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

08/26/2005

Overview

There are no licensure requirements in the State of Alaska for adult day services. There is no oversight for adult day service programs that serve only private pay clients.

All provider agencies that provide adult day services using Division of Senior and Disabilities Services (DSDS) grant funds or under a Medicaid Waiver must be certified as a Medicaid provider and meet the minimum standards as stated in Adult Day Services Standards, which the Alaska Commission on Aging adopted on February 20, 2003. Provider requirements and program standards are in the Home and Community-Based Waiver Services Certification Application Packet and in the chapter on Medical Assistance in the Alaska Administrative Code.

Adult day services are provided under a number of Medicaid Home and Community-Based Services (HCBS) Waivers, including Adults with Physical Disabilities and Older Alaskans.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐
Certification Only  ☒
Both Required  ☐
Other  ☐

Definitions

Adult day services are defined as the provision of an organized program of services during the day in a community group setting for the purpose of supporting an adult's personal independence and promoting his or her social, physical, and emotional well-being. Adult day services provide a variety of program activities designed to meet the individual needs and interests of the participants, and referral to and assistance in using appropriate community resources. Adult day services help clients remain in their communities and allows families and other caregivers to continue caring for them at home. The program must operate for a minimum of 5 hours each day.

Parameters for Who Can Be Served

Individuals may not be served whose medical conditions are beyond the professional expertise of the staff, who are bedfast or too weak to attend on a regular basis, who are actively infected with a communicable disease, who have emotional or behavioral disorders that include a pattern of disruptive behaviors that pose a danger to others, who make abusive use of alcohol and/or drugs, or who are too independent to benefit from adult day activities. Eligibility varies by funding source, and depending on the program, providers may serve individuals age 55 or older or age 60 or older, or persons of any age who have Alzheimer's disease or other dementia. Each adult day center must define the target population(s) it intends to serve.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☐
No  ☒

The rules specify only internal monitoring. Each adult day care program shall conduct an internal evaluation, at least annually, of its operation and services. The evaluation shall include: (1) the involvement of the governing body (if incorporated), advisory board, program director, staff, consumers, families/caregivers, and other relevant agencies, organizations, or businesses; (2) review of the extent to which the program assisted participants and their families and caregivers; (3) measurement of the achievement of goals and objectives; (4) outcome measures as designed by the agency (may include client satisfaction and/or caregiver surveys); (5) assessment of the cost-effectiveness of the program; (6) assessment of the relationship of the program to the rest of the community service network; and (7) recommendations for improvement, corrective action of problem areas, and future program directions.

Site visit inspections are required for programs receiving state grant funds (personal communication from state reviewer).

Required and Optional Services

  Adult Day Services
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

The program shall have a policy on medications, specifying that participants who are able to keep their medicines shall keep them safely and that the program will keep medicines of participants who are unable to be responsible for their own. Under no circumstances shall staff administer a participant's medications, unless the staff person is a licensed or certified professional whose scope of practice includes the ability to administer medications, such as an registered nurse (RN).

Participants shall bring and take their own medications. Staff may supervise participants' self-administration of medications by: (1) reminding residents to take medication, (2) opening bottle caps for participants, (3) opening prepackaged medication for participants, (4) reading the medication labels to residents, (5) observing participants while they take medication, (6) checking the self-administered dosage against the label of the container, (7) reassuring participants that they have obtained and are taking the dosage as prescribed, and (8) directing or guiding the hand of a legally competent participant who is administering his or her own medications.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. The program director has full authority and responsibility to plan, staff, direct, and implement the program and manage the center's day-to-day operations. In the absence of the director, a staff member shall be designated to supervise the program.

The program shall have as a staffing goal to have a registered nurse or a licensed practical nurse on staff or as a consultant. Person(s) responsible for the client assessment, development of a care plan, client monitoring, reassessment, and discharge plan must be a nurse, social worker, mental health professional, a certified care coordinator, or someone with similar or relevant experience.

Substitute or volunteer staff may be used to provide care in the absence of regular staff. The required staff to participant ratio shall be maintained. Two staff, one of which may be a volunteer, must be present at all times during operation of the program. Cardiopulmonary resuscitation (CPR)/first aid certification shall be required of at least one staff on duty at all time.

Staffing ratios. Adult day services providers shall meet a staff-to-participant ratio of a minimum of one-to-eight. Volunteers may be used and included in the staff-to-participant ratio only when they conform to the same standards as paid staff. Programs that serve a higher percentage of participants with dementia shall have a higher ratio of staff to participants of approximately one-to-four. Only staff involved in direct service to participants can be used in determining the adequate staff-to-participant ratio.

Training Requirements

The ADS agency shall provide an orientation to employees that transmit the agency values, philosophy, and mission and shall inform staff of all laws, policies, procedures, and individual reporting responsibilities regarding client abuse, neglect, and mistreatment, prior to actual service delivery. All paid and volunteer staff shall be provided general orientation to the facility (location, staff, activities, etc.), information on fire and safety measures/codes, an overview of participants and activities, and information on other staff training opportunities. All staff and volunteers who have contact with and responsibility for special populations should receive specific training in serving that population. The agency shall periodically assess the need for specific staff training programs and shall comply with all mandatory personnel licensure and training schedules.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Adult day services means health, social, and related support services, which are provided to adults with physical disabilities and older adults in a protective setting, other than a nursing facility, during any part of a day, but less than 24 hours per day. Recipients attend services on a planned basis during specified hours.

Admission. Adults over 18 years of age with disabilities and service needs similar to older Alaskans who are at risk of institutional placement, but who do not experience a developmental disability. Such persons must have service needs that are compatible with current adult day service participants so that the provision of care is of benefit to other participants and does not diminish services to the primary groups of persons being served.

Staff. Includes an activity coordinator. All employees who provide direct services must maintain current CPR and first aid qualifications.

Location of Licensing, Certification, or Other Requirements

  1. http://www.legis.state.ak.us/cgi-bin/folioisa.dll/aac/query=[group+!277+aac+43!2E1043!27!3A]/doc/{@1}/hits_only.
  2. http://hss.state.ak.us/dsds/dd/pdfs/combinedcertificationpacket2-12-04.pdf.
  3. http://www.hss.state.ak.us/dsds/hcbsforms/AdultDayStandards2003.pdf.

Citations

  1. Adult Day Services (Title 7 Health and Social Services--Part 3 Public Assistance and Medical Assistance, Chapter 43 Medical Assistance, Article 28 Home and Community-Based Waiver Services Program, Rule 43.1043). Alaska Administrative Code. [Effective 5/15/05]
  2. Home and Community-Based Waiver Services Certification Application Packet, Division of Senior and Disabilities Services. [Effective 2/12/04]
  3. Adult Day Services Standards, Division of Senior and Disabilities Services. [Effective 7/1/03]

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