What s Involved in Opening and Operating a Social Model Adult Day Care Program?

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1 What s Involved in Opening and Operating a Social Model Adult Day Care Program? Anne Hill, Policy Analyst ADHCC Elizabeth Grennille, BSN, RN, Program Director, DayBreak and Elant at Goshen ADHC Martha S. Wolf, MA, NCC, QDCP, Director of Community Dementia Care, Parker Jewish Institute How did we get here? Mandatory enrollment into MLTC opened flood gates to social model Influx of SADC programs in NYC; Senior Health Partners has 105 contracts SADC is a cheaper option for MLTCs than ADHC; SADC often paired with home care 1

2 How did we get here? Without MLTC contracts, it will not be financially feasible to operate a SADC Prior to mandatory MLTC, NYC had a shortage of social models Social model and/or community center NOT qualifier for mandatory enrollment into MLTC MLTC plans also contracting with senior centers for nutrition; senior centers do not need to follow social model regs. How did we get here? DOH is requiring all social models that wish to contract with MLTC plans MUST follow the NYSOFA Social Adult Day Care minimal standards of operation (NYCRR Title 9 Section ) Eff. March 1994 Responsibility is on the MLTC plan for ensuring social model complies with regulations 2

3 Key Concepts of SADC Any person or entity may open social model There is no CON and you do not need to notify or register your program with the state Program must have sufficient space to operate SADC provides functionally impaired individuals with core and optional services MLTC plans with which you contract will enforce regulatory compliance Regulations were written to allow for flexibility NYSOFA Minimum Standards Definition of program SADC program means a structured, comprehensive program which provides functionally impaired individuals with socialization; supervision and monitoring; personal care; and nutrition in a protective setting during any pry of the day, but for less than a 24 hour period Definition of functionally impaired client Functionally impaired means needing the assistance of another person in at least one o the following activities of daily living: toileting, mobility, transferring, or eating; or needing supervision due to cognitive and/or psycho-social impairment 3

4 Admission and Discharge Program must serve only individuals whose social adult day care needs can be met and managed by the program Assessment of functional capacities and impairments must be conducted Discharge participants who can no longer be safely or adequately served by the program The program, or MLTC, will assist in making other arrangements for care The Service Plan Each participant receives services in accordance with service plan written and developed by program staff, participant and/or participant s authorized rep Developed no later than 30 days after admission and reviewed at least annually Service plan based on assessment Must seek to attain and maintain the highest practicable physical, mental and psychosocial well being of the participant, including optimal capacity for independence and self care Must encourage the participant to use his/her existing capacities, develop new capacities and interests and compensate for existing or developing impairments in capacity Must specify the individual participant outcomes expected from the provision of SADC services 4

5 Required Services Required Socialization Supervision and monitoring Personal Care (some assistance PC Level II) Nutrition Optional Maintenance and enhancement of daily living skills Transportation between the home and program Caregiver assistance Case coordination Required Services Socialization Planned and structured activities which utilize the participant s skills, respond to participant s interests, capabilities, and needs; and minimize any impairments in capacity to engage in those activities Includes social, intellectual, cultural, educational and physical group activities Encourages participant to interact with others and seeks to establish, maintain, or improve sense of usefulness, sense of self-respect 5

6 Required Services Supervision and monitoring Observation and awareness of participant s whereabouts, activities, and current needs while at program Protects the safety and welfare of the participant and provides ongoing encouragement and assistance to the participant Required Services Personal Care - Some assistance with: Toileting Mobility Transfer Eating 6

7 Required Services Nutrition Provide nutritious meals for participants who are attending the program at normal meal times and includes offering snacks and liquids for all participants at appropriate times. Meals may be brought by the participant or provided by or consistent with the USDA Child and Adult Care Food Program. Optional Services Personal Care TOTAL assistance with toileting, mobility, transfer, and eating Some assistance or total assistance with dressing, bathing, grooming, self administration of medication (including prompting the participant as to time, identifying medication, opening container and disposing of used supplies/materials Routine skin care Changing simple dressing or Using supplies and adaptive and assistive equipment 7

8 Optional Services Maintenance and enhancement of daily living skills Transportation to and from the program Caregiver assistance Case coordination Policies and Procedures Participant eligibility Admission and discharge Service plan Staffing plan (including paid and volunteers) Participants rights Services delivery Program self evaluation Records and Emergency preparedness 8

9 Policies and Procedures Conduct a self evaluation of its administrative, fiscal, and program operations, including feedback from participants and caregivers, at least annually Maintain a copy of the self evaluation on file for review by the MLTC (or AAA) Records The program must maintain and keep confidential the following information on file: Administrative and financial records Participant personal records, including identifying, emergency and medical information including physician name, diagnosis, and medications Services records, including the individual assessment, service plan, and documentation of the delivery of services 9

10 Staffing The program shall have an adequate number of qualified staff, which may include volunteers, to perform all of the functions prescribed in the Part and to ensure the health, safety and welfare of participants The program must have at least two staff, one which must be paid, with the participants during the program day Each program must have a paid director Staff must have PPD test prior to employment and every 2 years Duties of program director Shall be a qualified individual with appropriate educational qualifications and work experience to ensure that activities and services are provided appropriately Ensure compliance with local, State, and Federal laws Submit reports as necessary Responsible for P&P 10

11 Personnel, cont. Services Staff Volunteers Responsible for carrying out service plan Complete training as required Must have appropriate training (as determined by program director) for assigned tasks Training Requirements for All Staff Orientation to the program provider, community and program itself Training on working with the elderly, participants rights, safety and accident prevention At least 6 hours in-service training annually Training annually in the use of fire extinguishers, evacuation and emergencies Training appropriate to the tasks must be provided and documented 11

12 Training Requirements for Service Staff, including volunteers Orientation to personal care skills Body mechanics Behavior management Within 3 months must complete additional training directed by RN, social worker, home economist, and/or other appropriate professional with at least a BA or 4 years related professional experience Training Requirements for Service Staff, including volunteers Training must total at least 20 hours Socialization skills and activities Supervision and monitoring Personal care skills, taught by RN Family and family relationships Mental illness and mental health CPR Must include evaluation of competency in each area 12

13 Training Certified PCA, HHA, CNA have met requirements Program must document training for all staff and volunteers Program must provide all service staff with periodic on-the-job training to evaluate job performance Physical Environment and Safety Must have sufficient space to accommodate program activities and services Notify in writing the local fire dept. of program and hours of operation Program must have current and written pro Emergency contact file for each participant Conduct fire drills 2/year Efficient insurance, including personal and professional liability 13

14 Participants Rights Program must protect and promote participant rights Program must give copy and explain rights at admission Program must post these rights, along with the addresses and telephone numbers of the AAA in a public space visible to participants, families and staff Morphing Your ADHC ADHC and SADC are not permitted to operate in the same space at the same time using the same staff If you open a SADC within the nursing home space, check to ensure that insurance policies will cover this activity and are updated 14

15 Morphing Your ADHC Can I operate a SADC in the ADHC space during off-hours Yes SADC is unlicensed, therefore, you DO NOT need to obtain a license, certification or permission from NYS to operate. You would have to follow SOFA regulations for SADC if you have a contract(s) with an MLTC(s). If you were replacing a second ADHC session with a SADC, you would have to notify DOH in writing and receive their approval to discontinue your second session. SADC operations cannot compromise the designated use or character of the ADHC space. Risks - an aggressive auditor could attempt to disallow a portion of the capital costs allocated to ADHC. Existing insurance policies check to ensure they would cover SADC in this space. Operator s lease, if any, should be reviewed to ensure there is no conflict. Morphing Your ADHC Can I reduce the capacity of my ADHC and physically divide my ADHC to make space for a SADC Yes Since you are both lowering your capacity and changing your physical space, currently you would have to file a Limited Review Certificate of Need (CON) application For changes to the physical space, you would be required to follow the environmental standards in place at the time you opened your program. Environmental standards are available at CON information/application is available at: tion/reviewprocess.htm 15

16 Questions about reconfiguring your ADHC space? Discuss the exact configuration with the architects at DOH and see if they think it will be a change in the ADHC space. The contact person is Richard Zlattner at Bottom Line Participants MUST be functionally impaired SADC MUST provide socialization, supervision, personal care and nutrition Each participant MUST have a service plan developed by staff, participant and/or caregiver within 30 days of admission and reviewed annually; service plan MUST be based on the assessment and include services delivered and individual outcomes 16

17 Thank you Questions? Anne S. Hill Policy Analyst/Operations Coordinator , ext