Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule is being promulgated to describe
the general requirements and process by which project participants will be
selected in order to implement Alzheimer's Demonstration Projects in accordance
with section
198.086, RSMo Supp.
1999.
PUBLISHER'S NOTE: The secretary of state has
determined that the publication of the entire text of the material which is
incorporated by reference as a portion of this rule would be unduly cumbersome
or expensive. Therefore, the material which is so incorporated is on file with
the agency who filed this rule, and with the Office of the Secretary of State.
Any interested person may view this material at either agency's headquarters or
the same will be made available at the Office of the Secretary of State at a
cost not to exceed actual cost of copy reproduction. The entire text of the
rule is printed here. This note refers only to the incorporated by reference
material.
(1) For the
purposes of this rule, "Health care facilities for persons with Alzheimer's
disease or Alzheimer's related dementia" means facilities that are specifically
designed and operated to provide elderly individuals who have chronic confusion
or dementia illness, or both, with a safe, structured but flexible environment
that encourages physical activity through a well-developed recreational and
aging-in-place activity program.
(2) Participation in the Alzheimer's
Demonstration Projects will be solicited by the Division of Aging by letter to
all providers currently licensed by the division and to all interested parties
who have advised the division of their interest. The solicitation letter will
advise all recipients of the criteria to be used in making the selection and
will be sent in advance of the selection with sufficient mailing time allowed
for the submission of proposals by the date specified.
(3) Potential project participants must
respond to the solicitation letter within thirty (30) days of the date
received. The division must receive proposals by the date specified in the
solicitation letter in order for the proposals to be considered. Proposals must
address the criteria contained in the letter.
(4) The criteria utilized to select
Alzheimer's Demonstration Project participants will be developed by a committee
appointed by the director of the Division of Aging consisting of
representatives of providers, consumers and professionals in the long-term care
industry who possess knowledge of the provision of treatment to individuals
with Alzheimer's disease or other related dementias.
(5) Proposals submitted will be screened
initially for the ability of project applicants to comply with the minimum
requirements set forth in section
198.086, RSMo Supp.
1999. Such applicants must provide supported assurances of their ability to
achieve initial and continued compliance with all such requirements in order to
be included in the final selection. Proposals from project applicants which are
determined to not meet the minimum requirements shall be removed from
consideration.
(6) The proposals
submitted by applicants which remain after the initial screening shall be
reviewed to determine whether all required components, as set forth in this
rule, are addressed. Proposals which are determined to have not addressed all
required components shall be removed from consideration.
(7) Proposals remaining shall be reviewed by
the director of the Division of Aging and initial selections made. Selections
for participants will be finalized only after the applicant reasonably
demonstrates the financial capacity necessary to effectively implement and
maintain the facility and program described in the proposal.
(8) Project participants selected for the
demonstration projects shall be notified by the division within sixty (60) days
from the date by which proposals shall be submitted to the division.
(9) All facilities selected to participate in
the demonstration projects shall demonstrate the ability to comply with the
following minimum requirements set forth in section
198.086, RSMo Supp.
1999:
(A) Each health care facility for
persons with Alzheimer's disease or other related dementias shall maintain
substantial compliance with all regulations under which they are licensed or
certified. A facility may request an exception to a state licensure regulation
in accordance with 13 CSR 15-10.010(4);
(B) Facilities shall design and implement
self-care, productive and leisure activity programs for individuals with
Alzheimer's or other related dementias. These programs shall continually strive
to promote the highest practicable physical and mental abilities and
functioning of each resident;
(C)
The facility may admit to the demonstration project facility only persons who
have been diagnosed with Alzheimer's disease or other related dementia and for
whom it has been determined that the facility is able to meet their needs. The
determination of whether a facility is able to meet a resident's needs shall be
made in consultation between the resident's physician, family members or health
care advocates;
(D) Facilities
shall designate a contiguous portion of the facility as the demonstration
project site, unless such facility exclusively admits individuals with
Alzheimer's or other related dementias as part of the demonstration project.
All designated demonstration project beds shall be located within this
designated contiguous portion of the facility;
(E) Facilities shall design and implement a
resident environment which promotes the maintenance of the residents' social
abilities through daily and frequent opportunities for socialization and
appropriate activities. The residential environment shall be designed and
utilized in such a way as to reflect the individual preferences of residents
and to provide as much independence and opportunities for choices throughout a
day as possible;
(F) A Minimum Data
Set (MDS) assessment shall be completed for any resident who occupies a bed
designated for demonstration project participants. The MDS must be completed
within fourteen (14) days of admission and an MDS quarterly review assessment
must be completed every ninety (90) days thereafter. The MDS must also be
completed whenever a significant change in condition occurs. For the purposes
of this rule, "significant change" means a change in medical condition or in
cognitive or psychosocial functioning which requires a change or modification
in services or treatments provided in order to maintain the individual at the
highest practicable level of functioning.
(G) Facilities shall be staffed twenty-four
(24) hours a day by the number and type of licensed and unlicensed personnel
sufficient to insure that all the needs of residents are met throughout the
day. Facilities must remain in compliance with the staffing regulations in
effect for the licensure category of the facility and as established by statute
and must provide any additional staffing required to insure that residents'
needs are met. Facilities shall determine appropriate staffing levels by
utilizing current and updated Minimum Data Set information to identify
residents' needs and shall make a determination on a daily and as-needed basis
regarding the number of staff required to meet these needs;
(H) Facilities shall conduct a total of at
least twenty-four (24) hours of staff training for all employees providing
direct care to demonstration project residents within the first thirty (30)
days of employment. This training shall consist of at least six (6) hours of
classroom training and two (2) hours of on-the-job training in the special
needs, care and safety of individuals with Alzheimer's disease or related
dementias;
(I) Additional training
provided shall address the needs, preferences and choices of the individual
demonstration project residents, the degree of and the provision of assistance
required with activities of daily living, the initiation of appropriate
activities for residents and the promotion of each resident's rights, dignity
and independence;
(J) Facilities
shall utilize personal electronic monitoring devices for any resident whose
physician recommends and orders the use of the device. Such orders shall be
documented in the resident's health care record;
(K) The facility shall be equipped with a
complete automated sprinkler system installed and maintained in accordance with
the 1996 edition of the National Fire Protection Association (NFPA) 13,
Standard for the Installation of Sprinkler Systems, or the
1996 edition of NFPA 13R, Sprinkler Systems in Residential Occupancies
Up to and Including Four Stories in Height, which are hereby
incorporated by reference in this rule. The facility shall also be equipped
with a complete electrically supervised fire alarm system and smoke barriers in
accordance with the provisions of the 1997 Life Safety Code for
Existing Health Care Occupancy, which code is hereby incorporated by
reference in this rule; and
(L)
Buildings and furnishings shall be designed to provide for residents' safety.
Facilities shall have indoor and outdoor activity areas, and electronically
controlled exits from the buildings and grounds to allow residents the ability
to explore while preventing them from exiting the facility's grounds
unattended.
(10) All
demonstration project facilities shall complete the Alzheimer's Special Care
Unit/Program Disclosure Form in accordance with section
198.510,
RSMo Supp. 1999, and develop an informational brochure in accordance with
section
198.515,
RSMo Supp. 1999. These must be submitted to the division's licensure unit prior
to the admission of any residents through the demonstration project and as
required for licensing purposes.
(11) In addition to the minimum requirements,
applicants will also be considered for selection based on their ability to
provide the following:
(A) A safe environment
for individuals with Alzheimer's disease and other related dementias;
(B) Admission and discharge criteria which
effectively identify those individuals for whom the participant is able to
effectively provide treatment services;
(C) The provision of services through a
social model for the residential environment;
(D) Staffing in sufficient numbers and by
appropriately qualified staff in order to meet the needs of all residents with
Alzheimer's disease or other related dementias on an ongoing basis;
(E) Specialized staff training relating to
the needs, care and safety of individuals with Alzheimer's disease or other
related dementias;
(F) Housing
arrangements designed to provide for residents' comfort and safety as well as
the provision of services;
(G)
Supportive services ancillary to the provision of treatment and which support
the treatment provided by the facility; and
(H) Adequate financial support of the
facility's demonstration project.
*Original authority: 198.534, RSMo
1999.
