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

08/26/2005

Overview

The Mississippi Department of Human Services, Division of Aging and Adult Services, administers and monitors adult day care centers that wish to enter into an agreement to provide services through the Area Agencies on Aging under Older Americans Act funding under a set of Quality Assurance Standards described in this profile.

The Division of Medicaid provides adult day center services under the Elderly and Disabled Waiver through providers who comply with Division of Medicaid regulations published in the Home and Community Based Services Manual and the Quality Assurance Standards for the waiver.

As of June 2005, the Mississippi legislature is considering certification or licensure requirements.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☐ 
Both Required  ☐ 
Other  ☒  provider agreement with the Division of Medicaid

Definitions

Adult day care is a place for aged and disabled individuals with serious health problems or impairments to go during the day for recreational activities, personal care supervision, nutrition, limited health care, and the opportunity to interact socially with other people in group or individual activities. Its purpose is to: (1) provide care, supervision, and services to individuals who are capable of only limited self-care; (2) meet health maintenance, prevention/intervention, and rehabilitation needs; and (3) promote a maximum level of independent functioning.

Parameters for Who Can Be Served

The definition of adult day care (above) indicates the parameters for who can be served.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Adult day care center providers are monitored on site quarterly by Area Agencies on Aging. The Bureau of Audit and Evaluation, Department of Human Services, monitors the providers annually and usually does not visit the site, although the agency may conduct an on-site evaluation.

Required and Optional Services

  Adult Day Care
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

Registered nurse services for preparing and administering medications shall be provided if needed by the participants.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. There must be a person designated to be responsible for the day-to-day operation of the center. Qualifications are established for the program directorsocial workernurseactivities coordinatorprogram assistant/aidesecretary/bookkeeperdriver, and custodian. Volunteers are permitted to supplement staff in established activities or provide additional services for which the volunteer is qualified.

Staffing ratios. There must be an adequate number of staff to accomplish the purpose of the program.

Training Requirements

All staff must complete first aid, cardiopulmonary resuscitation (CPR), and Heimlich Technique training. A minimum of 8 hours per year in-service training shall be provided, preferably quarterly, appropriate to job function and participant care needs.

All center staff providing direct care and participating in the day-to-day operation of the center must complete the Division's Adult Day Care Certification training within 12 months of hire date.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Mississippi provides adult day center services under the Elderly and Disabled Waiver administered by the Division of Medicaid.

Definitions. Adult day care services are defined as services for an aged and disabled individual, and consist of the provision of services for part of a day at a day care program site. Adult day care is the arrangement of a structured, comprehensive program that provides a variety of health, social, and related supportive services in a protected setting during daytime and early evening hours.

Admission criteria. Each adult day center shall define the target population it intends to serve and shall serve only participants whose needs while at the center do not exceed the center's resources or who would be served more appropriately in a different setting. The target population includes one or more of the following groups: adults with physical, psychosocial, or mental impairments who require assistance and supervision, adults who need functional maintenance therapy in order to restore or maintain an optimum level of functioning, and adults who require services by or under the supervision of an appropriately licensed nurse or other health care professional. Participants who are inappropriate for all adult day service programs include adults who are bedfast or do not have the strength or stamina to attend adult day services for the minimum hours defined in state licensing requirements; adults in an infectious stage of a communicable disease, unless a physician states there is no significant hazard; adults with emotional or behavioral disorders destructive to self or others or disruptive in a group setting, unless the center has the capacity to manage these problems; and adults who are too independent to benefit from the program.

Inspections. Commission on Accreditation of Rehabilitation Facilities accreditation is accepted in lieu of inspection.

Required services. ADL assistance, health monitoring/health related services, medication management, social services, transportation, health education, professional therapy services.

Optional services. Nursing and skilled nursing services.

Medications. Adult day services without full-time registered nurse (RN) services will maintain medication information and provide reminders or prompt the participant to initiate and follow through with self administration of medications brought by the client. If a client is unable to self medicate, an RN will be available to assist as indicated.

Staffing type. A sufficient number of staff with the skills needed to provide essential administrative and service functions is required. The center will have an administrator, and if the administrator is responsible for more than one site or has duties not related to the day services program, aprogram director should be designated to be on site. There shall be a social service staff personactivities coordinatorfood service coordinatordriver, and program assistants. For programs offering nursing services, the nurse shall be an RN.

Staffing ratios. There shall be at least two responsible persons, one a paid staff member, at the center at all times when there are two or more participants in attendance. The staff-to-participant ratio shall be between one-to-six and one-to-ten, except in programs serving a high percentage of severely impaired participants in which case the ratio should be one-to-four, or, in programs serving more than 20 participants, one-to-five. Volunteers can be included in this ratio only if they conform to the same standards as paid staff.

Training. All staff and volunteers who have contact with and responsibility for special populations should receive specific training in serving that population.

All paid and volunteer staff should receive general orientation including but not limited to the purpose and goals of adult day services, roles and responsibilities of other staff members, needs of the target population, depression, medication management, the center's policies and regulations, communication skills, basic terminology, advance directive policies, elder abuse reporting, safely and appropriately assisting participants with ADLs, and risk management.

Ongoing training includes at least four in-service training sessions per year. At the time of employment and annually each employee must receive training in the needs of the participants in the center target population; infection control; the fire, safety, and disaster plan; choking prevention and intervention techniques; body mechanics, transfer techniques, and ADL assistance; mandatory reporting laws for abuse/neglect; basics of nutritional care, food safety, and safe feeding techniques; CPR and first aid; behavioral intervention/acceptance/accommodation; and additional topics as available.

Location of Licensing, Certification, or Other Requirements

  1. http://www.dom.state.ms.us/Provider/Provider_Manuals/hcbs.pdf
  2. On file at RTI, provided via fax by the Division of Aging and Adult Services.
  3. On file at RTI, provides by the Division of Medicaid.

Citations

  1. Mississippi Home and Community Based Services Manual. Office of the Governor, Division of Medicaid. [1996]
  2. Quality Assurance Standards. Adult Day Care. Mississippi Department of Human Services, Division of Aging and Adult Services. [Revised 8/99]
  3. Adult Day Care Quality Assurance Standards. Home and Community-Based Services Elderly and Disabled Waiver. [7/1/2002]

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