Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes the minimum
requirements for operating an adult day care program and providing care to
participants; establishing and preserving certain rights of participants; and
requiring adult day care providers to have written program
policies.
(1) The adult day
care provider shall neither knowingly admit, nor continue to care for,
participants whose needs cannot be met by the program directly or in
cooperation with outside resources.
(2) Each adult day care provider shall have a
written emergency medical plan that assures the following:
(A) Transportation to a hospital or other
type of facility providing emergency or urgent care;
(B) A written agreement, signed by each
participant or legal guardian, shall be on file in the facility granting
permission to transport the participant in need of emergency care to the
designated hospital or other type of facility;
(C) Notes in the participant's record shall
be made immediately of any accident, injury or illness and the emergency
procedures taken;
(D) Emergency
telephone numbers for each participant shall be available to staff at all
times; and
(E) At a minimum, those
first-aid supplies, as recommended by the American Red Cross or other
comparable source, shall be readily available on-site.
(3) The adult day care provider shall require
a medical assessment by the participant's physician or that physician's
designated agent of the participant's medical condition to include activity
needs and restrictions, dietary modifications, indicated therapies and
medication as applicable prior to the first day of participation, signed by the
physician or that physician's designated agent within five (5) working days of
the first day of participation.
(4)
The adult day care provider shall develop a written individual plan of care for
each participant within five (5) contact days following the entry of the
participant into the adult day care program. The plan shall be designed to
maintain the participant at, or to restore to, optimal capability for
self-care. The plan shall be based on a functional assessment and information
obtained from the participant, participant's family, physician and the person
or agency referring the participant. The plan shall address the participant's
physical, social and psychological needs, goals and means of accomplishing
goals to the degree that the program is designed and the staff are qualified to
meet these goals. The plan shall identify the positions of persons responsible
for specific individualized activities provided for the participant that are
not documented by the regularly scheduled plan of activities for the program.
The plan of care shall identify the participant's regularly scheduled days for
attendance, including arrival and departure times. The plan of care shall be
revised as frequently as warranted by the participant's condition, but shall be
reviewed at least every six (6) months and updated as necessary.
(5) The program director or program
director's designee shall maintain communication with participants and their
families or other responsible persons to solve day-to-day problems which
confront the participants. Referrals to other community resources should be
made and services coordinated as needed.
(6) The adult day care provider or program
director or an other employee of the adult day care program shall report any
suspected incidents of physical or mental abuse, neglect, exploitation, or a
combination of these, of its participants to the Elderly Abuse and Neglect
Hotline (1-800-392-0210).
(7) The
adult day care provider is required to offer at least the following services:
(A) Activities of Daily Living. This includes
providing assistance and training in walking, toileting, feeding, personal care
and other activities of daily living in accordance with each participant's
individual plan of care;
(B)
Planned Group Activities. This includes providing planned activities during at
least fifty percent (50%) of the time that the program is open for daily
operation, with a maximum four (4) hours of planned activities required.
Activities shall be suited to the needs and interests of participants and
designed to stimulate interest, rekindle motivation and encourage physical
exercise. Activities shall be conducted individually and in small and large
groups. Planned activities include meals, rest periods, exercise, recreation
and social activities. Physical exercise shall be designed in relation to each
individual's needs, impairments and abilities and shall be alternated with rest
periods or quiet activities;
(C)
Food Service. This includes assuring the availability of meals and supplemental
snacks in accordance with each participant's individual plan of care. Meals
served by the adult day care provider shall provide at least one-third (1/3) of
the recommended dietary allowance of the National Research Council.
Supplemental snacks shall consist of nourishing food and beverages. Food may be
prepared, stored, served, or any combination of these, on-site in compliance
with the requirements of the local health department or applicable rule
established by the department under the provisions of
19 CSR
20-1.010. Food prepared away from the site shall be
prepared in a food preparation facility which meets the requirements of the
local health department or applicable rules established by the department under
19 CSR
20-1.010. The adult day care provider shall arrange
for special diets and other diet modifications as ordered by a physician or the
physician's designated agent. Such diets shall be served as ordered by the
participant's physician or the physician's designated agent with food
preparation and service being reviewed by a qualified dietitian, physician or
nurse at least every six (6) months. Modified diets shall be in effect for the
specified number of days indicated in the physician's order. If no time is
specified, the period may not exceed one (1) calendar year, at which time
another order from the physician shall be obtained; and
(D) Observation. The health, functional and
psychosocial status of each participant shall be observed and documented in the
participant's record at least monthly by the adult day care program director or
other designated professional staff and the plan of care modified if
necessary.
(8) The adult
day care provider may offer the following services:
(A) Transportation. If transportation
services are offered, directly or through a contract, they shall meet the
requirements of
19 CSR
15-7.040;
(B) Counseling Services. If counseling
services are offered, they shall be provided by qualified professional
personnel;
(C) Rehabilitation
Services. If rehabilitation services are offered, they shall be prescribed by a
physician and performed by qualified therapists. Orders for the various
therapies and treatments shall be in effect for the specified number of days
indicated by the physician's written order. If no time period is specified,
then the time period shall not exceed sixty (60) days and a new order by the
physician must be obtained. Therapy services provided shall be summarized in
the participant's record and progress noted at least monthly by the
therapist;
(D) Medical Services. If
medical services are offered, a licensed nurse shall be available at all times
that the program is in operation. Medical services shall be provided in
accordance with the particular needs of each participant. The licensed nurse
shall be the only individual authorized to receive, control and manage the
medication and drug program. The licensed nurse shall be responsible for the
following:
1. A safe, effective system of
identifying, handling and storing each participant's medications.
2. A system for administering and storing
medications that is reviewed not less than every ninety (90) days by a licensed
nurse.
3. Administration of
medications and treatments, including the following requirements:
A. Participants who are responsible for
taking their own medication at home shall be permitted and encouraged to
continue to be responsible for taking their own medication during the hours
spent in the program. If a participant is unable to self-administer medication,
then the adult day care provider shall assume responsibility in accordance with
the applicable provisions of this rule. If a participant refuses medication,
this refusal shall be documented in the participant's record and the
participant and their primary caregiver informed of the possible consequences
of not receiving the medication;
B.
Medications or treatments may not be administered without an order signed by a
licensed physician. Physician's phone orders may be taken only by a licensed
nurse. Phone orders shall be written into the participant's record by the
licensed nurse receiving them and shall be signed by that person. The physician
shall sign and date the order within five (5) working days after giving the
phone order;
C. Orders concerning
treatments and medications shall be in effect for a specified number of days as
indicated by the physician. If not specified, the period may not exceed sixty
(60) days;
D. The licensed nurse
shall communicate as indicated with the participant's physician to report
observed changes in health status, including reaction to medications and
treatments. If an adverse reaction to medications, treatments or diet is
observed, the licensed nurse shall promptly notify the participant's physician.
If contact cannot be made with the personal physician, emergency medical
procedures shall be followed; and
E. All medications, including
over-the-counter medications, shall be packaged and labeled in accordance with
applicable professional pharmacy standards, state and federal drug laws and
regulations. Labeling shall include accessory and cautionary instructions as
well as the expiration date, when applicable and the name of the medication as
specified in the physician's order. Over-the-counter medications for individual
participants shall be labeled with at least the participant's name;
and
4. Medication
storage that meets the following requirements:
A. The adult day care provider shall have a
safe, secure, locked place for storing medications or drugs and make them
available to the participant according to the instructions of his or her
personal physician;
B. Controlled
substances shall be locked separately from non-controlled substance
medications;
C. Medications
requiring refrigeration shall be kept refrigerated in a locked room or in a
separate locked refrigerator or in a locked box within the refrigerator or in a
refrigerator in a locked room; and
D. Nonprescription medicines may be retained
in the facility for administration as ordered by the participant's
physician.
5. Medication
records that meet the following requirements:
A. A written record of medications, including
over-the-counter medications, administered shall be maintained;
B. Records shall be kept of the receipt and
disposition of all controlled substances, separate from other records for two
(2) years;
C. Inventories of
controlled substances shall be reconciled at the time of the medication system
review and as needed to ensure accountability;
D. Receipt records of controlled substances
shall include the date, source of supply, resident name, prescription number,
medication name and strength, quantity and signatures of the supplier and the
receiver;
E. Administration records
of controlled substances shall include the date, time, resident name,
medication name, dose administered and signature of the person
administering;
F. Documentation of
waste of controlled substances at the time of administration shall include the
reason for the waste and the signature of an authorized employee witness;
and
G. All variances of controlled
substance records shall be documented and reported to the director for review
and investigation. All losses of controlled substances shall be reported to the
appropriate authorities.
(9) Each participant of the adult day care
program shall be assured of the following rights:
(A) To be treated as an adult, with respect
and dignity regardless of race, color, sex or creed;
(B) To participate in a program of services
and activities which promote positive attitudes regarding one's usefulness and
capabilities;
(C) To participate in
a program of services designed to encourage learning, growth and awareness of
constructive ways to develop one's interests and talents;
(D) To maintain one's independence to the
extent that conditions and circumstances permit, and to be involved in a
program of services designed to promote personal independence;
(E) To be encouraged to attain
self-determination within the adult day care setting, including the opportunity
to participate in developing one's plan for services;
(F) To decide whether or not to participate
in any given activity and to be involved in the extent possible in program
planning and operation;
(G) To be
cared for in an atmosphere of sincere interest and concern in which needed
support and services are provided;
(H) To have access to a telephone to make or
receive calls, unless necessary restrictions are indicated in the individual's
care plan;
(I) To have privacy and
confidentiality;
(J) To be free of
mental or physical abuse;
(K) To be
free to choose whether or not to perform services for the program;
(L) To be free of restraint, unless under
physician's order as indicated in the individual's care plan; and
(M) To be free of interference, coercion,
discrimination or reprisal.
(10) Participants and their families shall be
advised of participants' rights and program policies upon admission to the
adult day care program.
(11)
Participants' rights shall be posted in a conspicuous location in the adult day
care facility.
(12) The adult day
care provider shall have a written program description, copies of which are
available to the division, participants, families and other interested agencies
and individuals. The written program description shall contain at least the
following:
(A) Administrative organization,
including role of the advisory committee if applicable;
(B) Maximum number of participants that can
be served;
(C) Types of
participants that shall and shall not be admitted;
(D) Days of the week and hours of
operation;
(E) Services available
to participants and families;
(F)
Procedures and requirements for admission;
(G) Emergency arrangements for
participants;
(H) Criteria and
procedure for discontinuing service to a participant;
(I) Participant and family procedures for
resolving grievances;
(J)
Confidentiality of participant information and records; and
(K) A copy of the Alzheimer's SCS form (MO
FORM 886-3548) (if applicable) available at http://www.oa.state.mo.us/gs/form/
fm_indiv.htm
*Original authority: 660.050, RSMo 1984, amended 1988,
1992, 1993, 1994, 1995, 2001 and 660.418, RSMo 1984, amended 1993,
1994.
