(a) Manager qualifications and training.
(1) The manager of the certified Alzheimer facility or the supervisor of the certified Alzheimer
unit must be 21 years of age, and have:
(A) an associate’s degree in nursing, health care management;
(B) a bachelor’s degree in psychology, gerontology, nursing, or a related field; or
(C) proof of graduation from an accredited high school or certification of equivalency of
graduation and at least one year of experience working with persons with dementia.
(2) The manager or supervisor must complete six hours of annual continuing education regarding
(b) Staff training.
(1) All staff members must receive four hours of dementia-specific orientation prior to assuming
any job responsibilities. Training must cover, at a minimum, the following topics:
(A) basic information about the causes, progression, and management of Alzheimer’s disease;
(B) managing dysfunctional behavior; and
(C) identifying and alleviating safety risks to residents with Alzheimer’s disease.
(2) Direct care staff must receive 16 hours of on-the-job supervision and training within the first
16 hours of employment following orientation. Training must cover:
(A) providing assistance with the activities of daily living;
(B) emergency and evacuation procedures specific to the dementia population;
(C) managing dysfunctional behavior; and
(D) behavior management, including prevention of aggressive behavior and de-escalation
techniques, or fall prevention, or alternatives to restraints.
(3) Direct care staff must annually complete 12 hours of in-service education regarding
Alzheimer’s disease. One hour of annual training must address behavior management, including
prevention of aggressive behavior and de-escalation techniques, or fall prevention, or alternatives
to restraints. Training for these subjects must be competency-based. Subject matter must address
the unique needs of the facility. Additional suggested topics include:
(A) assessing resident capabilities and developing and implementing service plans;
(B) promoting resident dignity, independence, individuality, privacy and choice;
(C) planning and facilitating activities appropriate for the dementia resident;
(D) communicating with families and other persons interested in the resident;
(E) resident rights and principles of self-determination;
(F) care of elderly persons with physical, cognitive, behavioral and social disabilities;
(G) medical and social needs of the resident;
(H) common psychotropics and side effects; and
(I) local community resources.
(c) Staffing. A facility must employ sufficient staff to provide services for and meet the needs of
its Alzheimer’s residents. In large facilities or units with 17 or more residents, two staff members
must be immediately available when residents are present.
(d) Alzheimer’s Assisted Living Disclosure Statement form. A facility must use the Alzheimer’s
Assisted Living Disclosure Statement form and amend the form if changes in the operation of the
facility will affect the information in the form.
(e) Pre-admission. The facility must establish procedures, such as an application process,
interviews, and home visits, to ensure that prospective residents are appropriate and their needs
can be met.
(1) Prior to admitting a resident, facility staff must discuss and explain the Alzheimer’s Assisted
Living Disclosure Statement form with the family or responsible party.
(2) The facility must give the Alzheimer’s Assisted Living Disclosure Statement form to any
individual seeking information about the facility’s care or treatment of residents with Alzheimer’s
disease and related disorders.
(f) Assessment. The facility must make a comprehensive assessment of each resident within 14
days of admission and annually. The assessment must include the items listed in
§92.41(c)(1)(A)-(T) of this chapter (relating to Standards for Type A and Type B Assisted
(g) Service plan. Facility staff, with input from the family, if available, must develop an
individualized service plan for each resident, based upon the resident assessment, within 14 days
of admission. The service plan must address the individual needs, preferences, and strengths of
the resident. The service plan must be designed to help the resident maintain the highest possible
level of physical, cognitive, and social functioning. The service plan must be updated annually
and upon a significant change in condition, based upon an assessment of the resident.
(h) Activities. A facility must encourage socialization, cognitive awareness, self-expression, and
physical activity in a planned and structured activities program. Activities must be
individualized, based upon the resident assessment, and appropriate for each resident’s abilities.
(1) The activity program must contain a balanced mixture of activities addressing cognitive,
recreational, and activity of daily living (ADL) needs.
(A) Cognitive activities include, but are not limited, to arts, crafts, story telling, poetry readings,
writing, music, reading, discussion, reminiscences, and reviews of current events.
(B) Recreational activities include all socially interactive activities, such as board games and
cards, and physical exercise. Care of pets is encouraged.
(C) Self-care ADLs include grooming, bathing, dressing, oral care, and eating. Occupational
ADLs include cleaning, dusting, cooking, gardening, and yard work. Residents must be allowed
to perform self-care ADLs as long as they are able to promote independence and self worth.
(2) Residents must be encouraged, but never forced, to participate in activities. Residents who
choose not to participate in a large group activity must be offered at least one small group or oneon-one activity per day.
(3) Facilities must have an employee responsible for leading activities.
(A) Facilities with 16 or fewer residents must designate an employee to plan, supply, implement,
and record activities.
(B) Facilities with 17 or more residents must employ, at a minimum, an activity director for 20
hours weekly. The activity director must be a qualified professional who:
(i) is a qualified therapeutic recreation specialist or an activities professional who is eligible for
certification as a therapeutic recreation specialist, therapeutic recreation assistant, or an activities
professional by a recognized accrediting body, such as the National Council for Therapeutic
Recreation Certification, the National Certification Council for Activity Professionals, or the
Consortium for Therapeutic Recreation/Activities Certification, Inc.; or
(ii) has two years of experience in a social or recreational program within the last five years, one
year of which was full-time in an activities program in a health care setting; or
(iii) has completed an activity director training course approved by the National Association for
Activity Professionals or the National Therapeutic Recreation Society.
(4) The activity director or designee must review each resident’s medical and social history,
preferences, and dislikes, in determining appropriate activities for the resident. Activities must be
tailored to the residents’ unique requirements and skills.
(5) The activities program must provide opportunities for group and individual settings. On
weekdays, each resident must be offered at least one cognitive activity, two recreational
activities and three ADL activities each day. The cognitive and recreational activities (structured
activities) must be at least 30 minutes in duration, with a minimum of six and a half hours of
structured activity for the entire week. At least an hour and a half of structured activities must be
provided during the weekend and must include at least one cognitive activity and one physical
(6) The activity director or designee must create a monthly activities schedule. Structured
activities should occur at the same time and place each week to ensure a consistent routine within
(7) The activity director or designee must annually attend at least six hours of continuing
education regarding Alzheimer’s disease or related disorders.
(8) Special equipment and supplies necessary to accommodate persons with a physical disability
or other persons with special needs must be provided as appropriate.
(i) Physical Plant. Alzheimer’s units, if segregated from other parts of the Type B facility with
approved security devices, must meet the following requirements within the Alzheimer’s unit:
(1) Resident living area(s) must be in compliance with §92.62(m)(3) of this chapter (relating to
(2) Resident dining area(s) must be in compliance with §92.62(m)(4) of this chapter.
(3) Resident toilet and bathing facilities must be in compliance with §92.62(m)(2) of this chapter.
(4) A monitoring station must be provided within the Alzheimer’s unit with a writing surface
such as a desk or counter, chair, task illumination, telephone or intercom, and lockable storage
for resident records.
(5) Access to at least two approved exits remote from each other must be provided in order to
meet the Life Safety Code requirements.
(6) In large facilities, cross corridor control doors, if used for the security of the residents, must
be similar to smoke doors, which are each 34 inches in width and swing in opposite directions. A
latch or other fastening device on a door must be provided with a knob, handle, panic bar, or
other simple type of releasing device.
(7) An outdoor area of at least 800 square feet must be provided in at least one contiguous space.
This area must be connected to, be a part of, be controlled by, and be directly accessible from the
(A) Such areas must have walls or fencing that do not allow climbing or present a hazard and
meet the following requirements. These minimum dimensions do not apply to additional fencing
erected along property lines or building setback lines for privacy or to meet requirements of local
(i) Minimum distance of the enclosure fence from the building is 8 feet if the fence is parallel to
the building and there are no window openings;
(ii) Minimum distance of the enclosure fence (parallel with building walls) from bedroom
windows is 20 feet if the fencing is solid and 15 feet from bedroom windows if the fencing is
(iii) For unusual or unique site conditions, areas of enclosure may have alternate configurations
with DADS approval.
(B) Access to at least two approved exits remote from each other must be provided from the
enclosed area in order to meet the Life Safety Code requirements.
(C) If the enclosed area involves a required exit from the building, the following additional
requirements must be met:
(i) A minimum of two gates must be remotely located from each other if only one exit is
enclosed. If two or more exits are enclosed by the fencing and entry access can be made at each
door, a minimum of one gate is required.
(ii) The gate(s) must be located to provide a continuous path of travel from the building exit to a
public way, including walkways of concrete, asphalt, or other approved materials.
(iii) If gate(s) are locked, the gate nearest the exit from the building must be locked with an
electronic lock that operates the same as electronic locks on control doors and/or exit doors and
is in compliance with the National Electrical Code for exterior exposure. Additional gates may
also have electronic locks or may have keyed locks provided staff carry the keys. All gates may
have keyed locks, provided all staff carry the keys, and the outdoor area has an area of refuge
(I) extends beyond a minimum of 30 feet from the building; and
(II) the area of refuge allows at least 15 square feet per person (resident, staff, visitor) potentially
present at the time of a fire.
(8) Locking devices may be used on the control doors provided the following criteria are met:
(A) The building must have an approved sprinkler system and an approved fire alarm system to
meet the licensing standards.
(B) The locking device must be electronic and must be released when any one of the following
(i) activation of the fire alarm or sprinkler system;
(ii) power failure to the facility; or
(iii) activation of a switch or button located at the monitoring station and at the main staff station.
(C) A key pad or buttons may be located at the control doors for routine use by staff.
(9) Locking devices may be used on the exit doors provided:
(A) the locking arrangements meet §18.104.22.168 of the Life Safety Code; or,
(B) the following criteria are met:
(i) The building must have an approved sprinkler system and an approved fire alarm system to
meet the licensing standards.
(ii) The locking device must be electro-magnetic; that is, no type of throw-bolt is to be used.
(iii) The device must release when any one of the following occurs:
(I) activation of the fire alarm or sprinkler system;
(II) power failure to the facility; or
(III) activation of a switch or button located at the monitoring station and at the main staff
(iv) A key pad or buttons may be located at the control doors for routine use by staff.
(v) A manual fire alarm pull must be located within five feet of each exit door with a sign stating,
“Pull to release door in an emergency.”
(vi) Staff must be trained in the methods of releasing the door device
(a) Manager qualifications and training.