Adult day health care facilities in Pennsylvania are licensed under the terms of the Commonwealth Older Adult Daily Living Centers Licensing Act, whose provisions are embodied in the sections of the Pennsylvania Code cited in this profile, which is administered by the Department of Aging. The Department of Public Welfare provides Medicaid-funded services at older adult daily living centers through a waiver program administered by the Department of Aging. It also provides Medicaid-funded adult day health services in a limited geographic area under the Long Term Care Capitated Assistance Program. There are no Medicaid requirements for adult day health care providers other than licensure.
Licensure and Certification Requirements
|Licensure and Certification Requirements|
Older adult daily living center. A premises operated for profit or not for profit in which older adult daily living services are simultaneously provided for part of a 24-hour day for four or more clients who are not relatives of the operator.
Parameters for Who Can Be Served
Providers may serve individuals with functional impairment such as a post-stroke dementia, Parkinson's disease, or dementia-related disease such as Alzheimer's or other organic brain syndrome, who are in need of a structured program of activities or services, as determined by an intake screening process. Participants must be capable of being transported to and from the service site. Specific programs may have different age requirements depending on the funding source, but all participants must be 18 years of age or older.
Individuals may not be admitted or retained if they are bedfast; have a communicable disease; have emotional or behavioral disorders; are habitually addicted to alcohol or drugs and, as a consequence of the addiction, are disruptive in a group setting; or do not need the activities and services provided in the older adult daily living center and need referral to other, more appropriate programs, such as a senior center or nutrition site.
Providers may involuntarily discharge participants for one or more of the following reasons: a client experiences a sudden change in level of functioning that the center determines to be a threat to the client or others, a client is not capable of being transported to the center, a client does not have a functional impairment and is not in need of the structured program of activities or services offered by the center, or a client no longer meets the admission criteria.
Inspection and Monitoring
|Inspection and Monitoring|
At the Department's direction, each center shall complete and submit an annual survey questionnaire describing its programs and the clients it serves.
An authorized agent of the Department will conduct an on-site inspection of a center at least once every 12 months. (While the Department reserves the right to make on-site inspections, it may instead conduct the inspection without an on-site visit.) The center will be advised in advance of the date of the annual inspection. The annual inspection will be an announced inspection and will occur during normal business hours.
The center is subject to announced and unannounced on-site inspections. Unannounced inspections not based on a complaint will occur during normal business hours. Unannounced inspections based on a complaint may, as determined by the Department in accordance with the nature of the complaint, occur at any time.
Required and Optional Services
|Older Adult Daily Living Center|
|Note: Services at older adult daily living centers are required or provided only when and as specified in clients' individual plans of care.|
|Activities of Daily Living (ADL) Assistance||☒||☒|
|Health Education and Counseling||☒||☒|
|Health Monitoring/Health-Related Services||☒||☒|
|Physical Therapy, Occupational Therapy, or Speech Therapy||☒||☒|
|Skilled Nursing Services||☒||☒|
Provisions Regarding Medications
A center shall provide clients with assistance, as needed, with medication prescribed for self-administration. This assistance includes helping the client remember the schedule for taking the medication, storing the medication in a secure place, and making the medication available at the prescribed times. If a client refuses to take a prescribed medication, the refusal shall be promptly reported to the responsible party or practitioner, or both, and documented in the client's record.
To be considered capable of self-administration of medications, a client shall be able to identify the medication, acknowledge the amount of and schedule for medication, remember to take the medication on schedule with infrequent reminders from staff persons, and obtain medication from its container without assistance or with minimal assistance.
Medications and injections of substances that are not self-administered by clients shall be administered by one of the following qualified professionals: a licensed physician, licensed dentist, certified physician's assistant, CRNP, registered nurse (RN), or licensed practical nurse (LPN); a graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the center; or a student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the center.
Oral, topical, and eye and ear drop prescription medications may be administered by center staff persons who have completed the Department of Public Welfare's Medications Administration course and otherwise meet requirements set forth in 55 Pa. Code Chapter 2380 relating to medication administration training (in adult training facilities).
Provisions for Groups with Special Needs
|Provisions for Groups with Special Needs|
|Mental Retardation/Developmental Disabilities||☒|
Type of staff. There shall be one program director/administrator responsible for the center.
The center shall obtain the services of either an RN, currently licensed in this Commonwealth, or an LPN, currently licensed in this Commonwealth. The nurse may be a full-time or part-time staff member or a consultant, or may serve through some other arrangement that meets the needs of clients.
Center staff persons shall include an activities coordinator and a program assistant/aide.
A sufficient number of staff persons shall be trained, certified, and recertified in cardiopulmonary resuscitation and in first aid training so that at least one staff person who is trained, certified, and recertified in cardiopulmonary resuscitation (CPR) and first aid training is present in the center at all times.
Staffing ratios. The program staff-to-client ratio shall be a minimum of one-to-seven at all times.
Providers shall, using center staff persons, outside resources, or both, provide program staff persons with the following:
A general orientation in the following areas, within 3 months of employment: the purpose and goals of older adult daily living services; the roles and responsibilities of staff members; positive approach methods to manage behavior; health and safety precautions, including infection control; information on fire and safety measures/codes; the philosophy of the program and, if applicable, the parent organization; confidentiality; interdisciplinary team approach; client rights; the population served; the center's policies and regulations; communication skills; and the center's emergency procedures.
Training in the following areas, within 3 months of employment and annually thereafter: the needs of the clients in the center's target population; body mechanics/transfer techniques; voluntary reporting laws regarding abuse, neglect, and exploitation; and positive approach methods to manage behavior.
At least two training sessions, totaling at least 8 hours of training a year, to enhance quality of care and job performance, in addition to the general orientation and annual training.
Staff persons applying protective devices shall be trained in the specific techniques or procedures for their use.
Relevant Medicaid Contracting Requirements for Adult Day Services Providers
Pennsylvania provides older adult daily living center services through a waiver program administered by the Department of Aging, and adult day health services in a limited geographic area under the Long Term Care Capitated Assistance Program. There are no Medicaid requirements for adult day health care providers other than licensure.
Location of Licensing, Certification, or Other Requirements
- Older Adult Daily Living Centers. Pennsylvania Code. Chapter 11 Subchapter A. [Undated]
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