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

08/26/2005

Overview

Providers of adult day care and day health services must meet certification standards. The Division of Aging and Adult Services in the Department of Health and Human Services oversees the standards, which are based on North Carolina Administrative Code. These standards are summarized in this profile.

Adult day health programs and programs that provide adult day health in combination with adult day care must meet applicable state standards to be eligible for Medicaid reimbursement funds. There are no additional Medicaid provider requirements beyond the certification standards.

Licensure and Certification Requirements

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

Definitions

Adult day care means the provision of group care and supervision in a place other than their usual place of abode on a less than 24-hour basis to adults who may be physically or mentally disabled.

Adult day health services is 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. Services must include health care services as defined in state standards and 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.

Services must be provided in a home or a center certified to meet state standards for such programs. Adult day care homes can operate a day care program for 2-6 people in a single family dwelling. Adult day care centers can operate a day care program in a structure other than a single family dwelling.

Adult day health centers and adult day health homes can operate day health programs in a structure other than a family dwelling, but day health programs for 2-5 persons can operate in a single family dwelling. Adult day health combination programs can operate both adult day care and adult day health in one program. A minimum of 25 percent of the participants in daily attendance in a combination program must be enrolled for adult day care services.

Special care services are services by a certified adult day care center that promotes itself as providing programming, activities, or care specifically designed for persons with Alzheimer's disease or other dementias; mental health disabilities; or other special needs, diseases, or conditions as determined by the Medical Care Commission.

Parameters for Who Can Be Served

General. Providers must have specific enrollment policies to guard against enrolling people whose needs cannot realistically be met by the planned activities. The policies should also provide for dismissal of participants whose needs can no longer be met or who can no longer be cared for safely. Providers may serve both semiambulatory and nonambulatory persons.

Adult day health programs have additional requirements. Day health programs shall not enroll or continue to serve persons whose needs exceed the capability of the program. Providers may serve individuals who are 18 years of age or older who need day health services in order to support their independence and who require: (1) monitoring of a medical condition, (2) provision of assistance with or supervision of activities of daily living (ADL), and (3) administration of medication, special feedings, or provision of other treatment or services related to health care needs.

A participant transferring from standard day care services to special care services must meet the criteria for the special care service.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Adult day care and adult day health care programs shall be inspected annually and monitored at least monthly to assure compliance with standards. The certificate will be in effect for 12 months from the date of issuance unless it is revoked for cause, voluntarily or involuntarily terminated, or changed to provisional certification status. Following review of the certification application, a precertification visit may be made by staff of the state Division of Aging and Adult Services.

Required and Optional Services

  Adult Day Care Adult Day Health Care
Required Optional Required Optional
Adult day care requires five types of activities to be provided on a daily basis: diversional, educational, social, volunteer service, and program assistance.
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

Participants may keep and administer their own medicines while attending the day care program. If a participant is determined to be unable to be responsible for his or her medication, it shall be kept for him or her during the time the participant is present at the program and given at the prescribed time and dosage by the health care coordinator.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☒ 
Mental Retardation/Developmental Disabilities  ☐ 
Other  ☒  mental health disabilities, or other special needs, diseases, or conditions

Staffing Requirements

Type of staff. Adult day care and adult day health centers must have a full-time director. Adult day health centers must have a health care coordinator (a registered nurse (RN) or a licensed practical nurse (LPN) currently licensed to practice in North Carolina). If the health care coordinator is an LPN, supervision must be provided by an RN consistent with the Nursing Practices Act and on-site supervision by the RN must occur no less frequently than every 2 weeks. In adult day health centers with ten or fewer participants, the director may also serve as the health care coordinator. Adult day care homes must have an operator.

Staffing ratios. The staffing pattern shall be dependent upon the enrollment criteria and the particular needs of the participants who are to be served. The ratio of paid staff to participants shall be adequate to meet the goals and objectives of the program. The minimum ratios shall be as follows:

  • Adult day care homes--One paid staff person for up to six participants.
  • Adult day care centers--One paid staff person for each eight participants.
  • Adult day health centers and adult day health homes--One paid full-time equivalent staff person with responsibility for direct participant care for each five participants.
  • Adult day health combination--One paid full-time equivalent staff person with responsibility for direct participant care for each six participants.
  • Special care services--Adult day care program must disclose in writing procedures that address staff to participant ratios in the special care service to meet the needs of participants.

Training Requirements

Special care services. An adult day care program providing special care services shall assure that special care services staff document receipt of training specific to the population(s) to be served; have a written plan for training staff that identifies content, sources, evaluations and schedules of training; assure that within 1 month of employment each staff person assigned to special care services shall demonstrate knowledge of the needs, interests, and levels of abilities of the participants; and assure that within 6 months of employment, each staff person assigned to special care service shall complete three training experiences including but not limited to population-specific techniques for communication, behaviors, and ADL.

An adult day care program must disclose in writing procedures that address the amount and content areas of staff training both at orientation and annually based on the special care needs of the participants.

An adult day care program providing special care services shall assure that special care services staff receive at least the following orientation and training: (1) the program director shall assure that within a month of employment, each staff person assigned to special care services shall demonstrate knowledge of the needs, interests, and levels of abilities of the participants; (2) within 6 months of employment, each staff person assigned to special care service shall complete three training experiences including but not limited to, population-specific techniques for communication, behaviors, and ADL; and (3) each staff person working directly with participants in special care service shall complete a minimum of two population-specific educational experiences annually.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Adult day health programs and programs that provide adult day health in combination with adult day care must be certified as meeting these standards in order to be eligible to receive Medicaid funds. The certification process is described in Section VI of the Adult Day Care and Day Health Services Standards for Certification.

Location of Licensing, Certification, or Other Requirements

  1. http://www.dhhs.state.nc.us/aging/adcdhstd.pdf

Citations

  1. Adult Day Care and Day Health Services Standards for Certification 10A NCAC 06R .0101 and 06S .0101 (previously 10 NCAC 42E .0704 and 42Z .0501). North Carolina Department of Health and Human Services, Division of Aging and Adult Services. [September 2003]

Additional Information

The certification standards include additional requirements for both adult day health care programs and adult day care programs who market themselves as providing special care services.

Special care services. An adult day care program that provides or that advertises, markets, or otherwise promotes itself as providing special care services for persons with Alzheimer's disease or other dementias, a mental health disability, or other special needs, disease, or condition shall provide written disclosures to the Department and to persons seeking adult day care program special care services. The disclosure must address the process and criteria for enrollment in and discharge from special care services.

Only programs that meet these requirements may advertise or represent themselves as providing special care services. However, an adult day care program that does not advertise, market, or otherwise promote itself as providing special care services for persons with Alzheimer's disease or other dementias, is not prohibited from providing adult day care services to persons with Alzheimer's disease or other dementias, a mental health disability, or other special needs disease or condition.

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