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

08/26/2005

Overview

Standards for licensing day care facilities for adults are promulgated by the Department of Health and Environmental Control (DHEC) and administered by the Division of Health Licensing. The Community Long Term Care (CLTC) Medicaid waiver program authorizes adult day health care (ADHC) as a covered service. ADHC providers must maintain a current adult day care license from DHEC.

Licensure and Certification Requirements

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

Definitions

Adult day care services. Activities and therapies offered in a day care facility for adults through an individualized plan of care that sets forth measurable goals or behaviorally stated objectives, with such services being designed to activate, motivate, and retrain impaired or other categories of adults to enable them to sustain or regain functional independence.

Day care facility for adults. A facility for adults 18 years of age or older that offers in a group setting a program of individual and group activities and therapies. The program is directed toward providing community-based day care services for adults in need of a supportive setting, thereby preventing unnecessary institutionalization. The program shall provide a minimum of 4 and a maximum of 14 hours of operation a day.

Parameters for Who Can Be Served

Adults who need a supportive setting, thereby preventing unnecessary institutionalization, can be served. The physical and mental condition of a participant must not confine him/her to a bed, and a physician's report will determine whether appropriate services are available. Day care facilities for adults shall not serve participants whose needs exceed resources outlined in the regulations.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Each facility shall be inspected before initial licensure and at least annually by authorized DHEC representatives. All licensed and prospective licensed facilities are subject to inspection at any time. Medicaid/Medicare providers are surveyed with unannounced site visits, including those for medical record review, facility file review, observations, and resident and staff interviews.

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

The physician's report shall include information regarding medications (name, type, dosage, and whether the individual is capable of self-administering). All medications to be administered by the staff to participants shall be labeled and stored in a locked cabinet or container otherwise inaccessible to participants.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. Each facility shall have a staff who are capable of providing program services and supervision to the participants. A full-time administrator shall be selected by the governing authority or owner and shall have the authority to manage and administer the facility. An individual shall be appointed in writing to act in the absence of the administrator. At least one staff member who is certified with American Red Cross first aid training and cardiopulmonary resuscitation (CPR) (or American Heart Association CPR) and capable of recognizing symptoms of distress shall be present when participants are in the facility. If the staff member is a licensed nurse, first aid training will not be required.

Staffing ratios. The minimum staff/participant ratio shall be one direct care staff member to eight participants. Volunteers and interns may be used to augment the staff.

Training Requirements

Each facility shall have and execute a written orientation program to familiarize each new staff member with the facility and its policies and procedures, which are to include, as a minimum, fire safety measures and infection control. In-service training programs shall be planned and provided for all employees to ensure and maintain their understanding of their duties and responsibilities.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

The Community Long Term Care (CLTC) Medicaid waiver program authorizes adult day health care (ADHC) as a covered service. The objective of ADHC services is to restore, maintain, and promote the health status of Medicaid waiver clients through the provision of ambulatory health care and health-related supportive services in an ADHC center.

The ADHC provider must maintain a current adult day care license from DHEC and have on staff a nursing supervisor.

Services. The ADHC provider must provide the following nonbillable services, which are included in the daily rate. The provider may provide the services either directly or may provide some, but not all, through subcontractual arrangements: (1) daily nursing services performed by a registered nurse (RN) or under the supervision of an RN; (2) supervision of, assistance with, and training in personal care and ADL; (3) daily planned therapeutic activities; (4) one meal and a snack per day; and (5) transportation for all clients who reside within 15 miles of the center.

The provider must provide space within the adult day care center for the provision of physical, speech, and occupational therapy services.

Staffing. In addition to the minimum staffing requirements required by licensing, the following staffing standards for nurses and case managers apply:

For 1-35 home and community-based waiver ADHC clients, one RN must be present as follows: 1-10 clients, 2 hours minimum; 11-20 clients, 3 hours minimum; 21-25 clients, 4 hours minimum; 26-35 clients, 5 hours minimum.

For 36-60 home and community-based waiver ADHC clients, one RN and one additional RN or licensed practical nurse (LPN) must be present for a minimum of 5 hours. A licensed nurse must be present whenever home and community-based waiver clients are present.

For 61-90 home and community-based waiver ADHC clients: one RN and two additional RNs or LPNs; or one RN, one additional RN or LPN, and one case manager. Required nursing and case management staff must be present for a minimum of 5 hours. A licensed nurse must be present whenever home and community-based waiver clients are present.

For 91 or more home and community-based waiver ADHC clients: one RN and three additional RNs or LPNs, or one RN and two additional RNs or LPNs and one case manager. Required nursing and case management staff must be present for a minimum of 5 hours. A licensed nurse must be present whenever home and community-based waiver clients are present.

Location of Licensing, Certification, or Other Requirements

  1. http://www.scdhec.gov/hr/pdfs/licen/licregs/r61-75.pdf
  2. http://www.scdhec.gov/hr/cert/hrcltc.htm

Citations

  1. Regulation Number 61-75, Standards for Licensing Day Care Facilities for Adults. South Carolina Department of Health and Environmental Control. [Updated 12/5/03]
  2. Community Long Term Care, Bureau of Certification, SC Department of Health and Environmental Control Health Regulations.
  3. Medicaid Home and Community-Based Waiver, Scope of Services for Adult Day Health Care Services. Source: Office of the Director, Community Long Term Care Waiver Management, DHHS. [Dated 7/1/05]

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