Editorial Note on Part 51
Editorial Note: Nomenclature changes to part 51 appear at 74 FR 19432, Apr. 29, 2009.

§ 51.420 Quality of life. The State home must provide an environment that supports the quality of life of each participant by maximizing the participant's potential strengths and skills. (a) *Dignity.* The State home must promote care for participants in a manner and in an environment that maintains or enhances each participant's dignity and respect in full recognition of his or her individuality. ( b ) *Self-determination and participation.* The State home must ensure that the participant has the right to: ( 1 ) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care;
( 2 ) Interact with members of the community both inside and outside the facility; and
( 3 ) Make choices about aspects of his or her life in the facility that are significant to the participant.
( c ) *Participant and family concerns.* The State home must document any concerns submitted to the management of the program by participants or their family members. ( 1 ) A participant's family has the right to meet with families of other participants in the program.
( 2 ) Staff or visitors may attend meetings of participant or family groups at the group's invitation.
( 3 ) The State home must respond to written requests that result from group meetings.
( 4 ) The State home must listen to the views of any participant or family group and act upon the concerns of participants and families regarding policy and operational decisions affecting participant care in the program.
( d ) *Participation in other activities.* The State home must ensure that a participant has the right to participate in social, religious, and community activities that do not interfere with the rights of other participants in the program.
( e ) *Therapeutic participant activities.* ( 1 ) The State home must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each participant.
( 2 ) The activities program must be directed by a qualified professional who is a qualified therapeutic recreation specialist or an activities professional who: ( i ) Is licensed, if applicable, by the State in which practicing; and
( ii ) Is certified as a therapeutic recreation specialist or an activities professional by a recognized certifying body.
( 3 ) A critical role of adult day health care is to build relationships and create a culture that supports, involves, and validates the participant. Therapeutic activity refers to that supportive culture and is a significant aspect of the individualized comprehensive care plan. A participant's activity includes everything the individual experiences during the day, not just arranged events. As part of effective therapeutic activity, the adult day health care program must: ( i ) Provide direction and support for participants, including breaking down activities into small, discrete steps or behaviors, if needed by a participant;
( ii ) Have alternative programming available for any participant unable or unwilling to take part in group activity;
( iii ) Design activities that promote personal growth and enhance the self-image and/or improve or maintain the functioning level of participants to the extent possible;
( iv ) Provide opportunities for a variety of involvements (social, intellectual, cultural, economic, emotional, physical, and spiritual) at different levels, including community activities and events;
( v ) Emphasize participants' strengths and abilities rather than impairments, and contribute to participants' feelings of competence and accomplishment; and
( vi ) Provide opportunities to voluntarily perform services for community groups and organizations.
( f ) *Social services.* ( 1 ) The State home must provide medically-related social services to participants and their families.
( 2 ) An adult day health care program must provide a qualified social worker to furnish social services.
( 3 ) A qualified social worker is an individual with: ( i ) A bachelor's degree in social work from a school accredited by the Council of Social Work Education (Note: A master's degree in social worker with experience in long-term care is preferred);
( ii ) A social work license from the State in which the State home is located, if that license is offered by the State; and
( iii ) A minimum of one year of supervised social work experience in a health care setting working directly with individuals.
( 4 ) The State home must have sufficient social workers and support staff to meet participant and family social service needs. The adult day health care program must: ( i ) Provide counseling to participants and to families/caregivers;
( ii ) Facilitate the participant's adaptation to the adult day health care program and active involvement in the comprehensive care plan, if appropriate;
( iii ) Arrange for services not provided by adult day health care, and work with these resources to coordinate services;
( iv ) Serve as an advocate for participants by asserting and safeguarding the human and civil rights of the participants;
( v ) Assess signs of mental illness or dementia and make appropriate referrals;
( vi ) Provide information and referral for persons not appropriate for adult day health care;
( vii ) Provide family conferences, and serve as liaison between participant, family/caregiver and program staff;
( viii ) Provide individual or group counseling and support to caregivers and participants;
( ix ) Conduct support groups or facilitate participant or family/caregiver participation in support groups;
( x ) Assist program staff in adapting to changes in participants' behavior; and
( xi ) Provide or arrange for individual, group, or family psychotherapy for participants with significant psychosocial needs.
( 5 ) Space for social services must be adequate to ensure privacy for interviews.
( g ) *Environment.* The State home must provide: ( 1 ) A safe, clean, comfortable, and homelike environment, and support the participants' ability to function as independently as possible and to engage in program activities;
( 2 ) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;
( 3 ) Private storage space for each participant sufficient for a change of clothes. Upon request of the participant, the State home must offer storage space that can be secured with a lock;
( 4 ) Interior signs to facilitate participants' ability to move about the facility independently and safely;
( 5 ) A clean bed or reclining chair available for acute illness;
( 6 ) A shower for participants;
( 7 ) Adequate and comfortable lighting levels in all areas;
( 8 ) Comfortable and safe temperature levels; and
( 9 ) Comfortable sound levels.
(The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0160)