Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED
Chapter 4 - DEFINED SERVICES
Section 473-4-002 - ADULT DAY SERVICES

Universal Citation: 473 NE Admin Rules and Regs ch 4 ยง 002

Current through September 17, 2024

This section contains material governing adult day services as follows:

(A) The authorization and provision of adult day services; and

(B) The evaluation of adult day services.

002.01 DAY SERVICES DEFINITIONS. The following definitions apply to adult day services:

002.01(A) ADULT DAY SERVICES, HOME OR CENTER. A program of structured and monitored social, manual, physical, and intellectual services or activities provided for a minimum of three hours per day. These services are provided in a supervised setting in either a day services home or a center outside a recipient's own home. Adult day services is directed toward adults who do not require 24 hour institutional care and yet, because of physical or mental impairment or social isolation, require services in a group setting.
002.01(A)(i) ADULT DAY SERVICES CENTER. A facility meeting established standards that provides supervision and activities for four or more adults away from the recipient's home.

002.02(A)(ii) ADULT DAY SERVICES HOME. A facility meeting established standards that provides supervision and activities for fewer than four adults away from the recipient's home.

002.01(B) IN-HOME ADULT DAY SERVICES. Supervision or services provided in an individual's home that enables the recipient's caretaker who also lives in the home, to participate in employment or training. The services may include part-time chore and homemaker activities.

002.02 INDIVIDUALS SERVED. Adult day services are authorized only for those individuals who are 19 or older who are:

(A) Current Supplemental Security Income or State Supplemental recipients; or

(B) Low income aged or disabled persons.

002.03 NEED. Eligible recipients must need adult day services to increase or maintain social and emotional wellbeing through opportunities for intellectual, physical, manual, and social activities.

002.03(A) GOALS. Adult day services are necessary for the applicant or recipient to:
(i) Avoid unnecessary institutionalization or to delay institutionalization;

(ii) Facilitate community readjustment after institutionalization;

(iii) Improve level of functioning;

(iv) Alleviate deteriorating effects of isolation and self-neglect; or

(v) Aid in the transition from one living arrangement to another, such as a more independent living arrangement.

002.03(B) RELEVANT FACTORS. The Department considers the following when determining the recipient's need for adult day services:
(i) The individual's residential situation in terms of support available through a group or family setting;

(ii) What the individual has previously done with the their time that adult day services are now being considered, or what other service arrangements existed;

(iii) What other supportive community resources are available to the individual which may not make the provision of adult day services an urgent need; and

(iv) The individual's employment or training status. If the individual is employed or in a vocational or training program for part of the day, the need for adult day services would be questionable as the individual would already be on the path toward goal achievement.

002.03(C) IN-HOME DAYCARE NEED. In assessing the need for in-home day care, the applicant or recipient must demonstrate:
(i) The individual cannot remain alone. Documentation may be requested from the individual's medical provider for verification;

(ii) The individual's usual caretaker will be participating in employment or training;

(iii) The service required is of a non-medical supervisory nature; and

(iv) No other resources, including volunteers or community resources, are available to meet the individual's needs.

002.04 LIMITS FOR ADULT PROTECTIVE SERVICES INDIVIDUALS WITHOUT REGARD TO INCOME. Based upon the service needs assessment process, the Department may authorize adult day service for recipients eligible without regard to income for a maximum of 31 days in situations of abuse or neglect for an individual age 18 or older.

002.05 MAXIMUM RATES AND ALLOWABLE UNITS. The following criteria applies to authorization standards for adult day services:

002.05(A) RATES. The statewide rate is established utilizing the total federal funding appropriation to Nebraska for adult day care services and the total state funding for adult day care services divided by the projected total of the adult day care service days provided on an annual basis. The projected number of days to be provided is derived from the Department's historical data. Periodic increases or decreases may be made to the adult day care service rate in a percentage amount corresponding with legislative appropriations or budget directives from the Nebraska Legislature which result in general Medicaid service provider increases or decreases.

002.05(B) FREQUENCY. The frequency of services is by the hour or by the day. A day is defined as six or more hours per day.

002.05(C) MAXIMUM ALLOWABLE UNITS. Adult day services shall be authorized up to five days per week for the first six months. After the initial six months, adult day services may be authorized up to three days per week. If the recipient needs more days, an exception request must be submitted to the Department. A statement from the recipient's mental health provider or guardian, will be required.

002.06 ADULT DAY SERVICE PROVIDER STANDARDS. The following standards are applicable to adult day service providers:

002.06(A) PROVIDER SKILLS. Personnel who provide adult day services are required to be trained, or have home or work experience in performing day service duties. Personnel must:
(i) Practice courtesy, patience, and understanding with recipients;

(ii) Be sensitive to the special needs of elderly and disabled recipients for personal attention and assistance; and

(iii) Be able to recognize distress or signs of illness in recipients.

002.06(B) PROVIDER KNOWLEDGE. Personnel who provide adult day services must have practical knowledge of:
(i) Basic first aid procedures and available emergency medical resources;

(ii) Procedures to follow in case of a recipient's sudden illness or an accident;

(iii) Reasonable safety precautions to exercise when dealing with recipients and their property ;

(iv) Each recipient's address, telephone number, and means of transportation; and

(v) Procedures to follow when problems and grievances need to be discussed.

002.06(C) PROVIDER HEALTH. All personnel of adult day service facilities must be:
(i) Physically capable of completing assignments; and

(ii) Free of communicable disease and willing to provide a physician's verifying statement, requested by the Department

002.07 PROGRAM STANDARDS FOR CENTERS. Providers offering adult day service centers to program recipients must meet the following standards:

002.07(A) ACTIVITY GUIDELINES. Adult day services center staff will ensure:
(1) Activities are available to all recipients;

(2) Each recipient is encouraged to participate, but free to decline;

(3) The program is geared to the recipient's abilities and interests;

(4) The program provides intellectual and physical stimulation while preserving the dignity of the recipient; and

(5) The program meets the financial responsibility for any activities or field trips available as part of the Adult Day Care Services Program.
002.07(A)(i) ACTIVITY TYPES. Adult day services center staff will offer the following activities:
(1) Intellectual activities for exploring subjects of interest to the recipient population;

(2) Manual activities such as hobbies and home arts and crafts;

(3) Physical activities which stress physical fitness, either individually or as group programs; and

(4) Social activities involving groups. Adult day care services staff must be present with recipients at all times during the provision of any adult day service activity.

002.06(A)(ii) ACTIVITY EQUIPMENT. Adult day services center staff will provide:
(1) Furniture, equipment, supplies, and materials for recipient's use;

(2) Magazines, books, games, and recreational materials for recipient's use; and

(3) Quiet areas for reading and resting.

002.07(B) MEALS. If the recipient is in the facility more than four hours per day and the adult day services program provides a meal, the meal must include one third of an adult's daily nutritional requirement. If the program does not provide a meal and requires recipients to bring their own food, a meal cost must be deducted from the program's daily rate of Title XX reimbursement.

002.07(C) FACILITIES. Adult day services center staff and facilities must:
(i) Comply with fire prevention regulations, health and sanitation regulations, and zoning codes and regulations;

(ii) Maintain lavatory and toilet facilities that are available, accessible, and in working order;

(iii) Have adequate space, proper ventilation, and means of adequate temperature control for the number of individuals served;

(iv) Maintain facilities which are safe and free from hazards and barriers; and

(v) Contact the Department if:
(1) The adult day services program is to be provided in a facility licensed by the Department; or

(2) The program intends to provide medical services.

002.07(D) RECORDS MAINTENANCE. Adult day services staff are required to maintain the following records:
(i) Recipient's charts documenting individualized adult day services goals, activities in which the recipient participates, and all individual problem areas and the progress made through service provision. Progress notes should be recorded at least every three months;

(ii) Recipients' physicians, pertinent medical information and phone numbers of emergency contacts;

(iii) Signed consents for release of information about recipients and

(iv) Recipient attendance, services received, and method of payment;

(v) Program costs; and

(vi) Program admissions and program discharges.

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