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

08/26/2005

Overview

Adult day care (ADC) certification is voluntary; however, certification is needed if a provider plans to serve one or more participants who receive Medicaid Waiver funding. Regulation of facilities primarily serving adults is the responsibility of the Bureau of Quality Assurance (BQA). BQA is responsible for certifying adult day care facilities. Adult day care and family adult day care (FADC) certification standards differ are and described separately in this profile. FADC is defined in the standards, but ADC is not. The definition for ADC in this profile is taken from the Department of Health & Family Services Web page on adult day care. The ADC standards include separate provisions for adult day care programs located in a multiuse facility.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☒  voluntary except for Medicaid providers
Both Required  ☐ 
Other  ☐ 

Definitions

Adult day care facility means a facility that provides services for part of a day in a group setting to adults who need an enriched social or health-supportive experience, or who may need assistance with activities of daily living (ADL), supervision, and/or protection. Services may include personal care and supervision, provision of meals, medical care, transportation, and activities designed to meet physical, social, and leisure time needs. (See http://dhfs.wisconsin.gov/rl_DSL/AdultDayCare/AdultDCintro.htm for definition.)

Multiuse facility means an adult day care setting is typical of or strongly resembles the locations where adults in that community customarily congregate for social, recreational or association activities (e.g., clubs, church halls, private homes, lodges, restaurants). The building is consistent with the environment in terms of size, architectural style, and type (urban vs. rural) and would be attractive and inviting to members of that community. The setting, programs, and physical environment will enhance the dignity and individual respect of participants.

Family adult day care is provided for part of a day for small groups of no more than six adults in the provider's home.

Parameters for Who Can Be Served

Both ADC and FADC may serve severely impaired individuals, defined as having any impairment that results in an inability at the program to perform any three or more ADL (e.g., mobility, dressing, eating, toileting, hygiene) without assistance, supervision, or prompting. The impairment may be physical or cognitive in nature.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☐ 
No  ☒ 

Not specified.

Required and Optional Services

  Adult Day Care Family Adult Day Care
Required Optional Required Optional
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

Self-administered medications may be supervised by a staff member who may prompt the participant and observe him/her taking the medication. When medications are self-administered (whether supervised or not), the medication list must be reviewed and updated annually by the prescribing practitioner (i.e., physician, physician's assistant, or nurse practitioner). If staff administer participants' medications, nonlicensed staff must consult with the prescribing practitioner or pharmacist about each medication to be administered and other conditions related to storage and documentation must be met.

Provisions for Groups with Special Needs

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

Staffing Requirements

Adult Day Care

Type of staff. A program director is required. The program director must be at least 21 years of age and shall be knowledgeable about the specific disabilities of the persons being served by the adult day care program, including the physical and psychological aspects of these disabilities, the types of functional deficits that result from these disabilities, and the types of services the program must provide to meet the participants' needs resulting from these disabilities.

Staffing ratios. (1) At least one staff member over the age of 18 years shall be on the premises at all times when participants are present. (2) There shall be a minimum of one staff person for each eight nonseverely impaired participants at the ADC site. (3) There shall be a minimum of one staff person present for each four severely impaired participants at the ADC site. (4) The ADC program will provide sufficient staff time and staff expertise to implement the program as described in I.A.(1) and participant service plans. (5) Daily staffing patterns shall be documented (e.g., time cards, time sheets, or other methods used for payroll purposes). (6) Volunteers who meet the same standards, requirements, and training as employees and who have signed a written job description may be counted as part of the staff/participant ratio.

Family Adult Day Care

Type of staff. A provider is required. The provider shall be knowledgeable in the same areas as an ADC program director (see above).

Staffing ratios. (1) At least one person over the age of 18 years, designated by the provider, shall be on the premises at all times participants are present; no participant shall be designated as in charge. (2) The total number of persons served at any one time shall not exceed six; this includes adult family members or others the provider may be responsible for. (3) The maximum number of participants by care level for any one provider or staff person is shown in the following table:

Severely Impaired Not Severely Impaired Total
3 0 3
2 2 4
1 4 5
0 6 6

(4) The provider shall not care for children other than his/her own when participants are present. (5) Volunteers must be under the supervision of the provider.

Training Requirements

Adult day care. The ADC program shall have and implement a written plan for providing orientation and training to staff members. All ADC staff who interact with participants, and volunteers who are included as part of the staff/participant ratio, must complete an orientation within the first 2 weeks of employment which includes: (1) an explanation of participant rights; (2) an explanation of the adult day care program policies; (3) training in recognizing and responding appropriately to medical and safety emergencies; (4) an explanation of established emergency and evacuation procedures, including the proper use of the fire extinguisher; and (5) an explanation of the program's procedure related to standard precautions, prior to exposure to potentially infectious material.

Within 90 days of employment, all employees who provide care to participants shall have received training on the following topics, if those topics are pertinent to their job responsibilities: (1) the needs and abilities of the participants served; (2) the physical and psychological aspects of each participant's disabilities; (3) the techniques required to provide personal care to participants--bathing, grooming, walking, and feeding, etc; and (4) the interpersonal communication skills needed to relate to participants including understanding independent living philosophy; respecting participant rights, needs, and uniqueness; respecting age; cultural and ethnic differences; confidentiality; and other relevant topics.

After the first year of employment, all employees who have responsibility for direct care or program activities, including the program director, shall receive 10 hours of continuing education annually. The ADC program shall provide orientation, training, and supervision to volunteers.

Family adult day care. After the first year of operation, the provider shall document 5 hours of continuing education annually in topics pertinent to the job responsibilities.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Adult day care providers must be certified if one or more persons are receiving Medicaid Waiver funding for ADC services. No additional Medicaid contracting provisions are required.

Location of Licensing, Certification, or Other Requirements

  1. http://dhfs.wisconsin.gov/forms/ddes/DDE0947.pdf
  2. http://dhfs.wisconsin.gov/forms/ddes/DDE2611.pdf

Citations

  1. Adult Day Care Certification Standards Checklist. Division of Disability and Elder Services, Department of Health and Family Services. [11/04]
  2. Family Adult Day Care Certification Standards Checklist. Division of Disability and Elder Services, Department of Health and Family Services. [11/04]

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