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

08/26/2005

Overview

Adult day care centers that are funded by the Office of Services to the Aging (OSA) are not licensed. The OSA provides Operating Standards for Service Programs to be followed by providers of services to older persons in Michigan. Services may be provided only under an approved area plan through a formal contractual agreement between the area agency on aging and service provider agency.

The state identifies two types of adult day community services: adult day care and dementia adult day care. There are additional standards for dementia adult day care. Adult day health services are a Medicaid-funded service through the Program of All Inclusive Care for the Elderly (PACE) and the MI-Choice Home and Community-Based Waiver program. Medicaid providers under these two programs are required to follow the OSA standards included in their contracting requirements in addition to federal and state waiver program requirements.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☐ 
Both Required  ☐ 
Other  ☒  operating standards for service programs

Definitions

Adult day care is daytime care for any part of a day but less than 24 hours, for functionally impaired elderly persons and is provided through a structured program of social and rehabilitative and/or maintenance services in a supportive group setting other than the client's home.

Dementia adult day care is daytime care for any part of the day but less than 24 hours, for older persons with dementia, and is provided through a structured program of social and rehabilitative and/or maintenance services in a supportive or group setting other than the client's home.

Parameters for Who Can Be Served

The programs that fund adult day care services have eligibility criteria for these programs that indicate the parameters for who can be served. Participants must be 60 years of age and older unless otherwise allowed under eligibility criteria for a specific program.

Adult day care. Providers may serve participants who:

  • Require regular supervision in order to live in their own homes or the home of a relative.
  • Require assistance with activities of daily living (ADL).
  • Are capable of leaving their residence, with assistance, to receive service.
  • Need intervention in the form of enrichment and opportunities for social activities in order to prevent and/or postpone deterioration that would likely lead to institutionalization.

Dementia adult day care. Providers may serve individuals who:

  • Have a diagnosis of Alzheimer's disease or other type of dementia.
  • Have significant impairments in cognition, communication, and personal care ADL.
  • Are responsive to redirection and other supportive verbal interventions when angry, anxious, lost, or upset.

Providers may not serve individuals who have an acute medical illness, a communicable respiratory disease, or hepatitis.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Programs that receive federal and state funding through OSA are monitored at least one time per year by the area agencies on aging to assure compliance with OSA's minimum operating standards. PACE and MI-Choice Home and Community-Based Waiver programs are monitored per federal and state requirements.

Required and Optional Services

  Adult Day Care Dementia Adult Day Care
Required Optional Required Optional
Case coordination and recreation are also required services. Dental, medical support (e.g., x-rays and laboratory services), podiatric, and opthamological services are additional optional services.
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

Pharmaceutical services may be provided under order from a physician by licensed professionals. Participants can be assisted in taking either prescriptions or nonprescription medications.

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. Each adult day care program shall employ a full-time program director with a minimum of a bachelor's degree in a health or human services field or be a qualified health professional. Health support services may be provided only under the supervision of a registered nurse.

Staffing ratios. The program shall continually provide support staff at a ratio of no less than one staff person for each ten participants.

Dementia Adult Day Care

Type of staff. Each dementia respite program shall have a coordinator who possesses both formal education and prior work experience commensurate with the responsibilities of program development and operation; supervision and training of staff; interagency relations; and coordination and maintenance of all appropriate administrative, program and client records. All program personnel shall be knowledgeable about Alzheimer's disease and other dementias and demonstrate the ability to communicate effectively with people who have dementia. The program shall arrange to useprogram consultants such as medical and mental health professionals, environmental specialists, and other therapists as necessary.

Staffing ratios. Dementia adult day care programs shall have a minimum staff/volunteer/student-to-participant ratio of one-to-three. At least one staff shall be on site at all times when participants are in attendance.

Training Requirements

General. Service program staff are to participate in relevant OSA or area agency-sponsored or -approved in-service training workshops, as appropriate and feasible. New program staff must receive an orientation training which includes, at a minimum, introduction to the program, the aging network maintenance of records and files (as appropriate), the aging process, ethics, and emergency procedures.

Adult day care. Program staff shall be provided with an orientation training that includes at a minimum introduction to the program, assessment/observation skills, maintaining records and files, basic first-aid, aging process, and emergency procedures. At least twice each year program staff shall be provided in-service training specifically designed to increase their knowledge and understanding of the program and clients and to improve their skills at tasks performed in the provision of service.

Dementia adult day care. All programs shall have a formal staff development program. Dementia adult day care program staff shall be trained in crisis procedures. Inexperienced personnel shall complete dementia care training prior to being scheduled to work with clients. All staff shall complete an initial training program that includes content in areas including normal aging vs. Alzheimer's disease and related conditions, impact of Alzheimer's disease and other dementias on the person with dementia and family caregivers, and communication enhancement techniques. All personnel shall attend, at a minimum, two in-service training programs per year after completing the initial training program above. All programs shall have specific training for volunteers and students in the areas including communication enhancement techniques, assessment, and management of difficult behaviors, and physical care techniques related to ADL.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

As stated in the overview, adult day and dementia adult day services (called "adult day health services" in Medicaid contracting language) are Medicaid-funded services through PACE and the MI-Choice Home and Community Based Waiver program. Medicaid providers under these two programs are required to follow the OSA standards included in the contracting requirements in addition to federal and state waiver program requirements. PACE contracting requirements addressing staffing ratios and emergency situations are taken from OSA standards.

The MI-Choice waiver contractual requirements for adult day health services adopt many elements from the OSA standards (e.g., admission criteria). Under the waiver, adult day health services are furnished 4 or more hours per day on a regularly scheduled basis, for 1 or more days per week, in an outpatient setting, encompassing both health and social services needed to ensure the optimal functioning of the individual.

Location of Licensing, Certification, or Other Requirements

  1. http://www.miseniors.net/NR/rdonlyres/1B67EFED-7DC7-4EFE-99AE-E7E43B8618D2/214/standards2004.pdf

Citations

  1. Operating Standards for Service Programs (General Requirements for all Service Programs (II-K), Community Services-Adult Day Care (III-C C-1), and Community Services-Dementia Adult Day Care (III-C C-2). Michigan Office of Services to the Aging. April 1999.
  2. Operating Standards for the MI Choice Waiver Program (Section III). Michigan Department of Community Health. Last Revised 08/25/2004. [Hard copy only]
  3. Operating Standards for PACE Program (Section D.1.). Michigan Department of Community Health. [Hard copy only]

Additional Information

Specific program requirements for dementia adult day care. The program shall demonstrate evidence of:

  1. outreach services to nonenrolled families through home visits, follow-up phone calls, and dissemination of printed materials that clearly describe services provided by the program;
  2. provision of opportunities for caregivers to discuss concerns, feelings, physical care and stress management techniques via case consultation, care conferences, or supportive counseling; and
  3. provision of caregiver information and education about dementia or assistance for caregivers in obtaining it through referral to local self-help organizations or dementia resource libraries.

The program shall also have clear provisions for ensuring the availability of crisis response services for persons with dementia and their families.

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