Section 1640. Participation standards for provision of services

A. Facilities must have a signed provider agreement approved by DMAS to provide AAL Waiver services.

B. The facility must provide a safe, secure environment for waiver individuals. There may be one or more self-contained special care units in a facility or the whole facility may be a special care unit. Personalized care must be furnished to individuals who reside in their own living units, with semi-private rooms limited to two individuals and bathrooms consistent with 22VAC40-72-890.

C. Support in a facility must be furnished in a way that fosters the independence of each individual to age in place. Routines of care provision and service delivery must be individual-driven to the maximum extent possible and each individual must be treated with dignity and respect.

D. The medical care of individuals must be under the direction and supervision of a licensed physician. This can be the individual's private physician. The facility must ensure that residents have appointments with their physicians at least annually, and additionally as needed as determined by the physician.

E. Administrators.

1. Administrators of participating assisted living facilities must meet the regulatory requirements as set forth by the Virginia Department of Social Services (22VAC40-72-191) and the Board of Long-Term Care Administrators (18VAC95-30).

2. The administrator shall demonstrate knowledge, skills and abilities in the administration and management of an assisted living facility program including:

a. Knowledge and understanding of older adults who have impairments or individuals with disabilities;

b. Supervisory and interpersonal skills;

c. Ability to plan and implement the program; and

d. Knowledge of financial management sufficient to ensure program development and continuity.

3. The administrator shall demonstrate knowledge of supervisory and motivational techniques sufficient to:

a. Accomplish day-to-day work;

b. Train, support and develop staff; and

c. Plan responsibilities for staff to ensure that services are provided to individuals.

4. The administrator shall complete 20 hours of continuing education annually to maintain and develop skills. This training shall be in addition to first aid and CPR, and orientation training to be received upon commencement of employment.

F. Licensed health care professional (LHCP) requirements.

1. Each facility shall have at least one LHCP awake, on duty, and on-site in the facility for at least eight hours a day, five days each week. In addition, the facility shall provide for emergency call coverage at all hours of the day and night.

2. The LHCP is responsible for staff training, individual summaries, individual service plans, and medication oversight.

3. Individuals' summaries.

a.. Admissions summary. An LHCP must complete an admissions summary of each individual upon admission. The admissions summary includes the UAI and other relevant social, psychological, and medical information. The admissions summary must also include the physician's assessment information as contained in 22VAC40-72-40 and 22VAC40-72-440. The admissions summary must be updated yearly and when a significant change in an individual's health status or behavior occurs. The information gathered during the preparation of the admissions summary is used to create the individual's service plan as contained in 22VAC40-72-40 and 22VAC40-72-440.

b. Individual service plan. Based on the specific individual's admission summary and the UAI, the LHCP, in coordination with other caregivers including the individual's authorized representative, as may be appropriate, shall:

(1) Develop the individual's service plan and formulate interventions to address the specific problems identified;

(2) Evaluate both the facility's implementation and the individual's response to the plan of care; and

(3) Review and update the individual service plan at least quarterly and more often when necessary to meet the needs of the individual.

c. Monthly summary. The LHCP must complete a monthly summary. Significant changes documented on the monthly summary must be addressed in an updated individual service plan. The comprehensive admissions summary information shall also be updated as needed. At a minimum, the monthly summary must contain information about the following elements:

(1) Weight loss;

(2) Falls;

(3) Elopements;

(4) Behavioral issues;

(5) Adverse reactions to prescribed medications;

(6) Dehydration;

(7) Pressure ulcers;

(8) Fecal impaction;

(9) Cognitive changes;

(10) Change in diagnoses; and

(11) Change in levels of dependence in ADLs.

4. The facility's LHCP may also serve as the administrator. In all instances where the facility's LHCP is assigned duties as an administrator, the facility shall assure that the LHCP devotes sufficient time and effort to all clinical duties to secure health, safety, and welfare of individuals.

G. Structured activities program. There shall be a designated employee responsible for managing or coordinating the structured activities program. This employee shall be on site in the special care unit at least 20 hours a week, shall maintain personal interaction with the residents and familiarity with their needs and interests, and shall meet at least one of the following qualifications:

1. Be a qualified therapeutic recreation specialist or activities professional;

2. Be eligible for certification as a therapeutic recreation specialist or an activities professional by a recognized accrediting body;

3. Have at least one year full-time work experience within the last five years in an activities program in an adult care setting;

4. Be a qualified occupational therapist or an occupational therapy assistant; or

5. Prior to or within six months of employment, have successfully completed 40 hours of VDSS-approved training.

H. Direct care staff. In order to provide services in this waiver, the assisted living facility must use staff who comply with 22VAC40-72-250, 22VAC40-72-1110, and 22VAC40-72-1120 in staffing the specialty care unit.

I. The assisted living facility must have sufficient qualified and trained staff to meet the needs of the individuals living in the facility at all times.

J. There must be at least two ] awake direct care staff in the special care unit at all times and more if dictated by the needs of the individuals living in the special care unit, in accordance with 22VAC40-72-1110.

K. Training requirements for all staff.

1. All staff who have contact with individuals living in the facility, including the administrator, shall have completed 12 hours of Alzheimer's or related dementia-specific training within 30 days of employment. The training must be conducted by a health care educator, adult education professional, or a licensed professional, with expertise in Alzheimer's or related dementia. The health care educator, adult education professional, or licensed professional must be acting within the scope of his profession, have had at least 12 hours of training in the support of individuals with cognitive impairments due to Alzheimer's or related dementia prior to performing the training, and have had a minimum of three years experience in the health care or dementia fields. In addition to health care educators and adult education professionals, licensed professionals eligible to conduct this training may include, but shall not necessarily be limited to: physicians, psychologists, registered nurses, licensed practical nurses, occupational therapists, physical therapists, speech-language therapists, licensed clinical social workers, or licensed professional counselors.

2. All direct support staff must receive annual training in accordance with 22VAC40-72-250 and 22VAC40-72-260, with at least eight hours of training in the care of individuals living with dementia and medical nursing needs. This training may be incorporated into the existing training program and must address the medical nursing needs specific to each individuals living in the facility in the special care unit. This training must also incorporate problem areas that may include weight loss, falls, elopements, behavioral issues, and adverse reactions to prescribed medications. A health care educator, adult education professional or licensed professional with expertise in dementia must conduct this training.

L. Documentation. The assisted living facility shall maintain the following documentation for review by DMAS staff for each individual living in the assisted living facility:

1. All UAIs, authorization forms, individual service plans and summaries and individuals' admissions completed for the individuals living in the facility shall be maintained for a period not less than six years from the waiver individual's start of service in that facility;

2. All written communication related to the provision of services between the facility and the assessor, licensed health care professional, DMAS, VDSS, the waiver individual, or other related parties; and

3. A log that documents each day that the waiver individual is present in the facility.

Historical Notes

Derived from Volume 23, Issue 20, eff. July 11, 2007; amended, Virginia Register Volume 28, Issue 20, eff. July 5, 2012.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.