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

08/26/2005

Overview

The District of Columbia (DC) provides adult day care, also called geriatric day care, through District of Columbia Office on Aging grants issued under the District of Columbia State Plan on Aging to providers who are governed by geriatric day care requirements issued and administered by the Office on Aging. These requirements are cited in this profile.

The District of Columbia also provides adult Medicaid day treatment through the District of Columbia Department of Health Medical Assistance Administration (MAA) Elderly Waiver, using Medicaid providers certified by the Office of Disability and Aging under MAA regulations Chapter 7,Medicaid Day Treatment Programs, of the DC Municipal Regulations for Public Welfare. Those regulations are cited in the Medicaid Contracting Requirements section of this profile.

The District of Columbia does not license or certify social model adult day care providers.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☒  Medicaid day treatment providers must be certified to provide these services
Both Required  ☐ 
Other  ☒  adult day care providers must follow Office on Aging contracting requirements

Definitions

Geriatric day care is a therapeutic service provided to functionally impaired DC residents 60 years of age and older to avoid or forestall institutionalization. Geriatric day care involves care and supervision provided during the day by professionally qualified personnel in a suitable facility. Geriatric day care is a more intense level of care than center-based social and recreation services.

Parameters for Who Can Be Served

Provisions for the receipt of geriatric day care funded by the DC Office on Aging set the parameters for who can be served: functionally impaired individuals 60 years of age or older who may be at risk for institutionalization if they do not receive geriatric day care services, are able to maintain themselves with some assistance (i.e., are usually able to attend to toilet and feeding without assistance), are not bedfast, and represent no threat to themselves or others.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☐ 
No  ☒ 

None identified.

Required and Optional Services

  Geriatric Day Care
Required* Optional
* As necessary or as required by the enrollee's plan of care.
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

Nursing services such as injections and drug supervision shall be provided only by a qualified and licensed professional.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. None identified.

Staffing ratios. None identified.

Training Requirements

All staff providing service must be fully trained. The agency must maintain, follow, and continually update a training and supervision program to make sure day care staff are fully trained and familiar with agency procedures.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

The District of Columbia provides adult Medicaid day treatment through the DC Department of Health Medical Assistance Administration Elderly Waiver, using Medicaid providers certified by the Office of Disability and Aging under MAA regulations Chapter 7, Medicaid Day Treatment Programs, of the DC Municipal Regulations for Public Welfare.

Definitions. Day treatment program--a nonresidential program operated for the purpose of providing medically supervised day treatment services for elderly persons, children from birth through age three, adults with a developmental disability, and adults with mental disorders.

Discharge criteria. The participant shall be discharged from the day treatment program under one of the following conditions: if the participant demonstrates improvement sufficient to enable him or her to live more independently, if the participant requires institutional care due to illness, if the participant develops extreme behavior problems that require referral to a more appropriate environment for assistance before returning to the program, if the participant wishes to discontinue participation in the program, or if the participant's needs can be better met in another type of program. The provider will provide a discharge or referral summary with goals and recommendations for continuing care and appropriate referrals.

Inspections. None identified.

Required services. ADL assistance, health education and counseling, health monitoring, medication administration, nursing, skilled nursing, and social services.

Optional services. Physical, occupational, and speech therapy.

Services not required or optional. Transportation.

Medications. Medications shall not be administered without a written order signed by a physician. Injectable medications shall be given by a registered nurse, physician, or licensed practical nurse. The individual responsible for medicating participants who are not capable of self-medicating shall personally prepare the dosage and observe the act of swallowing oral medicines.

Groups with special needs. The program serving the population of persons with mental retardation/developmental disabilities shall also provide restorative, habilitation, or maintenance therapy services.

Staffing type. There shall be a minimum of two full-time professional staff members, one of whom shall be a social worker. The provider shall appoint one full-time professional staff member as the program director. The provider shall appoint one professional staff member as assistant program director to act in the absence of the program director. The provider shall appoint a registered nurse to be on the site daily for a minimum of 4 hours. A physician shall be available. The provider shall appoint an activities coordinator and program aides. If physical, occupational, or speech therapy services are offered, they shall be performed by or under the supervision of a licensed physical, occupational, or speech therapist. At least one staff member trained in first aid shall be on duty at all times.

Staffing ratios. There shall be a ratio of one full-time staff member involved in providing direct services to participants for each six participants. If there are 18 participants or more, the registered nurse shall be on the site daily for 8 hours. At least 25 percent of the staff of a day treatment program primarily serving mentally retarded adults shall be comprised of individuals certified as qualified mental retardation professionals.

Training. The program director shall provide for staff orientation and ongoing in-service training.

Under the Medicaid regulations, if a program is located outside the District and certified for participation in the Medicaid program of the state in which it is located, the Department may accept that state's certification as adequate for the provider's participation in the DC Medicaid Program.

Location of Licensing, Certification, or Other Requirements

  1. On file at RTI, provided by the DC Office of Aging.
  2. On file at RTI, provided by the DC Department of Health.

Citations

  1. DC Office on Aging. Geriatric Day Care. [Revised 9/2002]
  2. DC Department of Health. Chapter 7. Medicaid Day Treatment Programs. [Undated]

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