Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 240 - COMMUNITY CARE PROGRAM
Subpart B - SERVICE DEFINITIONS
Section 240.230 - Adult Day Service (ADS)
Universal Citation: 89 IL Admin Code ยง 240.230
Current through Register Vol. 48, No. 12, March 22, 2024
Adult day service is the direct care and supervision of adults aged 60 and over in a community-based setting for the purpose of providing personal attention and promoting social, physical and emotional well-being in a structured setting. These services shall be provided pursuant to an ADS Addendum to the participant's person-centered plan of care.
a) Required Service Components
1) Assessment of the participant's strengths
and needs and development of an individual written person-centered plan of care
for each participant that establishes specific participant goals for all
service components to be provided or arranged for by the service provider.
A) The individual ADS Addendum will be
developed by the adult day service team consisting of participant/authorized
representative, Program Coordinator/Director and Program Nurse, and may include
other staff at the option of the program Coordinator/Director.
B) The participant, caregiver and other
service providers will have the opportunity to contribute to the development,
implementation and evaluation of the individualized ADS Addendum.
C) The individualized ADS Addendum is to be
established not later than the fourth week of service.
D) The individualized ADS Addendum shall
address the needs identified by the CCU, as described in the comprehensive
assessment.
E) The individualized
ADS Addendum to the person-centered plan of care shall address the need
identified by the service provider's staff and participant/authorized
representative/caregiver during the individualized ADS Addendum
process.
F) Reassessing the
participant's needs and reevaluating the appropriateness of the individualized
person-centered plan of care shall be done as needed, but at least
annually.
2) A balance of
purposeful activities to meet the participant's interrelated needs and
interests (social, intellectual, cultural, economic, emotional, physical and
spiritual) designed to improve or maintain the optimal functioning of the
participant.
A) Activity programming shall
take into consideration participant differences in age, health status, sensory
deficits, lifestyle, ethnicity, religious affiliation, values, experiences,
needs, interests and abilities by providing for a variety of types and levels
of involvement.
B) Time for rest
and relaxation shall be provided as needed or prescribed.
C) Activity opportunities shall be available
whenever the service provider's facility is in operation and participants are
in attendance.
D) A monthly
calendar of activities shall be prepared and posted in a visible
place.
E) Opportunities to
participate in other activities outside of the ADS shall be provided. The
setting will be integrated in, and support access to, the greater
community.
3) Assistance
with or supervision of activities of daily living (e.g., walking, eating,
toileting and personal care), as needed.
4) Provision of health-related services
appropriate to the participant's needs as identified in the provider's
assessment and/or physician's orders, including health monitoring, nursing
intervention on a moderate or intermittent basis for medical conditions and
functional limitations, medication monitoring, medication administration or
supervision of self-administration, and coordination of health
services.
5) Provision of a daily
meal that meets the Dietary Guidelines for Americans, 2015-2020,
8th edition, published by the Secretary of Health
and Human Services and the Secretary of Agriculture; and that provides each
participant a minimum of 33.5 % of the Dietary Reference Intakes (DRI) as
established by the Food and Nutrition Board of the Institute of Medicine of the
National Academy of Sciences. Supplementary nutritious snacks shall also be
provided. Special diets shall be provided as directed by the participant's
physician.
6) Agency provision or
arrangement for transportation, with at least one vehicle physically
accessible, to enable participants to receive adult day service at the adult
day service provider's site and participate in sponsored outings.
7) Provision of emergency care as appropriate
in accordance with established adult day service provider policies and Section
240.1510.
8) Identifying and reporting critical events
including critical incidents, service improvement program complaints, and
requests for change of status in the Department's automated reporting system.
Completing initial critical event reports will occur within 7 days after the
date the event occurred or was identified to have occurred. Assisting CCUs in
their efforts to safeguard participant health, safety and welfare by
demonstrating a willingness to collaborate, discuss and resolve issues that
likely place a participant at increased risk for experiencing future critical
events. Supporting CCU risk mitigation efforts by demonstrating a willingness
to communicate about necessary adjustments to a participant's person-centered
plan of care or ADS Addendum in response to a critical
event.
b) Ancillary Service Components
1) Ancillary services,
including physical, occupational, speech and creative arts therapies may be
provided by site staff or through contractual arrangements when needed by
participants. If provided, ancillary services shall be within the framework of
the individualized person-centered plan of care and ADS Addendum and shall be
in accordance with professional practice standards and applicable State and
federal regulations.
2) Skilled
nursing services, including, but not limited to, catheter installation,
irrigations and care, dressings, enemas, oxygen therapy, suction/posturing,
ostomy care and restorative nursing such as bladder retraining. (All these
procedures/interventions require physician orders and shall be administered by
a Registered Nurse or a Licensed Practical Nurse, in accordance with the
Illinois Nursing Act [ 225 ILCS 65 ].)
3) Shopping assistance.
4) Escort to medical and social
services.
c) Unit of Service
1) One unit of adult day service is
defined as one direct participant contact hour (excluding transportation time)
provided to a participant. A direct participant contact hour is defined as 60
consecutive minutes of active programming, i.e., providing one or a combination
of the service components listed in subsections (a)(2) through (7).
2) One unit of documented adult day service
transportation, provided by the adult day service provider, is defined as a
one-way trip per participant to or from the adult day service provider's site
and the participant's home. No more than two units of transportation shall be
provided per participant in a 24-hour period, and shall not include trips to a
physician, shopping, or other miscellaneous trips.
3) For services (including transportation, if
specified in the individualized ADS Addendum) which the provider was unable to
provide due to the participant's absence without prior notification (see
Section
240.350
), the provider shall be reimbursed as follows:
A) Two and one half units of documented adult
day service per occurrence to a maximum of 5 units per participant per State
fiscal year.
B) One unit of
documented adult day service transportation, provided by the adult day service
provider, per occurrence to a maximum of 2 units per participant per State
fiscal year.
4) Refer to
Section
240.1950
for further information regarding reimbursement.
AGENCY NOTE: Reimbursement for costs of ancillary services is not included in the unit rate paid by the Department and will not be paid by the Department.
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