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

08/26/2005

Overview

The rules, regulations, and standards developed by the Department of Elderly Affairs apply to all facilities and programs that provide adult day services in Rhode Island to the frail elderly who are in need of supportive care and supervision during the daytime. The licensing standards apply to all providers regardless of reimbursement source. Adult day care is offered under the Medicaid state plan but is not covered under any waiver program. There are no additional Medicaid adult day services provider requirements other than licensure by the Department of Elderly Affairs to provide adult day services.

Licensure and Certification Requirements

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

Definitions

Adult day services means a community-based group program designed to meet the biopsychosocial needs of adults with impairments through individual plans of care. These structured, comprehensive, nonresidential programs provide a variety of health, social, and related support services in a protective setting. By supporting families and other caregivers, adult day services enable participants to live in the community. Adult day programs employ an interdisciplinary team to assess the biopsychosocial needs of each participant and to design and deliver integrated programs and services to meet those needs.

Parameters for Who Can Be Served

Admission and discharge criteria specified for adult day services programs indicate the parameters for who can and cannot be served in adult day services settings.

Adult day services programs are required to define the target population(s) they intend to serve. Each adult day services program shall serve only participants whose needs while at the program do not exceed the program's resources, and at least 51 percent of the program's average daily participants shall be persons 55 years of age or older. Each participant shall have a physical/mental condition indicating a need for nursing care, supervision, therapeutic services, support services, and/or socialization.

Providers are required to develop discharge/transition plans for participants with changes in service needs or functional status who require another level of care. Participants may be discharged from the program if they: (1) require specialized institutional care because of illness or (2) develop behavioral problems that may endanger and/or disrupt other participants or staff members and that are not modifiable by steps taken under the program's reevaluation protocol.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

The Department [of Elderly Affairs] shall make or cause to be made such inspections and investigations as it deems necessary at such time and frequencies as determined by the Department. A license issued to a new adult day services program or facility, unless sooner suspended or revoked, shall expire by limitation 1 year following its issuance and may be renewed for a second year after inspection, report, and approval by the Department. Such inspection may be made any time prior to the date of expiration of said license. A licensed new adult day services program or facility shall undergo an additional on-site inspection when ten participants have been enrolled and are in attendance on a regular basis.

A license issued to an adult day services program or facility that has been licensed for two consecutive 1-year periods, unless sooner suspended or revoked, shall expire by limitation 2 years following its issuance, and may be renewed for additional, successive 2-year periods after inspection, report, and approval by the Department. Such inspection may be made any time prior to the date of expiration of said license.

Required and Optional Services

  Adult Day Services
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

Licensed staff, including nurses and unlicensed persons who have completed a state-approved course in drug administration and are under indirect supervision by a nurse, physician, or pharmacist, may administer medication and monitor health indicators.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. The program shall designate one full-time staff member as the program director. The program shall employ a nurse who will be on-site daily for a minimum of 6 scheduled hours. If the program's daily enrollment is 20 or more participants, the program shall have a nurse on site daily for 6 hours who is available to the program to ensure full-day nursing coverage.

The program shall identify a staff person responsible for the functions of activities director who will be on-site daily for a minimum of 4 scheduled hours. If the program's daily enrollment is 24 or more participants, the program shall have access to case management services on site or available for a minimum of 20 hours each week. During all operating hours, the program shall have on site at least one staff member trained in first aid, including cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. Each program shall employ at least one certified nursing assistant licensed by the State of Rhode Island.

Staffing ratios. Each program shall employ sufficient staff to maintain a ratio of one full-time staff member involved in direct service to participants for each nine participants; a ratio of one-to-six is recommended. Secretaries, cooks, accountants, and other non-direct care staff members shall not be considered in calculating this one-to-nine ratio.

Training Requirements

Each program shall have a written plan for staff training and development. Training shall include at least the following:

  1. Orientation for all staff at the start of employment.
  2. First aid training, including CPR and the Heimlich maneuver, for appropriate staff.
  3. Training in standard precautions and latex safety.
  4. Training in developing, implementing, and evaluating individual plans of care.
  5. Training in any specialized services (e.g., behavior management) offered by the program.
  6. Training in identifying participants who abuse alcohol and/or other substances, suffer from depression, or are victims of elder abuse or self-neglect.
  7. Information about services available to participants from outside programs or agencies.
  8. Information about the medications prescribed for participants, benefits of the medications, common side effects and risks, and laws governing administration of prescribed medications.
  9. Training in participants' rights.
  10. Training in confidentiality of participant information and records.
  11. Training in diversity and cultural sensitivity.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

As stated in the Overview of this profile, Medicaid providers must be licensed to provide adult day services. The state covers adult day services under its Medicaid state plan but not under its waiver programs. There are no additional Medicaid requirements for adult day service providers other than licensure by the Department.

Location of Licensing, Certification, or Other Requirements

  1. http://www2.sec.state.ri.us/dar/regdocs/released/pdf/DELDA/DELDA_2358.pdf

Citations

  1. Rules, Regulations and Standards for Licensing of Adult Day Services Programs--State of Rhode Island and Providence Plantations--Department of Elderly Affairs. May 1999. [As amended January, 2002]

Additional Information

Required services not identified in the services exhibit above include individual and group activity programs, meals and two snacks, and mental health and substance abuse services.

Adult day services programs are required to follow up for up to 3 months with each participant discharged to independent living or to an institution on a short-term basis (fewer than 6 months).

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