0 Presentation to: DCH Board Presented by: Mary Scruggs Date: October 2014 Healthcare Facility Regulation Division Adult Day Centers

1 Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

2 Program Overview Program Name Healthcare Facility Regulation Division (HFR) Program Purpose Support the delivery of safe, accessible, affordable and quality healthcare services through effective and efficient planning, regulation and oversight. Program Goals To protect the public safety and reduce the unnecessary duplication of services. Target Population and Clients Providers and health care consumers.

3 Adult Day Centers: GA Law During the 2003/2004 Legislative Session, GA passed the Adult Day Center for Aging Adults Licensure Act (O.C.G.A et seq.) The act authorizes the licensure and regulation of adult day care and adult day health service providers. Draft rules were initially prepared by the Office of Regulatory Services (ORS), Department of Human Resources, but were not finalized as the program was not funded.

4 Adult Day Centers: Program Development ORS transitioned to the Department of Community Health and became the Healthcare Facility Regulation Division. For SFY15, the Department received $321,000 in state funding to initiate an adult day center licensure program. The Adult Day Center program is 100% state funded and will be administered as part of the Department’s personal care home program.

5 Adult Day Centers: Program Development Personal Care Home Staff Program Director 4 Regional Directors 16 Surveyors 1 Clerical Staff 2 New Surveyor Positions Pending for Adult Day Centers

6 Adult Day Centers: Program Development Subject to finalization of the rules, Healthcare Facility Regulation will: Receive and review licensure applications from existing and new adult day centers; Conduct initial inspections; Issue licenses and process licensure renewals on an annual basis; and Conduct complaint investigations and initiate enforcement action as appropriate.

7 Adult Day Centers: Program Development Existing adult day centers must submit an application for initial license within 90 days of the date the rules become effective. Existing adult day centers may continue to operate until Healthcare Facility Regulation makes a decision regarding the submitted application.

8 Adult Day Centers:Fees: Application Fee:$300 Licensure Fee – Social Model$250 Licensure Fee – Medical Model$350 Adult Day Centers: Program Development Chapter , Enforcement of General Licensing and Enforcement Requirements, Fee Schedule

9 Overview of Adult Day Center Rules

10 Adult Day Centers: Scope According to the Act, adult day care centers provide services to aging adults: –adults 60 years or older and –mature adults with needs substantially similar to adults 60+ or who have physical or mental limitations that restrict their abilities to perform normal activities of daily living and impede independent living Services are based on individual plans of care Services are provided for less than 24 hours a day

11 Adult Day Centers: Scope Exemptions: 1.The provision of adult day care services to less than 3 aging adults; 2.Individuals or charitable organizations operating an adult day center without receiving compensation as a condition of the participant’s receiving such services; 3.Programs which provide day habilitation and treatment services exclusively for developmentally disabled persons; and 4.Respite care services programs.

12 For facilities subject to licensure, the facility may elect to provide adult day care services on the basis of a (1) social model or (2) medical model. In addition, the facility may elect to operate at a permanent location or provide services on a mobile basis. Adult Day Centers: Service Models

13 Adult Day Centers: Service Models Social Model Social activities; Recreational activities; and Limited personal care assistance for sustaining the activities of daily living. Medical Model Services provided in Social Model AND Rehabilitation and health services to restore or maintain optimal capacity for self-care

14 Adult Day Centers: Service Models Mobile Adult Day Centers: Designated staff travel from one central location to off-site locations to provide adult day services. Staff and/or volunteers, participant records, supplies and program materials are transported to each off-site location for the provision of services. Up to 5 off-site locations designated per license. Services provided 4 days per week or less at any one location.

15 Adult Day Centers: Capacity For both permanent and mobile adult day centers, the participant capacity is determined as follows: At least 35 square feet of available floor space per participant for participant activity and The occupancy load determined by the local authority having jurisdiction over fire safety or the State Fire Marshal.

16 Adult Day Centers: Facility Requirements Facility must meet: Local zoning requirements; Physical plant and safety requirements; Fire safety requirements; and Approved water source and sewage disposal. Facility must maintain policies for: Staff/volunteer hiring, screening and training process; Disaster preparedness and fire safety; Admission and discharge, fees, refunds, participant rights, and complaint procedures; and Infection control, safe food handling, medication administration (if applicable), etc.

17 Adult Day Centers: Facility Requirements Transportation Services: Facilities may provide transportation services. If so, the facility must provide proof of insurance and vehicle registration. Nutrition Services: Nutrition services are optional if the adult day care center operates less than 4 hours per day. Otherwise, the provision of nutritious snacks and meals if required.

18 Adult Day Centers: Staffing Requirements Governing Body responsible for the following staff: Director: responsible for overall program management Sufficient staff to meet needs of participants with no less than 1 staff member to every 8 participants Sufficient staff to ensure safe evacuation of all participants; with increased staff presence as needed based on the number of non-ambulatory participants At least one staff member on site trained in CPR

19 Medical Model: In addition to other staff, must provide: at least one Registered Nurse (RN) Licensed Practical Nurses may be used if supervised by an RN Other qualified staff to provide other rehabilitative services such as occupational therapy, physical therapy and speech therapy Adult Day Centers: Staffing Requirements

20 Adult Day Centers: Reporting Licensed facilities are required to maintain records and submit timely reports (no later than next business day) of serious incidents occurring at the center or off-site during the provision of services: (a) Any death of a participant; (b) Any rape of a participant; (c) Any serious injury to a participant that requires medical attention; (d) Any suspected abuse, neglect or exploitation of a participant; and (e) Any time a participant cannot be located and the participant has been missing for more than thirty (30) minutes. Facility must allow the Department reasonable access and must cooperate with any investigation or inspection conducted by Department staff.

21 Adult Day Center Rules Questions? Next Steps: Department respectfully requests the Board’s favorable consideration of these proposed rules for initial adoption