#### § 59.160 Adult day health care requirements.

As a condition for receiving a grant and grant funds under this part for an adult day health care facility, States must meet the requirements of this section.

(a) Each adult day health care program, when it is co-located in a nursing home, domiciliary, or other care facility, must have its own separate designated space during operational hours.

(b) The indoor space for an adult day health care program must be at least 100 square feet per participant including office space for staff, and must be 60 square feet per participant excluding office space for staff.

(c) Each program will need to design and partition its space to meet its own needs, but the following functional areas must be available:

(1) A dividable multipurpose room or area for group activities, including dining, with adequate table setting space.

(2) Rehabilitation rooms or an area for individual and group treatments for occupational therapy, physical therapy, and other treatment modalities.

(3) A kitchen area for refrigerated food storage, the preparation of meals and/or training participants in activities of daily living.

(4) An examination and/or medication room.

(5) A quiet room (with at least one bed), which functions to isolate participants who become ill or disruptive, or who require rest, privacy, or observation. It should be separate from activity areas, near a restroom, and supervised.

(6) Bathing facilities adequate to facilitate bathing of participants with functional impairments.

(7) Toilet facilities and bathrooms easily accessible to people with mobility problems, including participants in wheelchairs. There must be at least one toilet for every eight participants. The toilets must be equipped for use by persons with limited mobility, easily accessible from all programs areas, *i.e.*, preferably within 40 feet from that area, designed to allow assistance from one or two staff, and barrier free.

(8) Adequate storage space. There should be space to store arts and crafts materials, personal clothing and belongings, wheelchairs, chairs, individual handiwork, and general supplies. Locked cabinets must be provided for files, records, supplies, and medications.

(9) An individual room for counseling and interviewing participants and family members.

(10) A reception area.

(11) An outside space that is used for outdoor activities that is safe, accessible to indoor areas, and accessible to those with a disability. This space may include recreational space and a garden area. It should be easily supervised by staff.

(d) *Furnishings* must be available for all participants. This must include functional furniture appropriate to the participants' needs.

(e) Unless determined by VA as necessary to accommodate an increased quality of care for patients, an adult day health care facility project may propose a deviation of no more than 10 percent (more or less) from the following net square footage for the State to be eligible for a grant of 65 percent of the total estimated cost of the project. If the project proposes building more than the following net square footage and VA makes a determination that it is not needed, the cost of the additional net square footage will not be included in the estimated total cost of construction.

Table to Paragraph (e)—Adult Day Health Care

| I. Support facilities [allowable square feet (or metric equivalent) per facility for VA participation]: | |
| Program Director | 200 |
| Assistant administrator | 150 |
| Medical officer, director of nursing or equivalent | 150 |
| Nurse and dictation area | 120 |
| General administration (each office/person) | 120 |
| Clerical staff (each) | 80 |
| Computer area | 40 |
| Conference room (consultation area, in-service training) | 500 (for each room). |
| Lobby/receiving/waiting area (150 minimum) | 3 (per participant) |
| Public/resident toilets (male/female) | 25 (per fixture). |
| Dining area (may be included in the multipurpose room) | 20 (per participant). |
| Vending machines | 1 (per participant). |
| Participant toilets (male/female) | 25 (per fixture). |
| Medical support (staff offices/family counseling, etc.) | 140 (for each room). |
| Janitor's closet | 40 |
| Dividable multipurpose room | 15 (per participant). |
| Employee lockers | 6 (per employee) |
| Employee lounge | 120 |
| Employee toilets | 25 (per fixture). |
| Physical therapy | 5 (per participant). |
| Office, if required | 120 |
| Occupational therapy | 5 (per participant). |
| Office, if required | 120 |
| Building maintenance storage | 2.5 (per participant). |
| Resident storage | 6 (per participant). |
| General warehouse storage | 6 (per participant). |
| Medical/dietary | 7 (per participant). |
| General laundry1 | |
| II. Other Areas: | |
| Participant quiet room | 3 (per participant). |
| Clean utility | 120 |
| Soiled utility | 105 |
| General storage | 100 |
| Nurses station, ward secretary | 260 |
| Medication/exam/treatment rooms | 75 |
| Waiting area | 50 |
| Program supply and equipment | 50 |
| Staff toilet | 25 (per fixture). |
| Wheelchair storage | 100 |
| Kitchen | 120 |
| Janitor's closet | 40 |
| Resident laundry | 125 |
| Trash collection | 60 |
| III. Bathing and Toilet Facilities: | |
| (A) Private or shared facilities: | |
| Wheelchair facilities | 25 (per fixture). |
| Standard facilities | 15 (per fixture). |
| (B) Full bathroom | 75 |
| | |
| --- | --- |
| 1 The size to be determined by the Chief Consultant, Geriatrics and Extended Care, as necessary to accommodate projected patient care needs (must be justified by State in space program analysis). | |

(Authority: [38 U.S.C. 101](https://www.govinfo.gov/link/uscode/38/101), [501](https://www.govinfo.gov/link/uscode/38/501), [1710](https://www.govinfo.gov/link/uscode/38/1710), [1742](https://www.govinfo.gov/link/uscode/38/1742), [8105](https://www.govinfo.gov/link/uscode/38/8105), [8131-8137](https://www.govinfo.gov/link/uscode/38/8131); Sections 2, 3, 4, and 4a of the Architectural Barriers Act of 1968, as amended, Public Law 90-480, [42 U.S.C. 4151-4157](https://www.govinfo.gov/link/uscode/42/4151))