Residential Care and Assisted Living Compendium: 2007. Provisions for Residents with Alzheimer’s Disease and Dementia

11/30/2007

Forty-five states have specific regulatory provisions for facilities serving people with Alzheimer’s disease and other dementias an increase from 44 in 2004, 36 in 2002 and 28 in 2000. Examples of state regulations for facilities serving residents with dementia follow.

  • Rhode Island requires a license for dementia care when one or more residents’ dementia symptoms affect their ability to function as demonstrated by behaviors that adversely impact the rights of others; elopement; or an inability to self preserve. Facilities that advertise or represent special dementia services or that segregate residents with dementia also need a license for dementia care. In addition to basic license requirements, dementia care licenses require staff training specific to dementia care; a RN on staff and available for consultation at all times; and a secure environment appropriate for the resident population.

  • Pennsylvania’s rules contain provisions for securing units and providing adequate indoor and outdoor wandering space. They also specify competency-based training requirements for administrators and staff covering mandated topics such as the definition and diagnosis of dementia; differences between dementia, delirium, and depression; managing behavioral symptoms; and working with family members.

  • Montana has a licensure category for facilities that serve residents who are not capable of expressing their needs or making basic decisions. Requirements apply to staffing provisions; general staff education, training, and experience requirements; dementia specific annual continuing education requirement, including the teaching of skills necessary to care for, intervene and direct residents who are unable to perform ADLs; and techniques for minimizing challenging behavior. Other requirements apply to locked units or distinct parts of facilities.

  • Washington’s regulations require staff with experience and training in dementia care to coordinate outside services, offer monthly educational and family support meetings, and advocate for residents. Staff training requirements include a minimum of 30 hours on care for residents with dementia; the nature, stages, and treatment of the disease; therapeutic interventions; communication techniques; medication management; therapeutic environmental modifications; assessment and care planning; the role of family and their need for support; staff burn-out prevention; and abuse prevention. Eight hours of continuing training is required annually.

    Staffing must be sufficient to provide 2.25 hours of direct care per resident per day. At least two staff must be present for units serving more than five residents. An RN must be available if residents require nursing procedures. The rules describe special requirements for the physical environment with security measures, including secured outdoor spaces.

    Licensed facilities that do not market themselves as SCUs but serve residents with early symptoms of dementia must provide staff training on dementia care, including strategies to help residents manage their behaviors.

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