Ohio Administrative Code › Title 173 - Department of Aging › Chapter 173-3 - Older Americans Act › Section 173-3-06.1 - Older Americans Act: adult day service

Current through all regulations passed and filed through July 1, 2024
(A) "Adult day service" ("ADS") means a
			 regularly-scheduled service delivered at an adult day center (center) in a
			 non-institutional, community-based setting. ADS includes recreational and
			 educational programming to support a consumer's health and independence goals;
			 at least one meal, but no more than two meals per day; and, sometimes, health
			 status monitoring, skilled therapy services, and transportation to and from the
			 center. Table 1 to this rule defines the three levels of ADS.
Table 1: Levels and Activities of ADS
BASIC ADS
ENHANCED ADS
INTENSIVE ADS
Structured activity programming
Yes
Yes
Yes
Health assessments
Yes
Yes
Yes
Supervision of ADLs
One or more ADL
One or more ADL
All ADLs
Hands-on assistance with ADLs
No
Yes, one or more ADL (bathing excluded)
Yes, minimum of two ADLs (bathing included)
Hands-on assistance with medication
						  administration
No
Yes
Yes
Comprehensive therapeutic activities
No
Yes
Yes
Monitoring of health status
No
Intermittent
Regular
Hands-on assistance with personal hygiene
						  activities
No
Yes (bathing excluded)
Yes (bathing included, as needed)
Social work services
No
No
Yes
Skilled nursing services
No
No
Yes
Rehabilitative services
No
No
Yes
(B)
								Requirements for
								
								every
			 AAA-provider agreement for ADS that is paid, in whole or in part, with Older
			 Americans Act funds:
(1)
									
									The AAA-provider agreement
									is
			 subject to
									 rule
			 173-3-06 of the Administrative
			 Code .
(2) Service requirements:
(a) Transportation: The provider shall
			 transport each consumer to and from the center by performing
			  transportation  that complies with rule
			 173-3-06.6 of the
			 Administrative Code, unless the provider enters into a contract with another
			 provider who complies with rule
			 173-3-06.6 of the
			 Administrative Code, or unless the caregiver 
										transports
			 or designates another person or non-provider, other than the center provider,
			 to transport the consumer to and from the center.
(b) Case manager's assessment: If the
			 consumer receives a case management service as part of care coordination:
(i) The case manager shall assess each
			 consumer's needs and preferences then specify which service level will be
			 approved for each consumer; and,
(ii) The provider shall retain records to
			 show that it provides the service at the level that the case manager
			 authorized.
(c)
			 Provider's initial assessment:
(i) The
			 provider shall assess the consumer before the end of the consumer's second day
			 of attendance at the center. If the consumer is enrolled in care coordination,
			 the provider may substitute a copy of the case manager's assessment of the
			 consumer if the case manager assessed the consumer no more than thirty days
			 before the consumer's first day of attendance at the center.
(ii) The initial assessment shall include
			 both of the following components:
(a)
			 Functional and cognitive profiles that identify the ADLs and IADLs that require
			 attention or assistance of the provider's staff members.
(b) Social profile including social activity
			 patterns, major life events, community services, caregiver data, formal and
			 informal support systems, and behavior patterns.
(d) Health assessment: No later
			 than thirty days after the consumer's initial attendance at the center or
			 before the consumer receives the first ten units of service at the center,
			 whichever comes first, the provider shall either obtain a health assessment of
			 each consumer from a licensed healthcare professional whose scope of practice
			 includes health assessments or require a staff member who is such a licensed
			 healthcare professional to perform a health assessment of each consumer. The
			 health assessment shall include the consumer's psychosocial profile and
			  identify the consumer's risk factors,
			 diet, and medications. If the licensed healthcare professional who performs the
			 health assessment is not a staff member of the provider, the provider shall
			 retain a record of the professional's name and phone number.
(e) Activity plan: No later than thirty days
			 after the consumer's initial attendance at the center or before the consumer
			 receives the first ten units of service at the center, whichever comes first,
			 the provider shall either obtain the services of a licensed healthcare
			 professional whose scope of practice includes developing activity plans to
			 draft an activity plan for each consumer or  require a staff member who is such a licensed
			 healthcare professional to draft an activity plan for each consumer. The plan
			 shall 
										do all of the following:
(i)
											Identify the
			 consumer's strengths, needs, problems or difficulties, and
			 objectives.
(ii)
											Describe the consumer's
											interests, preferences, and social
			 rehabilitative needs.
(iii)
											Describe the consumer's
											
											health
			 needs.
(iv)
											Describe the consumer's
											
											specific goals, objectives, and planned interventions
			 of ADS that meet the goals.
(v)
											Describe the consumer's
											
											level
			 of involvement in the drafting of the plan, and if the consumer has a caregiver, the caregiver's
			 level of involvement in the drafting of the plan.
(vi)
											Describe the consumer's
											
											ability to provide a unique identifier to verify
			 receipt of service delivery.
(f) Plan of treatment: Before administering
			 medication or meals with a therapeutic diet, and before providing a nursing
			 service, nutrition counseling, physical therapy, or speech therapy, the
			 provider shall obtain a plan of treatment from a licensed healthcare
			 professional whose scope of practice includes making plans of treatment. The
			 provider shall obtain the plan of treatment at least every ninety days for each
			 consumer that receives medication, a nursing service, nutrition counseling,
			 physical therapy, or speech therapy. For diet orders that may be part of a plan
			 of treatment, a new diet order is not required every ninety days. Instead, the
			 provider 
										is subject to the diet-order requirements
			  under rule
			 173-4-06 of the Administrative
			 Code.
(g) Interdisciplinary care
			 conference (conference):
(i) Frequency: The
			 provider shall conduct a conference for each consumer at least once every six
			 months.
(ii) Participants: The
			 provider shall conduct the conference between the provider's staff members and
			 invitees who choose to participate. 
											At least seven days before the conference begins,
			 the provider shall invite the 
											following persons  to participate in the
			 conference and provide those persons with the date and
			 time of the conference:
(a)
												The
			 consumer.
(b)
												The consumer's case manager, if the consumer receives
			 case management as part of care coordination.
(c)
												Any licensed
			 healthcare profession who does not work for the provider, but who provided the
			 provider with a health assessment of the consumer or an activity plan for the
			 consumer.
(d)
												The consumer's caregiver, if the consumer has a
			 caregiver.
(iii)
			 Revise activity plan: If the conference participants identify changes in the
			 consumer's health needs, condition, preferences, or responses to the service,
			 the provider shall obtain the services of a licensed healthcare professional
			 whose scope of practice includes developing activity plans to revise the
			 activity plan accordingly or  require
			 a staff member who is such a licensed healthcare professional to revise the
			 activity plan accordingly.
(h) Activities: The provider shall
			 announce daily and monthly planned activities through two or more of the
			 following media:
(i) Posters in prominent
			 locations throughout the center.
(ii) An electronic display (e.g., a
			 television) in a prominent location in the center.
(iii) The center's website.
(iv) A direct communication sent to consumers
			 (and others), such as email, text, mail, or another medium.
(i) Lunch and snacks:
(i) The provider shall provide lunch and
			 snacks to each consumer who is present during lunchtime or snacktime.
(ii) The provision of lunch shall comply with
			 paragraphs (A)(7) to (A) (12) of rule
			 173-4-05 of the Administrative
			 Code and paragraph (E) of rule
			 173-4-05.1 of the
			 Administrative Code.
(3) Center requirements: A provider
			 
									may
			 qualify for an AAA-provider agreement to provide ADS if the provider's
			 center 
									meets the following specifications:
(a) If the center is housed in a building
			 with services or programs other than ADS,  a separate, identifiable space and staff
			 are available for ADS activities during all hours in which the provider
			 provides ADS in the center.
(b) The
			 center 
										complies with the "ADA Accessibility Guidelines for
			 Buildings and Facilities" in appendix A to 28 C.F.R. Part 36 .
(c) The center 
										has at
			 least sixty square feet per individual that it serves, excluding hallways,
			 offices, rest rooms, and storage areas.
(d) The provider 
										stores
			 consumers' medications in a locked area that the provider maintains at a
			 temperature that meets the storage requirements of the medications.
(e) The provider 
										stores
			 toxic substances in an area that is inaccessible to consumers.
(f) The center 
										has at
			 least one toilet for every ten individuals present that it serves and at least
			 one wheelchair-accessible toilet.
(g) If the center provides intensive ADS, the
			 center 
										has bathing facilities suitable to the needs of
			 consumers who require intensive ADS.
(4) Staffing levels:
(a) The provider shall have at least two
			 staff members present whenever more than one consumer is present, including one
			 who is a paid PCA and one who is certified in CPR.
(b) The provider shall maintain a
			 staff-to-consumer ratio of at least one staff member to every six consumers at
			 all times.
(c) The provider shall
			 have one RN, or LPN under the direction of an RN, available whenever a consumer
			 who receives enhanced ADS or intensive ADS requires components of enhanced ADS
			 or intensive ADS that fall within a nurse's scope of practice.
(d) The provider shall employ an activity
			 director to direct consumer activities.
(5) Provider qualification:
(a) Type of provider:
			 
										Only agency providers qualify to provide ADS
			 .
(b) Staff
			 qualifications:
(i) Every
			 person who is an RN, LPN under the direction of
			 an RN, social worker, physical therapist, physical therapy assistant, speech
			 therapist, dietitian, occupational therapist, occupational therapy assistant,
			 or other licensed professional 
											qualifies to practice in the adult day center
			 
											only if the
			 person
											
											has a current and valid license to practice in
			 their profession.
(ii)
											
											A person
			 qualifies to be an activity director 
											only if the
			 person
											
											has at least one of the following:
(a) A baccalaureate or associate degree in
			 recreational therapy or a related degree.
(b) At least two years of experience as an
			 activity director, activity assistant or a related position.
(c) Compliance with the qualifications under
			 rule 3701-17-07 of the Administrative
			 Code for directing resident activities in a nursing home.
(d) A certification from the national
			 certification council for activity professionals (NCCAP).
(iii)
											
											A person qualifies to
			 be an activity assistant 
											only if the person
											
											has at least
			 one of the following:
(a) A high school
			 diploma.
(b) A high school
			 equivalence diploma as defined in section
			 5107.40 of the Revised
			 Code.
(c) At least two years of
			 employment in a supervised position to provide personal care, to provide
			 activities, or to assist with activities.
(iv)
											
											A person qualifies to be a PCA
			 
											only if the
			 person
											
											has at least one of the following:
(a) A high school diploma.
(b) A high school equivalence diploma as
			 defined in section 5107.40 of the Revised
			 Code.
(c) At least two years of
			 employment in a supervised position to provide personal care, to provide
			 activities, or to assist with activities.
(d) The successful completion of a vocational
			 program in a health or human services field.
(v) Each staff member who provides
			 transportation to consumers shall comply with all requirements under rule
			 173-3-06.6 of the
			 Administrative Code.
(c) Staff training:
(i) Orientation: 
											The provider shall 
											comply with the requirements for the orientation of
			 PCAs in rule
			 173-3-06.5 of the
			 Administrative Code.
(ii) Task-based training: Before
			 each new PCA provides an ADS, the provider shall provide task-based
			 training.
(iii) Continuing
			 education: Each staff member shall successfully complete at least eight hours
			 of in-service or continuing education on appropriate topics every twelve
			 months. A staff member's successful completion of one to eight hours of
			 continuing education or in-service training to maintain a professional license,
			 certification, or registration used to provide ADS counts towards this
			 eight-hour requirement if successfully completed during the same calendar
			 year.
(iv)
											
											Verification of compliance: The provider shall
			 
											comply with paragraph (B)(3)(f) of rule
			 173-3-06.5 of the
			 Administrative Code regarding records of each PCA's successful completion of
			 any training and competency evaluation program, orientation, and inservice
			 training.
(d)
										Performance reviews: The provider shall complete
			 a performance review of each staff member in relation to the staff member's job
			 description.
(6) Service verification:
(a) The
			 
										following are the
										
										mandatory reporting
										
										items for
			 each episode of service
										that a provider retains to comply
			 with the requirements under paragraph (B)(9) of rule
			 173-3-06 of the Administrative
			 Code:
(i)
											Consumer's name.
(ii)
											Service
			 date.
(iii)
											Consumer's arrival and departure times.
(iv)
											Consumer's mode
			 of transportation.
(v)
											Unique identifier of the consumer or the consumer's
			 caregiver to attest to receiving the service.
(b)
			 During a state of emergency declared by the governor or a federal public health
			 emergency, the provider may verify each episode of service provided without
			 collecting the unique identifier of the consumer or the
			 consumer's caregiver.