Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. SB 694
       
       
       
       
       
       
                                Barcode 649566                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/12/2012           .                                
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       The Committee on Children, Families, and Elder Affairs (Detert)
       recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (2) of section 429.917, Florida
    6  Statutes, is amended to read:
    7         429.917 Patients with Alzheimer’s disease or other related
    8  disorders; staff training requirements; certain disclosures.—
    9         (2) A center licensed under this part which claims that it
   10  provides special care for persons who have Alzheimer’s disease
   11  or other related disorders must disclose in its advertisements
   12  or in a separate document those services that distinguish the
   13  care as being especially applicable to, or suitable for, such
   14  persons. The center must give a copy of all such advertisements
   15  or a copy of the document to each person who requests
   16  information about the center and must maintain a copy of all
   17  such advertisements and documents in its records. The agency
   18  shall examine all such advertisements and documents in the
   19  center’s records as part of the license renewal procedure. An
   20  adult day care center may not claim to be licensed to provide
   21  specialized Alzheimer’s services unless it has been licensed
   22  pursuant to s. 429.918.
   23         Section 2. Section 429.918, Florida Statutes, is created to
   24  read:
   25         429.918Certification for specialized Alzheimer’s
   26  services.—
   27         (1) This act may be cited as the “Specialized Alzheimer’s
   28  Services Adult Day Care Act.”
   29         (2) As used in this section, the term:
   30         (a) “ADRD participant” means a participant who has a
   31  documented diagnosis of Alzheimer’s disease or a dementia
   32  related disorder (ADRD) from a licensed physician or a health
   33  care provider who is under the direct supervision of a licensed
   34  physician.
   35         (b) “Dementia” means the loss of at least two intellectual
   36  functions, such as thinking, remembering, and reasoning, which
   37  is severe enough to interfere with a person’s daily function.
   38  The term does not describe a disease, but describes a group of
   39  symptoms that may accompany certain diseases or physical
   40  conditions.
   41         (c) “Specialized Alzheimer’s services” means therapeutic,
   42  behavioral, health, safety, and security interventions; clinical
   43  care; support services; and educational services that are
   44  customized for the specialized needs of a participant’s
   45  caregiver and the participant who is affected by Alzheimer’s
   46  disease or an irreversible, degenerative condition resulting in
   47  dementia.
   48         (3) In addition to the standards required for licensure as
   49  an adult day care center under this part, an adult day care
   50  center may seek voluntary licensure under this section as an
   51  adult day care center - specialized Alzheimer’s services.
   52         (4) An adult day care center seeking licensure under this
   53  section must:
   54         (a) Have a mission statement that includes a commitment to
   55  proving dementia-specific services and disclose in the center’s
   56  advertisements or in a separate document the services that
   57  distinguish the care as being suitable for a person who has
   58  Alzheimer’s disease or a dementia-related disorder.
   59         (b) Provide ADRD participants with a program for dementia
   60  specific, therapeutic activities, including, but not limited to,
   61  physical, cognitive, and social activities appropriate for the
   62  ADRD participant’s age, culture, and level of function.
   63         (c) Maintain at all times a minimum staff-to-participant
   64  ratio of one staff member who provides direct services for every
   65  five ADRD participants.
   66         (d) Provide ADRD participants with a program for
   67  therapeutic activity at least 70 percent of the time that the
   68  center is open.
   69         (e) Provide ADRD participants with hands-on assistance with
   70  activities of daily living, inclusive of the provision of
   71  urinary and bowel incontinence care.
   72         (f) Use assessment tools that identify the ADRD
   73  participant’s cognitive deficits and identify the specialized
   74  and individualized needs of the ADRD participant and the
   75  caregiver. This assessment shall be conducted when the ADRD
   76  participant is initially admitted into the center and shall be
   77  updated when the ADRD participant experiences a significant
   78  change, but no less frequently than annually.
   79         (g) Create an individualized plan of care for each ADRD
   80  participant which addresses the identified, dementia-specific
   81  needs of the ADRD participant and the caregiver. The plan of
   82  care shall be established when the ADRD participant is initially
   83  admitted into the center and reviewed at least quarterly.
   84         (h) Conduct a monthly health assessment of each ADRD
   85  participant which includes, but is not limited to, the ADRD
   86  participant’s weight, vital signs, and level of assistance
   87  needed with activities of daily living.
   88         (i) Complete a monthly update in each ADRD participant’s
   89  file regarding the ADRD participant’s status or progress toward
   90  meeting the goals indicated on the individualized plan of care.
   91         (j) Assist in the referral or coordination of other
   92  dementia-specific services and resources needed by the ADRD
   93  participant or the caregiver, such as medical services,
   94  counseling, medical planning, legal planning, financial
   95  planning, safety and security planning, disaster planning,
   96  driving assessment, transportation coordination, or wandering
   97  prevention.
   98         (k) Offer, facilitate, or provide referrals to a support
   99  group for persons who are caregivers to ADRD participants.
  100         (l) Provide dementia-specific educational materials
  101  regularly to ADRD participants, as appropriate, and their
  102  caregivers.
  103         (m) Routinely conduct and document a count of all ADRD
  104  participants present in the center throughout each day. This
  105  count must be compared to each ADRD participant’s attendance
  106  record in order to ensure that an ADRD participant is not
  107  missing from the center.
  108         (n) Be a secured unit or have working alarm or security
  109  devices installed on every door that is accessible to the ADRD
  110  participant and provides egress from the center or areas of the
  111  center designated for the provision of adult day care -
  112  specialized Alzheimer’s services.
  113         (o) Not allow an ADRD participant to administer his or her
  114  own medication.
  115         (p) Not allow an ADRD participant to drive himself or
  116  herself to or from the center.
  117         (5) The operator of an adult day care center licensed under
  118  this section, and the operator’s designee, as applicable, hired
  119  on or after July 1, 2012, shall:
  120         (a) Have at least a bachelor’s degree in health care
  121  services, social services, or a related field, 1 year of
  122  supervisory experience in a social services or health care
  123  services setting, and a minimum of 1 year of experience in
  124  providing services to persons who have dementia;
  125         (b) Be a registered or practical nurse licensed in this
  126  state, have 1 year of supervisory experience in a social
  127  services or health care services setting, and have a minimum of
  128  1 year of experience in providing services to persons who have
  129  dementia; or
  130         (c) Have 5 years of supervisory experience in a social
  131  services or health care services setting and a minimum of 3
  132  years of experience in providing services to persons who have
  133  dementia.
  134         (6)(a) An adult day care center licensed under this section
  135  must provide the following staff training and supervision:
  136         1. A registered nurse or licensed practical nurse must be
  137  on site daily for at least 75 percent of the time that the
  138  center is open to ADRD participants. Each licensed practical
  139  nurse who works at the center must be supervised in accordance
  140  with chapter 464.
  141         2. Upon beginning employment with the center, each employee
  142  must receive basic written information about interacting with
  143  ADRD participants.
  144         3. In addition to the information provided in subparagraph
  145  2., every employee hired on or after July 1, 2012, who has
  146  direct contact with ADRD participants shall complete 4 hours of
  147  dementia-specific training within 3 months after employment.
  148         4. In addition to the requirements of subparagraphs 2. and
  149  3., each employee hired on or after July 1, 2012, who provides
  150  direct care to ADRD participants shall complete an additional 4
  151  hours of dementia-specific training within 6 months after
  152  employment.
  153         (b) The Department of Elderly Affairs or its designee shall
  154  approve the training required under this section. The department
  155  shall adopt rules to establish standards for employees who are
  156  subject to this training, for trainers, and for the training
  157  required in this section.
  158         (c) Upon completing any training described in this section,
  159  the employee shall be issued a certificate that includes the
  160  name of the training provider, the topics covered, and the date
  161  and signature of the training provider. The certificate is
  162  evidence of completion of training in the identified topics, and
  163  the employee is not required to repeat training in those topics
  164  if the employee changes employment to a different adult day care
  165  center.
  166         (d) Each employee hired on or after July 1, 2012, who
  167  provides direct care to ADRD participants, must receive an
  168  orientation plan that includes, at a minimum:
  169         1. Procedures to locate an ADRD participant who has
  170  wandered from the center. These procedures shall be reviewed
  171  regularly with all direct care staff.
  172         2. Information on the Silver Alert program in this state.
  173         3. Information regarding available products or programs
  174  used to identify ADRD participants or prevent them from
  175  wandering away from the center, their home, or other locations.
  176         (7)(a) An ADRD participant admitted to an adult day care
  177  center licensed under this section must:
  178         1. Require ongoing supervision to maintain the highest
  179  level of medical or custodial functioning and have a
  180  demonstrated need for a responsible party to oversee his or her
  181  care.
  182         2. Not actively demonstrate aggressive behavior that places
  183  himself, herself, or others at risk of harm.
  184         3. Provide the following medical documentation signed by a
  185  licensed physician or a health care provider who is under the
  186  direct supervision of a licensed physician:
  187         a. Any physical, health, or emotional conditions that
  188  require medical care.
  189         b. A listing of the ADRD participant’s current prescribed
  190  and over-the-counter medications and dosages, diet restrictions,
  191  mobility restrictions, and other physical limitations.
  192         4. Provide documentation signed by a health care provider
  193  licensed in this state which indicates that the ADRD participant
  194  is free of the communicable form of tuberculosis and free of
  195  signs and symptoms of other communicable diseases.
  196         (b) Before admitting an ADRD participant to an adult day
  197  care center licensed under this section, the center shall
  198  determine whether:
  199         1. The medical, psychological, safety, and behavioral
  200  support and intervention required by the ADRD participant can be
  201  provided by the center.
  202         2. The resources required to assist with the ADRD
  203  participant’s acuity level of care and support needed can be
  204  provided or coordinated by the center.
  205         (8)(a) An ADRD participant’s file must include a data
  206  sheet, which must be completed within 45 days before or within
  207  24 hours after admission to an adult day care center licensed
  208  under this section. The data sheet must contain:
  209         1. Information regarding the status of the ADRD
  210  participant’s enrollment in an identification or wandering
  211  prevention program, including the name of the program; and
  212         2. A current photograph of the ADRD participant.
  213         (b) Dementia-specific services shall be documented in the
  214  ADRD participant’s file.
  215         (c) An ADRD participant’s plan of care must be reviewed at
  216  least quarterly. Notes regarding services provided to the ADRD
  217  participant must be entered at least monthly in the ADRD
  218  participant’s file, and must indicate the ADRD participant’s
  219  status or progress toward achieving identified goals. Additional
  220  notes must be entered more frequently if indicated by the ADRD
  221  participant’s condition.
  222         (d) An ADRD participant shall annually provide the center
  223  with updated medical documentation required under subparagraphs
  224  (7)(a)3. and 4., and the center must place that documentation in
  225  the ADRD participant’s file.
  226         (9) An adult day care center licensed under this section
  227  must give to each person who enrolls as an ADRD participant in
  228  the center, or the caregiver, a copy of the ADRD participant’s
  229  plan of care, as well as information regarding resources to
  230  assist in ensuring the safety and security of the ADRD
  231  participant, which must include, but need not be limited to,
  232  information pertaining to driving for those persons affected by
  233  dementia, available technology on wandering-prevention devices
  234  and identification devices, the Silver Alert program in this
  235  state, and dementia-specific safety interventions and strategies
  236  that can be used in the home setting.
  237         (10) If an ADRD participant’s enrollment in the center is
  238  involuntarily terminated due to medical or behavioral reasons,
  239  the center shall coordinate and execute appropriate discharge
  240  procedures with the ADRD participant and the caregiver.
  241         (11) This section does not prohibit an adult day care
  242  center that does not become licensed under this section from
  243  providing adult day care services to persons who have
  244  Alzheimer’s disease or other dementia-related disorders.
  245         (12) The Department of Elderly Affairs may adopt rules to
  246  administer this section.
  247         Section 3. This act shall take effect July 1, 2012.
  248  
  249  ================= T I T L E  A M E N D M E N T ================
  250         And the title is amended as follows:
  251         Delete everything before the enacting clause
  252  and insert:
  253                        A bill to be entitled                      
  254         An act relating to adult day care centers; amending s.
  255         429.917, F.S.; prohibiting an adult day care center
  256         from claiming to be licensed to provide specialized
  257         Alzheimer’s services under certain circumstances;
  258         creating s. 429.918, F.S.; providing a short title;
  259         providing definitions; providing for the voluntary
  260         licensure of adult day care centers that provide
  261         specialized Alzheimer’s services; requiring an adult
  262         day care center seeking such licensure to meet
  263         specified criteria; providing educational and
  264         experience requirements for the operator of an adult
  265         day care center seeking licensure to provide
  266         specialized Alzheimer’s services; providing criteria
  267         for staff training and supervision; requiring that the
  268         Department of Elderly Affairs approve the staff
  269         training; requiring the department to adopt rules;
  270         requiring that the employee be issued a certificate
  271         upon completion of the staff training; providing
  272         requirements for staff orientation; providing
  273         requirements for admission into such an adult day care
  274         center; requiring that a participant’s file include a
  275         data sheet, which shall be completed within a certain
  276         timeframe; requiring that certain information be
  277         included in the data sheet; requiring that dementia
  278         specific services be documented in a participant’s
  279         file; requiring that a participant’s plan of care be
  280         reviewed quarterly; requiring that certain notes be
  281         entered into a participant’s file; requiring the
  282         participant to provide the adult day care center with
  283         updated medical documentation; requiring the center to
  284         give each person who enrolls as a participant, or the
  285         caregiver, a copy of the participant’s plan of care
  286         and safety information; requiring that the center
  287         coordinate and execute discharge procedures with a
  288         participant who has a documented diagnosis of
  289         Alzheimer’s disease or a dementia-related disorder and
  290         the caregiver if the participant’s enrollment in the
  291         center is involuntarily terminated; providing that the
  292         act does not prohibit an adult day care center that
  293         does not become licensed to provide specialized
  294         Alzheimer’s services from providing adult day care
  295         services to persons who have Alzheimer’s disease or
  296         other dementia-related disorders; authorizing the
  297         Department of Elderly Affairs to adopt rules;
  298         providing an effective date.