Ga. Comp. R. & Regs. 111-8-63-.19

Current through Rules and Regulations filed through October 17, 2024

Rule 111-8-63-.19 - Additional Requirements for Certified Memory Care Centers

(1) In addition to all other requirements contained in this Chapter, where an assisted living community holds itself out as providing additional or specialized care to persons with probable diagnoses of Alzheimer's Disease or other dementia, or charges rates in excess of that charged other residents for the provision of additional or specialized care, the assisted living community must meet the following requirements:

(a)Written Description. The assisted living community must include in its licensed residential care profile an accurate written description of the memory care center that includes the following:

1. a statement of philosophy and mission;

2. how the services and activities of the memory care center are different from those provided in the rest of the assisted living community;

3. staffing including job titles of staff who work in the center, staff training and continuing education requirements;

4. admission procedures, including screening criteria;

5. 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;

6. staffing patterns, including the ratio of direct care staff to resident for a 24-hour cycle, and a description of how the staffing pattern differs from that of the rest of the program;

7. a description of the physical environment including safety and security features;

8. a description of activities, including frequency and type, and how the activities meet the needs of residents with dementia,

9. the program's fee or fee structure for all services provided by the center or assisted living community;

10. the discharge criteria and procedures;

11. the procedures that will be utilized for handling emergency situations; and

12. the involvement of the center with families and family support programs.

(b)Physical Design, Environment, and Safety. The memory care center must be designed to accommodate residents with severe dementia or Alzheimer's Disease in an assisted living community-like environment which includes the following:

1. multipurpose room(s) for dining, group and individual activities which are appropriately furnished to accommodate the activities taking place;

2. secured outdoor spaces and walkways which are wheel chair accessible and allow residents to ambulate safely but prevent undetected egress;

3. high visual contrast 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;

4. adequate and even lighting which minimizes glare and shadows;

5. 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 two (2) residents;

6. individually identified entrances to residents' rooms to assist residents in readily identifying their own personal spaces;

7. an effective automated device or system to alert staff to individuals entering or leaving the center in an unauthorized manner. An assisted living community 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 assisted living community. If the exit door is not always staffed, then the assisted living community must activate an automated alert when the door is not attended;

8. 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

9. a center providing specialized memory care services 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 assisted living community.

(c)Staffing Requirements. The assisted living community must ensure that the memory care center is staffed with sufficient specially trained staff to meet the unique needs of the residents in the center. At a minimum, the memory care center must provide the following staffing:

(i) 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;

(ii) One registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times;

(iii) Two direct care staff persons on-site at all times, with at least one on each occupied floor; and

(iv) One registered professional nurse or licensed practical nurse on-site or available in the building at all times as follows:

(A) For memory care centers with one to 12 residents, a minimum of 8 hours per week;

(B) For memory care centers with 13 to 30 residents, a minimum of 16 hours per week;

(C) For memory care centers with 31 to 40 residents, a minimum of 24 hours per week; or

(D) For memory care centers with more than 40 residents, a minimum of 40 hours per week.

(d)Staff Training Requirements. The community 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. The memory care center shall meet the following training requirements:

(i) 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:

(A) Basic information about the nature, progression, and management of Alzheimer's and other dementias;

(B) Techniques for creating an environment that minimizes challenging behavior from residents with Alzheimer's and other dementias;

(C) Methods of identifying and minimizing safety risks to residents with Alzheimer's and other dementias; and

(D) Techniques for successful communication with individuals with Alzheimer's and other dementias.

(ii) 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:

(A) General training, to include:

(I) Development, updating, and implementation of comprehensive and individual service plans;

(II) Skills for recognizing physical or cognitive changes in the resident that warrant seeking medical attention;

(III) Residents' rights and identification of conduct constituting abuse, neglect, or exploitation;

(IV) General infection control principles;

(V) Emergency preparedness training;

(VI) Emergency first aid;

(VII) Cardiopulmonary resuscitation.

(B) A minimum of sixteen (16) hours of specialized, competency-based training using forms specified by the department, to include, at a minimum:

(I) The nature of Alzheimer's and other dementias;

(II) The center's philosophy related to the care of residents with Alzheimer's and other dementias;

(III) The center's policies and procedures related to care of residents with Alzheimer's and other dementias;

(IV) Common behavior problems characteristic of residents with Alzheimer's and other dementias;

(V) Positive therapeutic interventions and activities;

(VI) Skills for maintaining the safety of the resident; and

(VII) The role of the family in caring for residents with Alzheimer's and other dementias.

(iii) Ongoing Training. Direct care staff shall complete a minimum of eight (8) hours of specialized training in dementia care on an annual basis.

(iv) Training Documentation. The memory care center shall maintain documentation reflecting course content, instructor qualifications, agenda, and attendance rosters for all training sessions provided.

(e)Special Admission Requirements for Memory Center Placement. Residents must have a physician's report of physical examination completed within 30 days prior to admission to the center on forms made available 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 this center and waives his or her right to live in a less restrictive environment. In addition, the physical examination report must establish that the potential resident of the center does not require 24-hour skilled nursing care.

(f)Post-Admission Assessment. If the resident is admitted directly into the specialized memory care center, the center must obtain an assessment of 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.

(g)Individual Written Care Plan and Reviews. The resident's written care plan will be developed or updated by staff with at least one member of the specialized memory care staff providing direct care participating. Input from each shift of direct care staff that provides care to the resident will be requested. All team members participating shall sign the written care plan and the plan will be shared with the direct care staff providing care to the resident and serve as a guide for the delivery of care to the resident. The resident's family shall participate in the development of the plan, if possible, with incorporation of family and personal history to support a person-centered approach to care. The written care plan must be reviewed at least quarterly and modified as changes in the resident's needs occur.

(h)Therapeutic Activities. The unit shall provide activities appropriate to the needs of the individual residents and adapt the activities, as necessary, to encourage participation of the residents in the following at least weekly with at least some therapeutic activities occurring daily:

1. gross motor activities; e.g. exercise, dancing, gardening, cooking, etc;

2. self-care activities; e.g. dressing, personal hygiene/grooming;

3. social activities; e.g. games, music;

4. sensory enhancement activities, e.g. distinguishing pictures and picture books, reminiscing and scent and tactile stimulation; and

5. outdoor activities; e.g. walking outdoors and field trips.

(2) No licensed assisted living community is permitted to 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 such residents unless it meets the additional requirements specified in Rule 111-8-63-.19(1) and its subparagraphs (a) through (h) above.

Ga. Comp. R. & Regs. R. 111-8-63-.19

O.C.G.A. §§ 31-2-7, 31-2-8, 31-7-1et seq., 43-26-32.

Original Rule entitled "Additional Requirements for Specialized Memory Care Units" adopted. F. Dec. 13, 2012; eff. Jan. 2, 2012.

Amended: New title "Additional Requirements for Certified Memory Care Centers." F. Aug. 24, 2021; eff. Sept. 13, 2021.