free requirements.
• Illumination levels in all areas shall be adequate, and careful attention shall be given to avoiding glare in order to compensate for visual losses experienced by many older adults.
• Sound transmission shall be controlled.  Methods of sound control include acoustical ceiling surfaces, partitions between activity areas, separation of noisy rooms such as the kitchen, etc.
• Heating, cooling and ventilation system(s) shall permit comfortable conditions, regardless of the number of participants present, and excessive fan noise and drafts shall be avoided.
• The design shall facilitate the participants' movement throughout the center and involvement in activities and services.
• Sufficient furniture shall be available to accommodate the number of enrolled adult day care service participants.
• Furniture and equipment to be used by participants shall be selected for comfort and safety. Furnishings shall promote independence as much as possible and be appropriate for use by persons with visual and mobility limitations and other physical disabilities.
• A telephone shall be available for participant use.

2. The facility shall be accessible at street level.  Adequate elevators shall be available for center floors not located on street level.

• Each adult day care center, where it is collocated in a facility housing other services, shall have its own separate identifiable space.  (The allocation of separate identifiable space is necessary to be able to properly accommodate the number of enrolled day care participants.)
• The facility shall:

• Have at least thirty-five (35) square feet of program space for each day care participant.  (The square footage excludes hallways, offices, restrooms and storage areas.)
• Be flexible and adaptable for large and small groups and individual activities and services.
• The facility shall include toilets for male and female participants (at least one toilet per gender for each fifteen participants), equipped for use by mobility-limited persons and easily accessible from all program areas.
• At least one restroom with a lockable door/stall is available to recipients to assure recipients privacy.
• Have rest areas designated to permit privacy and to isolate participants who become ill.
• A parking area shall be available for the safe daily arrival and departure of participants.
• Space shall be available for outdoor activities, when appropriate.
• Space, such as closets and separate lockers, for outer garments and private possessions shall be provided for participants.

3. The facility and grounds shall be safe, clean and accessible to all participants.

• The facility shall be designed, constructed and maintained in compliance with all applicable local, state and Federal health and safety regulations. The center shall make arrangements as necessary for the security of the participants in the facility.

• Appropriate and locked storage space for medications shall be provided.
• At least two well-identified exits to the outside shall be available.
• Non-slip surfaces or carpets shall be provided on stairs, ramps and interior floors.
• Outside lighting shall be available at facility entrances and on the facility grounds.
• The facility shall be free of hazards, such high steps, steep grades, exposed electrical cords, etc. (When necessary, arrangements shall be made with local authorities to provide safety zones for those arriving by motor vehicle and adequate traffic signals for pedestrian crossings.)

• Safe and sanitary handling, storing, preparation and serving of food shall be assured.
• Procedures for fire safety shall be adopted and posted, including provisions for fire drills, inspection and maintenance of fire extinguishers.
• A representative of the local fire department or State Fire Marshal's office shall conduct a fire and safety inspection of the Adult Day Care Center prior to the center being approved for adult day care services.  Regular inspections shall be scheduled once every two years thereafter.
• Emergency first aid kits shall be visible and accessible.
• Written center policies shall be established on:

• Assisting adult day care participants in the self-administrator of medications; and
• For emergency medical care plans.

• Maintenance and housekeeping shall be carried out on a regular schedule and in conformity with generally accepted standards, without interfering with the program.

Standards for Adult Day Care Homes

1. Adult foster care homes which are licensed by the Department of Human Services are considered to have met the Adult Day Care standards contained in this section based upon their licensure status.

2. Adult Day Care Homes

Adult Day Care Home facilities shall meet the following standards:

1. The home and premises must be clean, neat, and free from hazards that jeopardize health and safety.
2. A rest area shall be provided separate from activity areas.
3. The phone numbers of the local police, fire department, and ambulance service shall be posted near every telephone located in areas where services are provided.
4. Safe storage for medications shall be provided in a central location with each participant's medication clearly labeled with the pharmacist's label.
5. The home must be equipped with adequate light, heat, ventilation, and plumbing for safe and comfortable occupancy.
6. All participant-occupied rooms shall have window screens which will keep out flies and mosquitoes.
7. Food and cooking utensils shall be stored to protect from dust, leakage from pipes, or other contamination.
8. Trash and garbage outside of participant occupied areas shall be kept in plastic or metal containers with properly fitted covers and disposed of on a daily basis.
9. A community or rural fire department shall be available to the home.
10. There shall be no accumulation of highly combustible material in closets, attics, basements, garages or other parts of the dwelling unit.
11. Fireplaces, steam radiators, and hot surfaces, such as steam pipes, shall be appropriately screened or covered to guard against accidental contact. Space heaters may not be utilized.
12. Participant occupied areas shall have at least two means of exit, each being at least 30 inches wide, at least one of which shall be a door providing a means of unobstructed travel to the outside of the building at street or ground level.
13. Heating units shall be inspected prior to the time adult day care service is provided in the home and every two years thereafter. A notice shall be posted on or near the heating unit indicating the last date of inspection.
14. No stove or combustion heater shall be so located as to block escape in case of fire caused from malfunctioning of the stove or heater.
15. At a minimum, a five-pound class "ABC" all purpose fire-extinguisher shall be maintained and installed in a location identified by the local fire department. Additional fire extinguishers may be required when warranted by special conditions.
16. Every adult day care home shall have photo-electric or ionization type smoke detectors which shall be:

• Mounted adjacent to rest areas and shall be located on or near the ceiling;
• Clearly audible in adjacent participant occupied areas with intervening doors closed;
• U.L. approved; and
• In working order at all times.

17. All participants shall be trained upon enrollment on how to exit from the home and how to respond to alarm.
18. If the home has a fireplace or auxiliary free-standing heating unit, it must be properly installed and maintained. It shall be inspected and approved by the local fire department or State Fire Marshal.
19. A representative of a local fire department or State Fire Marshal's Office shall conduct a fire and safety inspection of the adult day care home prior to the home being approved for adult day care services. Regular inspections shall be scheduled once every three years thereafter. Additional inspections of the home may be requested at any time there are concerns about fire safety aspects of the home.
20. All dangerous household products, flammable liquids and chemicals shall be stored in a safe manner. Questions as to "safe manner" may be referred to the local fire department.
21. The use of potentially hazardous materials and tools by a participant shall be supervised.
22. Exposed light bulbs shall not be used in the immediate area any participant uses.
23. The fuses in light circuits shall not exceed recommended amperes. Type "S" fuses are recommended, or there shall be a safeguard of approved circuit breakers.
24. House pets shall have all required shots.
25. Existing state or local building, fire, or safety codes supersede any of the requirements of this section.
26. At least one restroom with a lockable door/stall is available to recipients to assure recipient privacy.

Program Standards for Adult Day Care Centers and Adult Day Care Homes

Adult Day Care Center and Home service programs shall meet the following standards:

1. Self- Care Activities:  The adult day care program will provide assistance with activities of daily living. Changes in the participant’s status shall be noted in the participant's file and appropriate others notified.
2. Social, Leisure, and Educational Activities:  Planned individual and group activities, suited to the needs and abilities of the participants as supported by the HCBS comprehensive assessment shall be provided. recipients may not be required to participate in any activity.
3. Nutrition:

1. A nutritious meal including the basic four food groups shall be provided to each participant in attendance during mealtime.
2. Meals shall be prepared and served in a sanitary manner using safe food handling techniques.
3. A nutritious mid-morning and mid-afternoon snack shall be offered daily to participants. Recipients must have access to food/ snack at all times.
4. Fluids shall be available as needed by participants.
5. A modified diet shall be available for participants requiring a restricted diet.  A registered dietitian or nutritionist may be consulted by the provider on special nutritional needs.

Emergencies: Adult Day Care Centers/Homes

A written procedure for handling emergencies shall be posted in the facility.  To respond to emergencies:

1. The participant's file shall include a written agreement with the participant or family regarding arrangements for emergency care and ambulance transportation.
2. A conspicuously displayed notice shall indicate fire procedures plus signs designating emergency evacuation routes; regularly (2 times annually) scheduled fire drills shall be conducted at the center; staff and volunteers shall be trained in evacuation procedures.
3. Training shall be provided for program staff and participants in emergency procedures.

Standards for Issuance to Adult Day Care Providers

The HCBS Case Manager shall provide the following information to potential adult day care service providers:

1. Community-Based Services:  Qualified Service Provider Handbook.
2. Adult Day Care Standards Compliance Checklist (SFN 1703).
3. Adult Day Care Centers:  Facility Standards.
4. Adult Day Care Homes:  Standards

The potential adult day care center or adult day care home service provider will complete and submit a self-administered Adult Day Care Standards Compliance Checklist, SFN 1703, together with evidence of any required inspections (fire and safety) to the HCBS Program Administrator.

By completing and submitting the Adult Day Care Standards Compliance Checklist, SFN 1703, the adult day care provider is notifying the HCBS Program Administrator that they are ready to have the HCBS Case Manager review their compliance with adult day care standards.

The HCBS Case Manager shall then make an on-site visit to the home or center and verify the compliance with adult day care standards and forward a copy of the final SFN 1703 to the HCBS Program Administrator.

Re-Assessment of Adult Day Care Standards for Compliance

The Adult Day Care Standards Compliance Checklist, SFN 1703, is valid for not more than two years from the date of issuance.  If a provider chooses to continue to provide adult day care, the HCBS Case Manager must review all components of the Adult Day Care Program for compliance and complete the Adult Day Care Standards Compliance Checklist, SFN 1703. A copy should be forwarded to the HCBS Program Administrator.

Adult Day Care Recipient Experience Requirements

Individuals have freedom and support to control their schedules at the setting and are not required to participate in activities and have access to food/snack at any time.

Any modifications of the recipient experience requirements must be supported by specific assessed need: justified and documented in the person-centered service plan.