Regulatory Review of Adult Day Services: Final Report - Section 2. Alabama

08/26/2005

Overview

Alabama provides adult day care (ADC) as a function of Adult Protective Services, under the Department of Human Resources, under Adult Day Care Requirements from the Office of Social Service Contracts.

Alabama provides adult day health care (ADHC) as a service of the Elderly and Disabled Waiver. The State Medicaid Agency requires waiver service providers to have specific approval to offer adult day health care under the waiver, with staffing qualifications and required services outlined in the Elderly and Disabled 1915(c) Waiver document and the regularly updated Provider Manual.

The profile contains requirements for both adult day care and adult day health care.

Alabama also provides adult day health care as a respite service through the Department of Senior Services Caregiver Support Program, Alabama CARES (Caregiver Assistance with Resources, Education, and Support). This Older American Act-funded service is implemented by Area Agencies on Aging through contracts with waiver providers who agree to the additional Medicaid specifications noted in this profile. These services are monitored by the Alabama Department of Senior Services.

There is no state agency that regulates facilities other than those served by these programs.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only   ☐
Certification Only   ☐
Both Required   ☐
Other   ☒  contracting requirements for both ADC and ADHC

Definitions

Adult day care. The purpose of the adult day care program is to protect an individual, 18 years of age or older at risk of abuse, neglect, or exploitation; to provide services to such an individual at risk of institutionalization; and to provide services to such an individual who is in need of supervision or assistance with activities of daily living outside the home for a portion of a day.

Adult day health care (two types). (1) Adult day health (ADH) is a service that provides waiver clients 18 years of age or older with a variety of health, social, recreational, and support activities in a supervised group for 4 or more hours per day on a regular basis. ADH is based on the needs of the individual client. (2) Adult day health care under the Medicaid Elderly and Disabled waiver provides social and health care for a minimum of 4 hours per day in a community facility approved to provide such care and includes health education, self-care training, therapeutic activities, and health screening. Services are provided Monday through Friday except for regularly scheduled holidays.

Parameters for Who Can Be Served

The eligibility criteria for the publicly funded programs set the parameters for who can be served.

Adult day care. Adults who are 18 years of age or older who are certified as eligible by the appropriate County Department of Human Resources.

Adult day health care. All individuals 18 years of age or older who needs can be met in an outpatient setting, encompassing both health and social services needed to ensure optimal functioning.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒
No  ☐

Adult day care. An annual monitoring is conducted to ensure that providers are in compliance.

Adult day health care. None identified.

Required and Optional Services

  Adult Day Care Adult Day Health Care
Required Optional Required Optional
Activities of Daily Living (ADL) Assistance  ☐  ☐  ☒  ☐
Health Education and Counseling  ☐  ☐  ☐  ☐
Health Monitoring/Health-Related Services  ☒  ☐  ☒  ☐
Medication Administration  ☐  ☐  ☒  ☐
Nursing Services  ☒  ☐  ☒  ☐
Physical Therapy, Occupational Therapy, or Speech Therapy  ☐  ☐  ☒  ☐
Skilled Nursing Services  ☐  ☐  ☒  ☐
Social Services  ☒  ☐  ☒  ☐
Transportation  ☐  ☒  ☒  ☐

Provisions Regarding Medications

Adult day care. Program staff will not administer medications.

Adult day health care. Services include supervising medication and observing for possible reaction and assisting, supervising, or administering medication. Unlicensed staff may not administer medications but can only assist or supervise clients with taking their medications, including reminding a client to take medication. A registered nurse (RN) or licensed practical nurse (LPN) licensed by the Alabama Board of Nursing may administer medications from a container filled by a licensed pharmacist with a pharmacy label indicating physician instructions.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☐
Mental Retardation/Developmental Disabilities  ☐
Other  ☐

Staffing Requirements

Adult Day Care

Type of staff. The director and at least one other staff person must be certified in cardiopulmonary resuscitation (CPR) and first aid. An LPN or RN must be available to provide clients a monthly health screening.

Staffing ratios. At a minimum the provider will maintain one staff member for 1-10 clients, two for 11-25 clients, three for 26-35 clients, four for 36-43 clients, and an additional staff member for each additional eight clients. At least two staff will be in the center when clients are present, and at least one of these must be certified in CPR and first aid. Staff whose primary responsibilities do not require direct involvement with clients will not be counted unless their job descriptions specify time periods when they have responsibility only for working with clients. Volunteers may be counted in the staff ration if they meet the same qualifications as paid staff and are scheduled for the entire period that a paid worker would have worked.

Adult Day Health Care

Type of staff. There shall be a designated person to serve as the center administrator who does not have to be full-time, and a registered or licensed practical nurse must be available 2 hours per week or 8 hours per month for consultation.

Staffing ratios. At a minimum the provider will maintain one staff member for 1-10 clients, two for 11-25 clients, three for 26-35 clients, four for 36-43 clients, and an additional staff member for each additional eight clients. At least two staff will be at the center when clients are present. At least one staff member present must be certified in CPR and trained in first aid. Waiver ADH centers must have at least two staff members with CPR and first aid certification.

Training Requirements

Adult day care. Training will assure that day care staff have sufficient knowledge of the adult process (mental, emotional, and physical) to enable them to meet individual client needs. The program shall provide staff who have no previous experience or training in adult day care an on-site orientation and a designated period of supervised training.

All staff shall regularly (at least quarterly) participate in in-service training or other available training related to adult day care. This shall include training on how to deal with clients with physical, mental, or emotional impairments.

Adult day health care.

  1. The provider will assure that the staff have sufficient knowledge of the adult process (mental, emotional, and physical) to enable them to meet individual client needs. The training program must be approved by the Operating Agency and the Alabama Medicaid Agency.
  2. The provider will assure that staff who have had no previous experience or training working with adults who are elderly and disabled have on-site orientation with a designated period of supervised training. The minimum training requirement must be completed prior to initiation of service with a client. The ADHC center is responsible for providing and/or conducting training.
  3. The provider will assure that all ADH staff have at least 6 hours in-service training annually in the following areas: behavior intervention, acceptance, and accommodation; providing care and supervision including safety and nonmedical care; first aid; documenting client participation; fire and safety measures; confidentiality; client rights; needs of the elderly and disabled population; basic infection control/universal standards; communication skills; and other areas of training as appropriate or as mandated by Medicaid and the operating agencies. Documentation of CEU training required by the Alabama Board of Nursing may be accepted as in-service training for licensed nurses.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Alabama has one 1915(c) Medicaid waiver, the Elderly and Disabled Waiver, which provides adult day health care. Specific regulations for providers of adult day health care under the waiver are described in this profile under the Adult Day Health Care heading.

Location of Licensing, Certification, or Other Requirements

  1. http://www.medicaid.state.al.us/MANUALS/April%202005/provman.pdf.
  2. http://www.medicaid.state.al.us/ABOUT/AdultDayHlthStds.pdf.
  3. http://www.medicaid.state.al.us/ABOUT/E&DwaiverRequest.pdf.
  4. Provided by the State of Alabama Department of Human Resources; on file at RTI.

Citations

  1. Provider Manual, Alabama Medicaid Management Information System. [April 2005]
  2. Alabama Medicaid Adult Day Health Standards Program Narrative. [9/18/03]
  3. Section 1915(c) Waiver Format, Application to CMS for a 1915(c) Elderly and Disabled Waiver. [October, 2002]
  4. Adult Day Care Requirement. Office of Social Service Contracts, Department of Human Resources. [Revised 11/2001]

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