HB 529

1	A bill to be entitled
2	An act relating to adult day care centers; providing a
3	short title; providing definitions; providing for the
4	licensure of adult day care centers that provide
5	specialized Alzheimer's services; requiring an adult
6	day care center seeking such licensure to meet
7	specified criteria; providing educational and
8	experience requirements for the operator of an adult
9	day care center seeking licensure to provide
10	specialized Alzheimer's services; providing criteria
11	for staff training and supervision; providing the
12	minimum ratio of staff members to participants;
13	providing requirements for staff orientation;
14	providing requirements for admission into such an
15	adult day care center; requiring that a participant's
16	file include a data sheet, which must be completed
17	within a certain timeframe; requiring that certain
18	information be included in the data sheet; requiring
19	that dementia-specific services be documented in a
20	participant's file; requiring that a participant's
21	plan of care be reviewed each month; requiring that
22	certain notes be entered into a participant's file;
23	requiring the participant to provide the adult day
24	care center with updated medical documentation;
25	requiring the center to give each person who enrolls
26	as a participant or the caregiver a copy of the
27	participant's plan of care and a copy of the center's
28	policies and procedures; requiring the center to
29	coordinate and execute discharge procedures with a
30	participant whose enrollment in the center is
31	involuntarily terminated; providing that only an adult
32	day care center that holds an appropriate license may
33	use the term "adult day care - specialized Alzheimer's
34	services" or advertise that it provides specialized
35	care for persons who have Alzheimer's disease or other
36	dementia-related disorders; authorizing the Department
37	of Elderly Affairs to adopt rules; providing an
38	effective date.
39
40	Be It Enacted by the Legislature of the State of Florida:
41
42	Section 1.  (1)  This act may be cited as the "Alzheimer's
43	Adult Day Care Dignity Act."
44	(2)  As used in this section, the term:
45	(a)  "Dementia" means the loss of at least two intellectual
46	functions, such as thinking, remembering, and reasoning, which
47	is severe enough to interfere with a person's daily function.
48	The term does not describe a disease, but describes a group of
49	symptoms that may accompany certain diseases or physical
50	conditions.
51	(b)  "Specialized Alzheimer's services" means therapeutic,
52	behavioral, health, safety, and security interventions; clinical
53	care; support services; and educational services that are
54	customized for the specialized needs of a participant's
55	caregiver and the participant who is affected by Alzheimer's
56	disease or an irreversible, degenerative condition resulting in
57	dementia.
58	(3)  In addition to the standards required for licensure as
59	an adult day care center under s. 429.917, Florida Statutes, an
60	adult day care center may seek licensure under this section as
61	an adult day care center - specialized Alzheimer's services.
62	(4)  An adult day care center seeking licensure under this
63	section must:
64	(a)  Have a mission statement that includes a commitment to
65	providing dementia-specific services and disclose in the
66	center's advertisements or in a separate document the services
67	that distinguish the care as being suitable for a person who has
68	Alzheimer's disease or a dementia-related disorder.
69	(b)  Provide a program for dementia-specific, therapeutic
70	activities, including, but not limited to, physical, cognitive,
71	and social activities appropriate for a participant's level of
72	function.
73	(c)  Maintain at all times a minimum staff-to-participant
74	ratio of one staff member who provides direct services for every
75	five participants.
76	(d)  Provide a program for therapeutic activity at least 70
77	percent of the time that the center is open to participants.
78	(e)  Use assessment tools that identify the participant's
79	cognitive deficits and identify the specialized and
80	individualized needs of the participant and the caregiver, if
81	applicable. This assessment must be conducted when the
82	participant is initially admitted into the center and must be
83	updated at least annually.
84	(f)  Create an individualized plan of care for each
85	participant which addresses the identified, dementia-specific
86	needs of the participant and the caregiver, if applicable. The
87	plan of care must be established when the participant is
88	initially admitted into the center and reviewed at least
89	monthly.
90	(g)  Conduct a monthly health assessment of the participant
91	which includes, but is not limited to, the participant's weight,
92	vital signs, and level of assistance needed with activities of
93	daily living.
94	(h)  Complete a monthly narrative in the participant's file
95	regarding the participant's status or progress toward meeting
96	the goals indicated on the individualized plan of care.
97	(i)  Assist in the referral or coordination of other
98	dementia-specific services and resources needed by the
99	participant or the caregiver, such as medical services,
100	counseling, medical planning, legal planning, financial
101	planning, safety and security planning, disaster planning,
102	driving assessment, and wandering prevention. The center may
103	establish relationships with providers that have a demonstrated
104	knowledge and commitment to serving participants affected by
105	Alzheimer's disease or a dementia-related disorder and their
106	caregivers.
107	(j)  Offer, facilitate, or provide referrals to a support
108	group for persons who are caregivers to participants who are
109	affected by Alzheimer's disease or a dementia-related disorder.
110	(k)  Provide to participants and caregivers at least one
111	dementia-specific educational program every 3 months.
112	(l)  Conduct and document at least three times each day a
113	count of all participants present in the center. This count must
114	be compared to each participant's attendance record to ensure
115	that a participant is not missing from the center.
116	(m)  Be a secured unit or have working, audible alarm
117	devices installed on every door that provides egress from the
118	center and is accessible to the participants.
119	(n)  Not allow a participant to administer his or her own
120	medication.
121	(o)  Not allow a participant to drive himself or herself to
122	or from the center.
123	(5)(a)  The operator of an adult day care center licensed
124	under this section, or the operator's designee, must:
125	1.  Have at least a bachelor's degree in health care
126	services, social services, or a related field, 1 year of
127	supervisory experience in a social services or health care
128	services setting, and a minimum of 1 year of experience in
129	providing dementia-specific services;
130	2.  Be licensed as a registered nurse, have 1 year of
131	supervisory experience in a social services or health care
132	services setting, and have a minimum of 1 year of experience in
133	providing dementia-specific services; or
134	3.  Have 5 years of supervisory experience in a social
135	services or health care services setting and a minimum of 3
136	years of experience in providing dementia-specific services.
137	(b)  An adult day care center licensed under this section
138	must provide the following staff training and supervision:
139	1.  A registered nurse or licensed practical nurse must be
140	on site during all hours of program operation. Each licensed
141	practical nurse who works at the center must be supervised in
142	accordance with chapter 464, Florida Statutes.
143	2.  Each employee who has direct contact with participants
144	must complete 4 hours of state-approved, dementia-specific
145	training within the first 3 months following employment.
146	3.  Each employee who provides direct care to participants
147	must complete an additional 4 hours of state-approved training
148	in dementia within 6 months following employment.
149	4.  A staff member who provides direct care to a
150	participant must provide hands-on assistance and care with the
151	participant's activities of daily living.
152	(c)  The plan for staff orientation must include, at a
153	minimum:
154	1.  Information regarding Alzheimer's disease and other
155	dementia-related disorders.
156	2.  Procedures to locate a participant who has wandered
157	from the center. These procedures must be reviewed at least once
158	every 3 months with all direct care staff.
159	3.  Information on the Silver Alert program in this state.
160	4.  Information regarding available products or programs
161	used to identify participants or prevent them from wandering
162	away from the center.
163	(6)(a)  In order to be admitted as a participant into an
164	adult day care center licensed under this section, a person:
165	1.  Must have a documented diagnosis of Alzheimer's disease
166	or a dementia-related disorder from a physician licensed in this
167	state.
168	2.  Must require ongoing supervision to maintain the
169	highest level of medical or custodial functioning and have a
170	demonstrated need for a responsible party to oversee his or her
171	care.
172	3.  Must be mobile to the degree that the person can bear
173	enough weight to assist in transferring himself or herself
174	between seated and standing positions.
175	4.  Must not require more than two staff members to safely
176	transfer the person from a seated position to a standing
177	position.
178	5.  Must not actively demonstrate aggressive behavior that
179	places himself, herself, or others at risk of harm.
180	6.  Must provide the following medical documentation signed
181	by a physician licensed in this state or a health care provider
182	under the direct supervision of a physician licensed in this
183	state:
184	a.  Any physical or emotional conditions that require
185	medical care;
186	b.  A listing of the current prescribed medications and
187	dosages, diet restrictions, and mobility restrictions; and
188	c.  Proof that the person is free of the communicable form
189	of tuberculosis and free of signs and symptoms of other
190	communicable diseases.
191	(b)  Before a person is admitted as a participant into an
192	adult day care center licensed under this section, the center
193	must determine whether:
194	1.  The medical, psychological, or behavioral support and
195	intervention required by the person can be provided by the
196	center.
197	2.  The resources required to assist with the person's
198	acuity of care and support needed can be provided or coordinated
199	by the center.
200	(7)(a)  A participant's file must include a data sheet,
201	which must be completed within 45 days before or within 24 hours
202	after admission to an adult day care center licensed under this
203	section. The data sheet must contain:
204	1.  Information regarding the status of the participant's
205	enrollment in an identification or wandering-prevention program,
206	including the name of the program; and
207	2.  A current photograph of the participant.
208	(b)  Dementia-specific services must be documented in a
209	participant's file.
210	(c)  A participant's plan of care must be reviewed at least
211	once each month. Notes regarding nursing and social work
212	services provided to the participant and the participant's
213	activities must be entered at least monthly in the participant's
214	file, and must indicate the participant's status or progress
215	toward achieving identified goals. Additional notes must be
216	entered more frequently if indicated by the participant's
217	condition.
218	(d)  A participant shall annually provide the center with
219	updated medical documentation required under subparagraph
220	(6)(a)6., and the center must place that documentation in the
221	participant's file.
222	(8)  An adult day care center licensed under this section
223	must give to each person who enrolls as a participant in the
224	center or the caregiver a copy of the participant's plan of care
225	and a copy of the policies and procedures of the center which
226	must include, but are not limited to, information pertaining to
227	driving for those persons affected by dementia, available
228	technology on wandering-prevention devices and identification
229	devices, the Silver Alert program in this state, and dementia-
230	specific safety interventions and strategies that can be used in
231	the home setting.
232	(9)  If a participant's enrollment in the center is
233	involuntarily terminated due to medical or behavioral reasons,
234	the center shall coordinate and execute appropriate discharge
235	procedures with the participant and the caregiver.
236	(10)  Only an adult day care center licensed under this
237	section may use the term "adult day care - specialized
238	Alzheimer's services" and advertise that the center provides
239	specialized care for persons who have Alzheimer's disease or
240	other dementia-related disorders.
241	(11)  The Department of Elderly Affairs may adopt rules to
242	administer this section.
243	Section 2.  This act shall take effect July 1, 2012.

CODING: Words stricken are deletions; words underlined are additions.