Current through Register Vol. 48, No. 12, March 22, 2024
a) In addition to this Section, Alzheimer and
dementia programs shall comply with all of the other provisions of the Act.
(Section 150(a) of the Act)
b) No
person shall be admitted or retained in an assisted living or shared housing
establishment if the establishment cannot provide or secure appropriate care,
if the resident requires a level of service or type of service for which the
establishment is not licensed or which the establishment does not provide, or
if the establishment does not have the staff appropriate in numbers and with
appropriate skill to provide such services. (Section 150(b) of the
Act)
c) No persons shall be
accepted for residency or remain in residence if the person's mental or
physical condition has so deteriorated to render residency in such a program to
be detrimental to the health, welfare or safety of the person or of other
residents of the establishment. The assessment must be approved by the
resident's physician and shall occur prior to acceptance for residency,
annually, and at such time that a change in the resident's condition is
identified by a family member, staff of the establishment, or the resident's
physician. (Section 150(c) of the Act)
d) Individual residents shall be assessed
prior to admission to the establishment using any one or a combination of the
following assessment tools, based on the resident's condition and stage in the
disease process:
1) Functional
A) Functional Activities Questionnaire
(FAQ)
B) Physical Self-Maintenance
Scale (PSMS); Activities of Daily Living
C) Instrumental Activities of Daily Living
(IADL)
D) Clock Drawing Task
(CDT)
E) Progressive Deterioration
Scale (PDS)
F) Functional
Assessment Staging (FAST)
2) Cognitive
A) Allen Cognitive Disabilities
Theory
B) Alzheimer's Disease
Assessment Scale, Cognitive Subsection (ADAS-Cog)
C) Blessed Information-Memory Concentration
Test (BIMC)
D) Short Test of Mental
State (STMS)
E) Clinical Dementia
Rating Scale (CDR)
F) Mini-Mental
State Examination (MMSE)
3) Global
A)
Clinical Global Impression of Change (CGIC)
B) Clinical Interview-Based Impression
(CIBI)
C) Global Deterioration
Scale (CDS)
D) Brief Cognitive
Rating Scale (BCRS) (to use with Global Deterioration Scale)
e) No person shall be
accepted for residency or remain in residence if the person is dangerous to
self or others and the establishment would be unable to eliminate the danger
through the use of appropriate treatment modalities. (Section 150(d) of the
Act)
f) No person shall be accepted
for residency or remain in residence if the person meets the criteria provided
in subsections (b) through (g) of Section 75 of the Act. (Section 150(e) of the
Act)
g) If an establishment accepts
any individuals with cognitive impairments that prevent them from safely
evacuating the establishment independently, sufficient staff members shall be
present and awake 24 hours a day to assist in evacuation.
h) An establishment that offers to provide a
special program for persons with Alzheimer's disease and related disorders
shall:
1) Disclose to the Department and to a
potential or actual resident of the establishment information as specified
under the Alzheimer's Special Care Disclosure Act;
2) Ensure that a resident's representative is
designated for the resident;
3)
Develop and implement policies and procedures that ensure the continued safety
of all residents in the establishment including, but not limited to, those who:
A) May wander; and
B) May need supervision and assistance when
evacuating the building in an emergency;
4) Provide coordination of communications
with each resident, resident's representative, relatives and other persons
identified in the resident's service plan;
5) Provide, in the service plan, appropriate
cognitive stimulation and activities to maximize functioning, which include a
structure and rhythm that are comfortable and predictable; offer an appropriate
balance of rest and activity and private and social time; allow residents to
express their accustomed social roles, whatever they may be; offer residents
access to familiar activities that they enjoyed doing and that tap memories and
retained abilities; and provide the flexibility to accommodate variations in
the resident's mood, energy level, and inclination;
6) Provide an appropriate number of staff for
its resident population. The establishment shall provide staff sufficient in
number, with qualifications, adequate skills, education, and experience to meet
the 24-hour scheduled and unscheduled needs of the residents and who
participate in ongoing training, to serve the resident population. At a
minimum, at least one staff member shall be awake and on duty at all
times;
7) At a minimum, provide 1.4
hours of services per resident per day. For purposes of this Section, services
shall mean assistance with activities of daily living, activities-based
programming, and services delivered to the resident to meet the unique needs of
residents with dementia;
8) Require
the manager and direct care staff to complete sufficient comprehensive and
ongoing dementia and cognitive deficit training as set forth in subsection (i)
of this Section;
9) Develop
emergency procedures and staffing patterns to respond to the needs of
residents; (Section 150(f) of the Act)
10) Provide encouragement to eat snacks and
meals and to take liquids; and
11)
Have a supervisor of the program with training as outlined in subsection (i)(1)
of this Section.
i)
Training requirements for individuals working in a special program:
1) Manager qualifications and training:
A) The manager of an establishment providing
Alzheimer care or the supervisor of an Alzheimer program must be 21 years of
age and have:
i) a college degree with
documented course work in dementia care, plus one year of experience working
with persons with dementia; or
ii)
at least two years of management experience with persons with
dementia.
B) The manager
or supervisor must complete, in addition to the training required in subsection
(i)(2) of this Section and in Section
295.3020,
six hours of annual continuing education regarding dementia care.
2) Staff training:
A) All staff members must receive, in
addition to the training required in Section 295.3020, four hours of
dementia-specific orientation prior to assuming job responsibilities without
direct supervision within the Alzheimer's/dementia program. Training must
cover, at a minimum, the following topics:
i)
basic information about the causes, progression, and management of Alzheimer's
disease and other related dementia disorders;
ii) techniques for creating an environment
that minimizes challenging behavior;
iii) identifying and alleviating safety risks
to residents with Alzheimer's disease;
iv) techniques for successful communication
with individuals with dementia; and
v) residents' rights.
B) Direct care staff must receive 16 hours of
on-the-job supervision and training within the first 16 hours of employment
following orientation. Training must cover:
i)
encouraging independence in and providing assistance with the activities of
daily living;
ii) emergency and
evacuation procedures specific to the dementia population;
iii) techniques for creating an environment
that minimizes challenging behaviors;
iv) resident rights and choice for persons
with dementia, working with families, caregiver stress; and
v) techniques for successful
communication.
C) Direct
care staff must annually complete 12 hours of in-service education regarding
Alzheimer's disease and other related dementia disorders. Topics may include:
i) assessing resident capabilities and
developing and implementing service plans;
ii) promoting resident dignity, independence,
individuality, privacy and choice;
iii) planning and facilitating activities
appropriate for the dementia resident;
iv) communicating with families and other
persons interested in the resident;
v) resident rights and principles of
self-determination;
vi) care of
elderly persons with physical, cognitive, behavioral and social
disabilities;
vii) medical and
social needs of the resident;
viii)
common psychotropics and side effects;
ix) local community resources; and
x) other related issues.