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.
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.
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.
