216-40-10 R.I. Code R. § 7.5

Current through June 12, 2024

Section 216-RICR-40-10-7.5 - Requirements for Adult Day Care Programs

7.5.1Admission Policies and Procedures

A. Each adult day care program shall define the target population(s) it serves.

B. Each adult day care program shall have a written policy on participants who are appropriate for enrollment.

C. Each adult day care program shall have a mission and philosophy statement that reflects the needs of the participants and the care and services it provides.

D. Each participant shall have a physical/mental condition that indicates a need for nursing care, supervision, therapeutic services, support services, and/or socialization.

E. Each adult day care program shall serve only participants whose needs are compatible with the program's resources.

F. No less than fifty-one percent (51%) of the program's average daily number of participants shall be fifty-five (55) years of age or older.

G. Prior to an individual's acceptance as a participant, the program shall require a notice from the applicant's primary care physician (or other authorized provider acting within the scope of his/her practice) including a medical history and documentation that a physical examination has taken place within the past year. Physician's (or other authorized provider acting within the scope of his/her practice) documentation shall include, but not be limited to, the following:

1. A list of current medications and treatments;

2. A list of immunizations (e.g., tetanus, pneumococcal, influenza) with dates; and indication of TB test results, if test has been given;

3. Any special dietary requirements;

4. A statement indicating any limitations to the individual's participation in program activities;

5. Recommendations for therapy, when applicable.

H. In a documented crisis situation, the program may allow up to thirty (30) days after enrollment in the program for receipt of the complete physician's documentation as required in §7.5.1(G) of this Part.

I. The program shall have procedures for orientation of the participant and/or family to policies, services, and facilities.

J. The program shall assure that all participants or their authorized representatives review all consents and permission documents and either sign where indicated or state in writing that they have read and understand the documents and are unwilling to sign them. Copies of these signed documents shall be filed in the participant's individual record.

K. The participant (or their authorized representative) and family shall be informed of the program's procedures for advance directives.

L. Program policies shall define the target population, admission criteria, discharge criteria, medication policy, participant rights, confidentiality, and grievance procedures.

7.5.2Participant Policies

A. All programs shall promote a restraint-free environment. The use of chemical and/or physical restraints shall be restricted to those participants whose physicians (or other authorized provider acting within the scope of his/her practice) have ordered such restraints.

B. The rights listed in §7.5.3(A) of this Part shall be posted. These rights shall be explained to all participants or their representatives, families, staff, and volunteers in the language understood by the individual.

C. A grievance procedure shall be established to enable participants and their families/caregivers to have their concerns addressed without fear of recrimination.

D. The program shall comply with the state mandatory procedures for reporting suspected elder abuse to the Department as outlined in R.I. Gen. Laws Chapter 23-17.8. Any employee of a licensed adult day care program who has reasonable cause to believe that a participant has been abused, exploited, neglected, or mistreated shall, within twenty-four (24) hours of the receipt of said information, transfer such to the Director. Staff shall be trained in signs and symptoms of potential abuse.

7.5.3Participant Rights and Responsibilities

A. Adult day care programs shall assure that all participants are afforded the following rights, as well as any others deemed appropriate by the specific program:

1. The right to be treated with consideration, respect, and dignity, including privacy in treatment;

2. The right to participate in program of services and activities designed to encourage independence, learning, growth and awareness of constructive ways to develop one's interests and abilities;

3. The right to self-determination within the adult day care setting, including the opportunity to:

a. Participate in developing or changing one's plan for services;

b. Decide whether or not to participate in any given activity;

c. Be involved to the extent possible in program planning and operation;

d. Refuse treatment and be informed of the consequences of such refusal;

e. End participation in the adult day care program at any time.

4. The right to a thorough initial assessment, development of an individualized plan of care, and a determination of the required level of care;

5. The right to be cared for in an atmosphere of sincere interest and concern in which needed support and services are provided;

6. The right to a safe, secure, and clean environment;

7. The right to receive nourishment and assistance with meals as necessary to maximize functional abilities and quality of life;

8. The right to confidentiality and the guarantee that no personal or medical information will be released to persons not authorized under law to receive it without the participant's written consent, in accordance with R.I. Gen. Laws Chapter 5-37.3;

9. The right to voice grievances about care or treatment without discrimination or reprisal;

10. The right to be fully informed, as documented by the participant's written acknowledgment, of all participants' rights and of all rules and regulations regarding participant conduct and responsibilities;

11. The right to be free from harm, including unnecessary physical or chemical restraint, isolation, excessive medication, abuse, or neglect;

12. The right to be fully informed, at the time of acceptance into the program, of services and activities available and related charges;

13. The right to communicate with others to the extent of the participant's capability.

7.5.4Program Services

A. Programs shall offer, or make available through arrangements with community agencies, the services specified below in order to meet the needs of the participant population:

1. Nursing services shall be provided in accordance with the particular needs of each participant and shall include, but not be limited to, the following:

a. Supervision of and/or administration of medications and treatments as prescribed by the participant's physician (or other authorized provider working within the scope of his/her practice);

b. Participation in the development and implementation of the individual participant's plan of care;

c. Ongoing monitoring of each participant's health status;

d. Maintenance-therapy treatment as recommended by a therapist; and

e. Coordination of orders from the participant's physician (or other authorized provider working within the scope of his/her practice).

2. Programs shall provide or arrange for health education, which may include promotion, prevention, screening and detection.

B. Therapeutic services shall be provided to, or coordinated for, each participant, as needed, when recommended by a therapist or prescribed by a physician (or other authorized provider working within the scope of his/her practice).

1. Therapeutic services shall include occupational, physical, and/or speech therapy.

C. The program shall establish written agreements with occupational, physical, and speech therapists to define the nature and extent of the working relationship.

D. Program staff members shall provide therapeutic services to participants following a plan of care devised by a therapist.

E. Program staff members shall provide maintenance therapy to meet the particular needs of a participant when indicated by the program therapy consultants or the participant's physician (or other authorized provider acting within the scope of his/her practice). The program's nurse, or other licensed professional, shall supervise the administration of maintenance therapy to participants.

F. Program staff members shall provide individual and group activity programs that offer social, recreational, and educational events.

G. The dignity, interests, and therapeutic needs of individual participants shall be considered in the development of activity programs.

H. Nursing assistants and aides, under the supervision of a nurse, shall provide personal care services and shall offer training and assistance in dressing, grooming, personal hygiene, use of special aids, accident prevention, and activities of daily living.

I. Personal care services and assistance with activities of daily living shall be provided in a safe and hygienic manner, with recognition of each individual participant's dignity and right to privacy, and in a manner that encourages the maximum level of independence.

J. Programs shall provide a noon meal and make available two (2) snacks per day for each participant every full day he/she attends the program.

K. Menus shall be developed under the direction of a nutritionist or registered dietician licensed by the Department.

L. The noon meal shall be equivalent to at least one-third the recommended daily dietary allowance established by the U.S. Department of Agriculture (USDA).

M. The program shall provide or arrange for any special diets, if required by a participant and prescribed by his/her physician (or other authorized provider working within the scope of his/her practice).

N. The program shall offer or arrange for nutritional counseling, as necessary.

O. Food shall be prepared in accordance with the Rhode Island Food Code (Part 50-10-1 of this Title).

P. The program shall assist participants and their families with personal and social issues.

Q. The program shall provide or arrange for mental health and substance abuse services for participants when indicated by a physician (or other authorized provider working within the scope of his/her practice).

R. Mental health and substance abuse services shall be documented in the individual participant's plan of care.

S. The program shall establish written emergency policies and procedures. Emergency procedures shall include, but not be limited to, the following:

1. A written plan and/or agreement for emergency care;

2. A written plan and/or agreement for emergency transportation;

3. A file readily located for each participant containing at least the following:

a. Name and telephone number of his/her physician;

b. Hospital preference;

c. Insurance information;

d. Medications and allergies;

e. Current diagnoses and history;

f. Name and telephone number of emergency contact;

g. Copy of any advance directive, power of health care attorney, etc.; and

h. Photograph (for participant identification);

4. A conspicuously displayed notice indicating emergency fire procedures in accordance with local and state fire department regulations;

5. Training for participants in emergency procedures, written records of which shall be kept; and

6. Annual training for direct program staff members, including drivers, in emergency procedures, written records of which shall be kept.

T. The program shall provide a balance of purposeful activities to meet the participants' needs and interests (i.e., social, intellectual, cultural, economic, emotional, physical, and spiritual).

U. Program activities and services shall be designed to promote personal growth and enhance the self-image, and/or improve and maintain the functioning level of participants to the extent possible.

V. Activity opportunities shall be available whenever the program is in operation.

W. If a participant receives services from several community agencies, the program shall coordinate with the participant's case manager to ensure that services are not duplicated.

X. Programs shall arrange for ancillary services to meet needs identified through the assessment and individual care planning process.

Y. Ancillary services shall include education for the participant and/or family caregiver and may be delivered on a one-to-one basis or in a group setting.

Z. Ancillary services shall be provided within the framework of the individualized plan of care and as part of the overall array of services the participant receives.

AA. Services shall be rendered in accordance with the prevailing community standard of practice.

7.5.5Alzheimer Dementia or Other Dementia Special Care Services Disclosure

A. Any adult day care program that offers to provide or provides services to participants with Alzheimer dementia or other dementia shall be required to disclose on a standard disclosure form provided by the Department the type of services provided, in addition to those services required by this Part.

B. Said disclosure shall be made to the Department and to any person seeking placement in an Alzheimer Dementia or other dementia special care services component of an adult day care program.

C. The information disclosed shall explain the additional care that is provided in each of the following areas:

1. Philosophy: the Alzheimer Dementia or other Dementia special care services written statement of its overall philosophy and mission which reflects the needs of participants affected by dementia;

2. Termination from the Program: the process and criteria for transfer or termination from the program/unit;

3. Assessment, Service Planning and Implementation: the process used for assessment and establishing the plan of service and its implementation, including the method by which the plan of service evolves and is responsive to changes in condition;

4. Staffing Patterns and Training Ratios: staff training and continuing education practices;

5. Physical Environment: the physical environment and design features appropriate to support the functioning of cognitively impaired adults;

6. Participant Activities: the frequency and types of activities for participants;

7. Family Role in Providing Support and Services: the involvement in families and family support programs;

8. Program Costs: the cost of care and any additional fees.

D. The Department shall review the information provided on the disclosure form by the adult day care program to verify the accuracy of the information reported on it. Any significant changes in the information provided by the adult day care program on its disclosure form shall be reported to the Department at the time the changes are made.

E. Any adult day care program that provides care for participants with Alzheimer disease or other dementia shall maintain written policies and procedures that detail specific services, including admission and discharge criteria for participants and/or their responsible parties in the program.

F. Training for employees who work in an Alzheimer Dementia or other dementia special care services program shall meet all of the requirements of §§7.4.4(B) and (C) of this Part.

G. The adult day care program that has an Alzheimer Dementia or other dementia special care services program shall have no less than one (1) registered nurse on staff and available for consultation at all times with appropriate training and/or experience with dementia to manage and supervise all participant dementia-related health and behavioral issues.

H. The adult day care program with an Alzheimer Dementia or other dementia special care services program shall provide a secure environment appropriate for the participant population. This requirement may include, but not be limited to, a locked unit, secured perimeter, or other protocol to ensure participant safety and quality of life. The adult day care program shall have elopement policies in place.

7.5.6Individual Assessments, Plans of Care, and Participant Records

A. Each adult day services program shall conduct an assessment of each potential participant in order to determine whether or not that participant is suitable for enrollment in the program.

B. This assessment shall be conducted by a licensed staff member working within the scope of his/her practice, shall be reviewed by a registered nurse, and shall include interviews of family members, as appropriate.

C. Initial assessment information and information provided by the applicant's physician (or other authorized provider acting within the scope of his/her practice) shall be reviewed by at least one registered nurse member of the program.

D. The assessment shall include no less than the following components:

1. Participant's ability to self-preserve including cognitive and physical considerations;

2. Assistance with medications that may be required;

3. Health status including medical and nursing needs;

4. Dementia care needs;

5. Assistance with personal needs, including activities of daily living;

6. Providing or arranging for health and supportive services;

7. Monitoring activities to ensure health, safety, and well-being;

8. Cognitive needs;

9. Functional needs; and

10. Social needs.

E. Written documentation of this initial assessment shall be maintained by the program in the participant's record.

F. Upon admission to the program, program staff shall negotiate a written agreement with the participant (or their authorized representative), and if appropriate, with the participant's legal guardian. This agreement shall specify at least the following:

1. A disclosure statement that describes the program's range of care and services;

2. Basic services offered to the participant by the program;

3. Staffing profile;

4. Participant confidentiality policies and procedures;

5. Admission, discharge, and/or transfer criteria;

6. Fees and arrangements for reimbursement and payment;

7. Identification of and authorization for third party payers;

8. Any non-financial obligations of the participant and his/her family, such as a commitment by the participant to attend the program a specified number of days per week;

9. Days and hours of program operation;

10. Schedule of holidays when the program is closed;

11. Announcement procedures for unexpected closing of the program due to disaster or severe weather conditions.

G. Each participant shall designate a health care provider to contact in the event of an emergency and for ongoing care.

H. Each program shall maintain a participant record system, including a separate record for each participant.

I. Programs shall conduct the assessment as required herein and utilize the results of this assessment to develop an individual written plan of care for each participant within thirty (30) days after the individual enters the program.

J. Each plan of care shall be drafted by an interdisciplinary team, with input from nursing assistants. The participant, caregiver, and other service providers shall have the opportunity to contribute to the development, implementation, and evaluation of his/her care plan.

K. If coordination of care is needed and if the participant is a client of another agency, the care plan shall be developed in conjunction with the services provided by that agency. The participant's case manager or other appropriate staff member from that agency shall be invited to participate in the care-planning meeting.

L. The individual plan of care shall consist of these elements:

1. Specific problems, needs or challenges faced by the participant;

2. Realistic goals and/or objectives for the participant for each item identified in §7.5.7(L)(1) of this Part;

3. Measurable action steps to be taken during the coming quarter to achieve the goals and/or objectives identified in §7.5.7(L)(2) of this Part;

4. Specific observations to be made and/or data to be collected to measure progress toward achieving the goals and/or objectives identified in §7.5.7(L)(2) of this Part; and

5. Specific timelines for making observations and collecting data as identified in §7.5.7(L)(4) of this Part.

M. There shall be a care plan review quarterly conducted by one of the three members of the interdisciplinary team, including the participant and/or family/ caregiver, that reassesses the individual participant's needs and reevaluates the appropriateness of service plans. At least the following items shall be reviewed:

1. Scheduled days of attendance;

2. Services, objectives, and goals of the plan of care;

3. Progress, or lack thereof, in achieving objectives and goals of the plan of care; and

4. Conditions of participation.

N. Progress notes shall be written no less than monthly by a licensed member of the interdisciplinary team and shall be maintained as part of each participant's record.

O. The program shall maintain individual participant records arranged for ready access by staff.

P. Each individual participant record shall contain at least the following sections:

1. Progress notes no less than monthly and quarterly;

2. Assessment information;

3. Summary of quarterly plan of care meetings, including names and titles of all in attendance and documentation of any person(s) invited who did not attend;

4. Medical and other health-related information, including physician's (or other authorized health care provider's) orders;

5. Medication records; and

6. Financial records, including eligibility and payment documents.

Q. Emergency information about each participant and a recent photograph of each participant shall be maintained for ready access.

R. Individual participant records and all other documents associated with identifiable individual participants shall be maintained as confidential materials in accordance with current state and federal laws, rules and regulations. Storage of all participant records and documents shall assure their safety from inappropriate use and from fire and other unplanned destruction.

S. The program shall develop and follow written policies establishing guidelines for storage and retention of participant records, including but not limited to the following:

1. The required participant information shall be contained in record formats appropriate to the efficient and effective delivery of services and accessible for review upon request by the Department or other appropriate health oversight agency.

2. Guidelines for the removal of participant records from file.

3. Retention of participant records for five (5) years from the date of discharge in accordance with R.I. Gen. Laws Chapter 23-3.

7.5.7Discharge Planning

A. The program shall develop a re-evaluation protocol that specifies:

1. Those changes in medical and/or behavioral status that trigger an unscheduled reassessment of the participant;

2. Observational and data-gathering procedures-including inquiries made of the family concerning the participant's status outside program hours-to yield measurable status changes;

3. Procedures to be followed by the treatment team to attempt to modify status changes so that the participant may continue in the program;

4. Description of criteria to be followed to determine that discharge procedures should be initiated.

B. Steps taken under the re-evaluation protocol shall be documented in the individual participant record.

C. The program shall develop a discharge protocol that includes criteria and notification procedures.

D. Discharge/transition plans shall be developed for participants that describe changes in service needs and changes in functional status that prompted another level of care.

E. Each participant and/or family/caregiver shall be given written notice if the participant is to be discharged from the program.

F. Discharge procedures shall include at least the following:

1. A discharge summary;

2. Recommendations for continuing care;

3. In consultation with the participant, family member or guardian, referral to community service agencies for any appropriate services, if the participant is returning to more independent living.

G. The program shall complete and maintain on file a discharge form indicating a discharge plan for each participant leaving the program.

H. The program shall discuss and agree upon the discharge plan with the participant and his/her family as far in advance of discharge as possible.

I. Any adult day care program that refers participants to any health care facility licensed pursuant to R.I. Gen. Laws Chapter 23-17, to an assisted living residence licensed pursuant to R.I. Gen. Laws Chapter 23-17.4, or to an adult day care program in which the referring entity has a financial interest shall, at the time a referral is made, disclose and document that the following information was provided to the participant:

1. That the referring entity has a financial interest in the program or provider to which the referral is being made;

2. That the participant has the option of seeking care from a different program or provider that is also licensed by the state to provide similar services to the participant.

J. The adult day care program shall offer the participant a written list prepared by the Department of all alternative licensed health care facilities, assisted living residences, and adult day services programs. Said written list may be obtained by contacting:

Rhode Island Department of Health Office of Facilities Regulation

3 Capitol Hill, Room 305

Providence, RI 02908

(401) 222-2566

www. health.ri.gov

7.5.8Medication Services

A. The program shall store and administer medications to participants as required and in accordance with all applicable state and federal laws and regulations.

B. Participants shall have the right to refuse any and all medications.

C. The program shall inform the participant's family or a participant's authorized representative when a participant has refused medication(s). The nurse shall inform the participant's physician (or other authorized provider acting within the scope of his/her practice), as she/he deems appropriate.

D. The program shall have the right not to accept, and/or to discharge a participant who refuses assistance with medications if the program reasonably feels that the participant cannot safely possess and control his/her medications.

E. The program shall record each instance of medication refusal by a participant in the participant's individual record.

F. All medications shall be stored securely and in a manner to prevent spoilage, dosage errors, administrative errors, inappropriate access, or diversion. Provided, further, medications stored in a refrigerator shall be stored separately from the food in a secured container.

G. Licensed nurses and medication aides may administer medications and monitor health indicators.

H. All medications shall be checked against a physician's (or other authorized provider working within the scope of his/her practice) orders by a nurse or pharmacist.

I. All medications shall be in the original pharmacy-dispensed container with a proper label and directions attached and shall be administered in accordance with such label.

J. Injectable medications, including but not limited to insulin, shall be administered by a nurse.

K. Individual medication records shall be retained for each participant to whom medications are being administered and each dose administered to the participant shall be properly recorded.

L. Such records shall be retained by the program for no less than five (5) years after discharge from the program.

M. A nurse shall monitor the medication regimen for all participants.

N. Unused or discontinued prescription medications shall be the property of the participant and shall be given to the participant's family or authorized representative, whenever possible.

O. Any unused or discontinued prescription medications that are left with a program shall be disposed of in accordance with the Rules and Regulations Governing the Disposal of Legend Drugs.

216 R.I. Code R. § 216-RICR-40-10-7.5