Rule 111-8-62-.19 - Additional Requirements for Certified Memory Care Centers(1) A home must meet the additional requirements contained in rule 111-8-62-.19 where the home serves persons with probable diagnoses of Alzheimer's Disease or other dementia and does any of the following:(a) Holds itself out as providing additional or specialized care to such residents; or(b) Charges rates in excess of that charged other residents for the provision of additional or specialized care.(2)Written Description. The home must develop an accurate written description of the memory care center that includes the following: (a) A statement of philosophy and mission.(b) How the services of the memory care center are different from services provided in the rest of the personal care home.(c) Staffing, including job titles of staff who work in the center, staff training and continuing education requirements.(d) Admission procedures, including screening criteria.(e) Assessment and service planning protocol, including criteria to be used that would trigger a reassessment of the resident's status before the customary quarterly review.(f) Staffing patterns, maintained within the center, including the ratio of direct care staff to resident for a 24-hour cycle.(g) A description of the physical environment including safety and security features.(h) A description of activities, including frequency and type, how the activities meet the needs of residents with dementia.(i) The program's fee or fee structure for all services provided by the center.(j) Discharge criteria and procedures;(k) The procedures that will be utilized for handling emergency situations.(l) The involvement of the center with families and family support programs.(3)Disclosure of Description. A personal care home with a memory care center must disclose the written description of the center to:(a) Any person upon request.(b) The family or resident's representative before admission of the resident to the center.(4)Physical Design, Environment, and Safety. The memory care center must be designed to accommodate residents with severe dementia or Alzheimer's Disease in a home-like environment which includes the following: (a) Multipurpose room(s) for dining, group and individual activities which are appropriately furnished to accommodate the activities taking place.(b) Secured outdoor spaces and walkways which are wheel chair accessible and allow residents to ambulate safely but prevent undetected egress.(c) High visual contrasts between floors and walls and doorways and walls in resident use areas except for fire exits, door and access ways which may be designed to minimize contrast to conceal areas where the residents should not enter.(d) Adequate and even lighting which minimizes glare and shadows.(e) The free movement of the resident, as the resident chooses, between the common space and the resident's own personal space in a bedroom that accommodates no more than four residents.(f) Individually identified entrances to residents' rooms to assist residents in readily identifying their own personal spaces.(g) An effective automated device or system to alert staff to individuals entering or leaving the building in an unauthorized manner. A home need not use an automated alert for an exit door when the particular exit is always staffed by a receptionist or other staff member who views and maintains a log of individuals entering and leaving the home. If the exit door is not always staffed, then the home must have a system that activates an automated alert when the door is not attended;(h) A communication system(s) which permit staff in the center to communicate with other staff outside the center and with emergency services personnel as needed; and(i) A center or home which undergoes major renovation or is first constructed after December 9, 2009 must be designed and constructed in compliance with applicable state and local building and fire codes relevant to the center and the home.(5)Staffing Requirements. The home must ensure that the center is staffed at all times with sufficient specially trained staff to meet the unique needs of the residents in the center. At a minimum, the home must provide the following staffing: (a) One dementia trained direct care staff person for every 12 residents on-site during all waking hours and for every 15 residents on-site during all nonwaking hours based on a monthly average; provided, however, that such ratio is adequate to meet the needs of the residents;(b) One registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times;(c) Two direct care staff persons on-site at all times, with at least one on each occupied floor; and(d) One registered professional nurse or licensed practical nurse on-site or available in the building at all times as follows:(i) For memory care centers with one to 12 residents, a minimum of eight hours per week;(ii) For memory care centers with 13 to 30 residents, a minimum of 16 hours per week;(iii) For memory care centers with 31 to 40 residents, a minimum of 24 hours per week; or(iv) For memory care centers with more than 40 residents, a minimum of 40 hours per week.(6)Staff Training Requirements. The home shall ensure that all staff are properly trained initially and on an annual basis to provide safe, quality care to residents in the memory care center. Effective July 1, 2021, the memory care center shall meet the following training requirements: (a) General Orientation. All staff, regardless of role, shall receive at least four (4) hours of dementia-specific orientation within the first thirty (30) days of working in the center. Such orientation shall include: (i) Basic information about the nature, progression, and management of Alzheimer's and other dementias;(ii) Techniques for creating an environment that minimizes challenging behavior from residents with Alzheimer's and other dementias;(iii) Methods of identifying and minimizing safety risks to residents with Alzheimer's and other dementias; and(iv) Techniques for successful communication with individuals with Alzheimer's and other dementias.(b) Direct Care Orientation. All direct care staff shall receive initial orientation training within the first thirty (30) days of caring for residents independently that, at a minimum, includes: (i) General training, to include: (A) Development, updating, and implementation of comprehensive and individual service plans;(B) Skills for recognizing physical or cognitive changes in the resident that warrant seeking medical attention;(C) Residents' rights and identification of conduct constituting abuse, neglect, or exploitation;(D) General infection control principles;(E) Emergency preparedness training;(F) Emergency first aid; and(G) Cardiopulmonary resuscitation.(iii) A minimum of sixteen (16) hours of specialized, competency-based training using forms specified by the department, to include, at a minimum: (A) The nature of Alzheimer's and other dementias;(B) The center's philosophy related to the care of residents with Alzheimer's and other dementias;(C) The center's policies and procedures related to care of residents with Alzheimer's and other dementias;(D) Common behavior problems characteristic of residents with Alzheimer's and other dementias;(E) Positive therapeutic interventions and activities;(F) Skills for maintaining the safety of the resident; and(G) The role of the family in caring for residents with Alzheimer's and other dementias.(c) Ongoing Training. Direct care staff shall complete a minimum of eight (8) hours of specialized competency-based training in dementia care on an annual basis using forms specified by the department. (d) Hospice Training for Certified Medication Aides Administering Morphine. The memory care center shall ensure that any medication aide(s) who will be administering liquid morphine to any hospice patient(s) residing in the center receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The memory care center shall maintain documentation of all training provided.(e) Training Documentation. The memory care center shall maintain documentation reflecting course content, instructor qualifications, agenda, and attendance rosters for all training sessions provided.(7)Special Admission Requirements for Memory Care Center Placement. Residents must have a Report of Physical Examination completed by a licensed physician, nurse practitioner or physician's assistant within 30 days prior to admission to the center on forms provided by Department. The physical examination must clearly reflect that the resident has a diagnosis of probable Alzheimer's Disease or other dementia and has symptoms which demonstrate a need for placement in the center. However, the center may also care for a resident who does not have a probable diagnosis of Alzheimer's Disease or other dementia, but desires to live in the center as a companion to a resident with a probable diagnosis of Alzheimer's Disease or other dementia with which the resident has a close personal relationship. In addition, the physical examination report must establish that each potential resident of the center does not require 24-hour skilled nursing care.(8)Post-Admission Assessment. The home must assess each resident's care needs to include the following components: resident's family supports, level of activities of daily living functioning, physical care needs and level of behavior impairment.(9)Individual Service Plans. The post-admission assessment must be used to develop the resident's individual service plan within 14 days of admission. The service plan must be developed by a team with at least one member of the direct care staff participating and input from each shift of direct care staff that provides care to the resident. All team members participating must sign the service plan and the service plan must be shared with the direct care staff providing care to the resident and serve as a guide for the delivery of services to the resident. The service plan must include the following:(a) A description of the resident's care and social needs and the services to be provided, including frequency to address care and social needs.(b) Resident's expressed preferences regarding care, activities and interests.(c) Specific behaviors to be addressed with interventions to be used.(d) Names of staff primarily responsible for implementing the service plan.(e) Evidence of family involvement in the development of the plan, if possible, with incorporation of family and personal history to support a person-centered approach to care.(f) Evidence of the service plan being updated at least quarterly or more frequently if the needs of resident change substantially.(10)Therapeutic Activities. The center must provide therapeutic activities appropriate to the needs of the individual residents and adapt the activities, as necessary, to encourage the participation of the residents. The following kinds of therapeutic activities must be provided at least weekly with at least some therapeutic activities occurring daily: (a) Gross motor activities; e.g. exercise, dancing, gardening, cooking, other outdoor activities.(b) Self-care activities; e.g. dressing, personal hygiene/grooming;(c) Social activities; e.g. games, music, crafts.(d) Sensory enhancement activities, e.g. distinguishing pictures and picture books, reminiscing and scent and tactile stimulation.(11) No licensed personal care home may provide or hold itself out as providing specialized care for residents with probable Alzheimer's disease or other dementia or charge a differential rate for care of residents with cognitive deficits that place the residents at risk of engaging in unsafe wandering activities (eloping) unless it meets the additional requirements specified in Rule 111-8-62-.19.Ga. Comp. R. & Regs. R. 111-8-62-.19
O.C.G.A. §§ 31-2-7, 31-2-9, 31-7-1et seq., 43-26-32.
Original Rule entitled "Requirements for Memory Care Services" adopted. F. Nov. 19, 2009; eff. Dec. 9, 2009.Amended: New Title "Additional Requirements for Specialized Memory Care Units or Homes". F. Dec. 19, 2012; eff. Jan. 8, 2013.Amended: New Title "Additional Requirements for Certified Memory Care Centers." F. Aug. 24, 2021; eff. Sept. 13, 2021.