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

08/26/2005

Overview

Adult day health care (ADHC) in Louisiana is regulated by the Department of Health and Hospitals (DHH), Bureau of Community Supports and Services (BCSS) under Title 50 of the Louisiana Administrative Code. Providers are licensed to provide service to Medicaid adult day health care waiver clients, to private pay clients, and under private contracts with Health Administrations (e.g., the Veterans Administration).

Adult day care in Louisiana is regulated by minimum licensing standards as published in Title 48 of the Louisiana Administrative Code, administered by the Bureau of Licensing in the Department of Social Services. The regulatory responsibility for adult day care is scheduled to be transferred to the Department of Health and Hospitals (DHH) before the end of 2005.

Louisiana adult day care is a unique system with six distinct types of licensed services providing structured and productive settings for developmentally disabled clients at levels of independence related to their capacities. The system is funded by DHH under the New Opportunities Waiver. Because the focus of this regulatory review is on programs that serve older persons, only limited information about adult day care is included in this profile

Licensure and Certification Requirements

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

Definitions

Adult day care is a group program for persons with developmental disabilities designed to meet the individual needs of functionally impaired adults, which is structured and comprehensive and provides a variety of health, social, vocational, or related services in a protective setting for a portion of a 24-hour day. Several types of adult day care programs are licensed: Sheltered Workshop, Enclave Module, Mobile Work Crew Module, Psychosocial Module, and the Competitive Jobs Module.

Adult day health care programs are designed to meet the individual needs of the functionally impaired elderly and adults by providing a structured and comprehensive variety of health, social, and related support services in a protective setting for a portion of a 24-hour day. The ADHC Waiver covers a 5-hour stay.

An adult day care center is any place that is owned or operated for profit, or not for profit, by a person, society, agency, corporation, institution, or any other group and that serves for a portion of a 24-hour day, 10 or more functionally impaired adults who are not related to the owner or operator of the facility.

Parameters for Who Can Be Served

Few provisions other than the type of services provided indicate the parameters for who may be served in ADHC programs. Services that may be provided indicate that providers may serve individual with extensive activities of daily living (ADL) and nursing needs. Providers may not admit any client whose presence would pose a documented health and safety risk to themselves or other ADHC participants.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

The DHH/BCSS is required to conduct inspections for ADHC Licensing as required by the Department, and for ADHC Waiver continued stay by the Centers for Medicare & Medicaid Services (CMS). The Department also investigates any report of mistreatment of clients (abuse, neglect, and exploitation) and any person, agency, or organization suspected of operating an adult day care facility without a license or provisional license or of operating in violation of the Adult Day Health Care Licensing Minimum Standards, ADHC Waiver Standards for Participation.

Required and Optional Services

  Adult Day Health Care
Required Optional
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

Medication administration and oversight must be provided by licensed nurses (registered nurse [RN] or licensed practical nurse [LPN]).

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. The following staff positions are required. Administration: director/director designee; Health Services Qualified Professionals: RN; Health Services Consultant or Full-time: LPN and direct care staff; Activities and Social Services: MSW consultant and social service designee; Nutrition: dietician consultant and food supervisor; and Operations: housekeeping and transportation.

Staffing ratios. The client to staff ratio shall be one staff per nine clients.

Training Requirements

Where certification or licensing standards exist for professional staff, these individuals shall possess current certifications/licenses and continuing education training.

ADHC providers will furnish orientation and annual training for all employees. Topics for training include but are not limited to ADHC goals, mission, organization, and structure; ADHC program and policy; instruction in the specific responsibilities of the employee's job/job description; the ADHC emergency policy, emergency disaster plan/evacuation plan, and safety procedures including medical emergencies; the detection and reporting of suspected abuse, neglect, and exploitation and the reporting of complaints and critical incidents.

All direct care employees shall have certification in adult cardiopulmonary resuscitation (CPR) and first aid upon hire, maintain documentation of certification and be recertified annually. Direct care staff shall receive additional annual training related to the care of the elderly and adults.

Professional staff will have certification of professional annual training and additional supervisory or management training as required by the ADHC provider.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

  1. Adult day health services are provided under the state Medicaid 1915(c) Adult Day Health Care Waiver.
  2. Adult day care services are provided under the state Medicaid 1915(c) New Opportunities Waiver.

Location of Licensing, Certification, or Other Requirements

  1. http://www.dss.state.la.us/Documents/OS/AdultDayCare.pdf
  2. On file at RTI International, provided by the Department of Health and Hospitals.

Citations

  1. Adult Day Care and Day Health Services Standards for Licensing, Louisiana Administrative Code, Title 48--Chapter 43. [1/20/98]
  2. Adult Day Health Care. Subpart 3 of Home and Community Based Services Waivers. Louisiana Administrative Code, Title 50--Chapter 21. [9/20/2004]

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