Additional Requirements for Specialized

When deciding to include a memory care unit in your community you must be diligent to ensure the following regulations are followed closely due to the enhanced care that dementia-related diseases require:

111-8-63-.19 Additional Requirements for Specialized

Memory Care Units

(1) In addition to all other requirements contained in this Chapter, where an assisted living community holds itself out as providing additional or specialized care to persons with probable diagnoses of Alzheimer’s Disease or other dementia or charges rates in excess of that charged other residents because of cognitive deficits which may place the residents at risk of eloping, the assisted living community must meet the following requirements:

(a) Written Description Requirements. The assisted living community must include in its licensed residential care profile an accurate written description of the special care unit that includes the following:

  1. a statement of philosophy and mission;
  2. how the services and activities of the special care unit are different from those provided in the rest of the assisted living community;
  3. staffing including job titles of staff who work in the unit, staff training, and continuing education requirements;
  4. admission procedures, including screening criteria;
  5. assessment and service planning protocol, including criteria to be used that, would trigger a reassessment of the resident’s status before the customary quarterly review;
  6. staffing patterns, including the ratio of direct care staff to the resident for a 24-hour cycle, and a description of how the staffing pattern differs from that of the rest of the program;
  7. a description of the physical environment including safety and security features;
  8. a description of activities, including frequency and type, and how the activities meet the needs of residents with dementia
  9. the program’s fee or fee structure for all services provided by the unit or assisted living community;
  10. discharge criteria and procedures
  11. the procedures that will be utilized for handling emergency situations; and
  12. the involvement of the unit with families and family support programs.

(b) Physical Design, Environment, and Safety. The memory care unit or special care unit must be designed to accommodate residents with severe dementia or Alzheimer’s Disease in an assisted living community-like environment which

includes the following:

  1. multipurpose room(s) for dining, group, and individual activities which are appropriately furnished to accommodate the activities taking place;
  1. secured outdoor spaces and walkways which are wheelchair accessible and allow residents to ambulate safely but prevent undetected egress;
  1. the high visual contrast between floors and walls and doorways and walls in resident use areas-except for fire exits, door and access ways which may be designed to minimize contrast to conceal areas where the residents should not enter;
  1. adequate and even lighting which minimizes glare and shadows;
  1. the free movement of the resident, as the resident chooses, between the common space and the resident’s own personal space in a bedroom that accommodates no more than two (2) residents;
  1. individually identified entrances to residents’ rooms to assist residents in readily identifying their own personal spaces;
  1. an effective automated device or system to alert staff to individuals entering or leaving the unit in an unauthorized manner. An assisted living community need not use an automated alert for an exit door when the particular exit is always staffed by a receptionist or other staff member who views and maintains a log of individuals entering and leaving the assisted living community. If the exit door is not always staffed, then the assisted living community must activate an automated alert when the door is not attended;
  1. communication system(s) which permit staff in the unit to communicate with other staff outside the unit and with emergency services personnel as needed; and
  1. a unit providing specialized memory care services that undergoes major renovation or is first constructed after December 9, 2009, must be designed and constructed in compliance with applicable state and local building and fire codes relevant to the specialized unit and the assisted living community.

(c) Staffing and Initial Staff Orientation. The assisted living community must ensure that the container unit is staffed with sufficient specially trained staff to meet the unique needs of

the residents in the unit.

  1. At a minimum, the assisted living community must employ certified medication aides in the unit to administer certain medications.
  1. At least one staff member who is awake and supervising the unit at all times and sufficient numbers of trained staff on duty at all times to meet the needs of the residents.
  1. Staff who, prior to caring for residents independently, have successfully completed an orientation program that includes at least the following components in addition to the general training required in Rule 111-8-63-.09:

(i) the assisted living community’s philosophy related to the care of residents with dementia in the unit;

(ii) the assisted living community’s policies and procedures related to care in the unit and the staff’s particular responsibilities including wandering and egress control; and

(iii) an introduction to common behavior problems characteristic of residents residing in the unit and recommended behavior management techniques.

(d) Initial Staff Training. Within the first six months of employment, staff assigned to the unit shall receive training in the following topics:

  1. the nature of Alzheimer’s Disease and other dementias, including the definition of dementia, and knowledge of dementia-specific care needs;
  1. common behavior problems and recommended behavior management techniques;
  1. communication skills that facilitate better resident-staff relations;
  1. positive therapeutic interventions and activities such as exercise, sensory stimulation, activities of daily living skills;
  1. the role of the family in caring for residents with dementia, as well as the support needed by the family of these residents;
  1. environmental modifications that can avoid problematic behavior and create a more therapeutic environment;
  1. development of comprehensive and individual service plans and how to update or provide relevant information for updating and implementing them consistently across all shifts, including establishing baseline care needs;
  1. new developments in dementia care that impact the approach to caring for the residents in the special unit;
  1. skills for recognizing physical or cognitive changes in the resident that warrant seeking medical attention; and
  1. skills for maintaining the safety of residents with dementia.

(e) Special Admission Requirements for Unit Placement. Residents must have a physician’s report of a physical examination completed within 30 days prior to admission to the community or unit on forms made available by the Department. The physical examination must clearly reflect that the resident has a diagnosis

of probable Alzheimer’s Disease or other dementia and has symptoms that demonstrate a need for placement in the specialized unit. However, the unit may also care for a resident who does not have a probable diagnosis of Alzheimer’s Disease or other dementia, but desires to live in this unit and waives his or her right to live in a less restrictive environment. In addition, the physical examination report must establish that the potential resident of the unit does not require 24-hour skilled nursing care.

(f) Post-Admission Assessment. If the resident is admitted directly into the specialized memory care unit, the unit must obtain an assessment of each resident’s care needs to include the following components: resident’s family supports, level of activities of daily living functioning, physical care needs, and level of behavioral impairment.

(g) Individual Written Care Plan and Reviews. The resident’s written care plan will be developed or updated by staff with at least one member of the specialized memory care staff providing direct care participating. Input from each shift of direct care staff that provides care to the resident will be requested. All team members participating shall sign the written care plan and the plan will be shared with the direct care staff providing care to the resident and serve as a guide for the delivery of care to the resident. The written care plan must be reviewed at least quarterly and modified as changes in the resident’s needs occur.

(h) Therapeutic Activities. The unit shall provide activities appropriate to the needs of the individual residents and adapt the activities, as necessary, to encourage participation of the residents in the following at least weekly with at least some therapeutic activities occurring daily:

  1. gross motor activities; e.g. exercise, dancing, gardening, cooking, etc;
  1. self-care activities; e.g. dressing, personal hygiene/grooming;
  1. social activities; e.g. games, music;
  2. sensory enhancement activities, e.g. distinguishing pictures and picture books, reminiscing and scent and tactile stimulation; and
  1. outdoor activities; e.g. walking outdoors and field trips.
    (2) No licensed assisted living community is permitted to hold itself out as providing specialized care for residents with probable Alzheimer’s disease or other dementia or charge a differential rate for care of residents with cognitive deficits that place the residents at risk of engaging in unsafe wandering

activities (eloping) unless it meets the additional requirements specified in Rule 111-8-63-.19(1) and its subparagraphs (a) through (h) above.

Check out the top three takeaways from the regulations on Additional Requirements for Specialized Memory Care Units:

  1. (d) Initial Staff Training. Within the first six months of employment, staff assigned to the unit shall receive training in the following topics: 1-10

Surveyors will ensure to focus on areas of training, especially when it comes to the training records of those held responsible for maintaining the care of residents who suffer from dementia-related diseases. You must have a system set up for any care staff that could possibly be assigned for the unit. It is recommended that you or your designee verify the completion of this training.

  1. (e) Special Admission Requirements for Unit Placement. Residents must have a physician’s report of a physical examination completed within 30 days prior to admission to the community or unit on forms made available by the Department. The physical examination must clearly reflect that the resident has a diagnosis of probable Alzheimer’s Disease or other dementia and has symptoms that demonstrate a need for placement in the specialized unit. However, the unit may also care for a resident who does not have a probable diagnosis of Alzheimer’s Disease or other dementia, but desires to live in this unit and waives his or her right to live in a less restrictive environment. In addition, the physical examination report must establish that the potential resident of the unit does not require 24-hour skilled nursing care.

Just as any resident moving into your community, those moving into a memory care unit must also have been given a physical exam by a physician at a minimum of 30 days prior to admission. The exam must state that the resident suffers from a diagnosis of dementia OR they are voluntarily choosing to live in an environment that is more restrictive than your typical assisted living.

  1. (Written Description) 8. a description of activities, including frequency and type, and how the activities meet the needs of residents with dementia Programming for the residents in your memory care unit will be paramount to the success of the unit. Not only does a fruitful activity program enhance the likelihood for resident and family satisfaction, it also is proven to decrease behaviors which will surely be appreciated by your staff.

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