For the purposes of these regulations the following terms are defined as follows:
a. Activities of Daily Living (ADL’s): Ambulating, toileting, grooming, eating, bathing, or dressing.
b. Advertise: To make publicly and generally known. For purposes of this definition, advertise includes, but is not limited to:
1. Signs, billboards, or lettering;
2. Electronic publishing or broadcasting, including the use of the Internet or email; and
3. Printed material.
c. Alzheimer’s Special Care Unit: A separate and distinct unit within a Long Term Care facility that segregates and provides a special program for residents with a diagnosis of probable Alzheimer’s disease or related dementia; and that advertises, markets or otherwise promotes the facilityn as providing specialized Alzheimer’s or related dementia care services.
d. Alzheimer’s Disease: An organic, neurological disease of the brain that causes progressive degenerative changes.
e. Common Areas: Portions of the Alzheimer’s Special Care Unit, exclusive of residents’ rooms and bathrooms. Common areas include any facility grounds accessible to residents of the Alzheimer’s Special Care Unit (ASCU).
f. Continuous: Available at all times without cessation, break or interruption.
g. Dementia: A loss or decrease in intellectual ability that is of sufficient severity to interfere with social or occupational functioning; it describes a set of symptoms such as memory loss, personality change, poor reasoning or judgment, and language difficulties.
h. Department: Department of Human Services (DHS), Division of Medical Services (DMS), or Office of Long Term Care (OLTC)
i. Direct Care Staff: An individual, such as a nurse or a certified Nurse’s Aide, who is an employee of the facility or who is an employee of a
temporary agency assigned to work in the facility, and who has received, or will receive, in accordance with these regulations, specialized training regarding Alzheimer’s or related dementia, and is responsible for providing direct, hands-on care or services to residents in the ASCU.
j. Disclosure Statement: A written statement prepared by the facility and provided to individuals or their responsible parties, and to individuals families, prior to admission to the unit, disclosing form of care, treatment, and related services especially applicable or suitable for the ASCU. The disclosure statement shall be approved by the Department prior to use, and shall include, but not be limited to, the following information about the facility’s ASCU:
1. The philosophy of how care and services are provided to the residents;
2. The pre-admission screening process;
3. The admission, discharge and transfer criteria and procedures;
4. Training topics, amount of training time spent on each topic, and the name and qualification of the individuals used to train the
direct care staff;
5. The minimum number of direct care staff assigned to the unit each shift;
6. A copy of the Residents’ Rights;
7. Assessment, Individual Support Plan & Implementation. The process used for assessment and establishment of the plan of care
and its implementation, including the method by which the plan of care evolves and is responsive to changes in condition;
8. Planning and implementation of therapeutic activities and the methods used for monitoring; and
9. Identification of what stages of Alzheimer’s or related dementia for which the unit will provide care.
k. Facility: A Level II Assisted Living Facility that houses an ASCU.
l. Individual Assessment Team: A group of individuals possessing the knowledge and skills to identify the medical, behavioral, and social
needs of a resident and to develop services designed to meet those needs
m. Individual Support Plan: A written plan developed by an Individual Assessment Team (IAT) that identifies services to a resident. The plan shall include and identify professions, disciplines and services that:
1. Identifies and states the resident’s medical needs, social needs, disabilities and their causes;
2. Identifies the resident’s specific strengths;
3. Identifies the resident’s specific behavioral management needs;
4. Identifies the resident’s need for services without regard to the actual availability of services;
5. Identifies and quantifies the resident’s speech, language, and auditory functioning;
6. Identifies and quantifies the resident’s cognitive and social development; and,
7. Identifies and specifies the independent living skills, and other services, provided by the facility to meet the needs of the resident.
n. Nursing Personnel: Registered or Licensed Practical nurses who have specialized training or will undergo specialized training, in accordance with these regulations, by the Alzheimer’s Special Care Unit.
o. Responsible Party: An individual, who, at the request of the applicant or resident, or by appointment by a court of competent jurisdiction, agrees to act on behalf of a resident or applicant for the purposes of making decisions regarding the needs and welfare of the resident or applicant. These regulations, and this definition, does not grant or permit, nor should be construed as granting or permitting, any individual authority or permission to act for, or on behalf of, a resident or applicant in excess of the authority or permission granted by law. A competent resident may select a responsible party or may choose to not select a responsible party.
In no event may an individual act for, or on behalf of, a resident or applicant when the resident or applicant has a legal guardian, attorney infect, or other legal representative. For purposes of these regulations only, responsible party will also refer to the terms legal representative, legal guardian, power of attorney or similar phrase.
801 GENERAL ADMINISTRATION
a. Miscellaneous
1. Visitors shall be permitted at all times. However, facilities may deny visitation when visitation results, or substantial probability
exists that visitation will result, in disruption of service to other residents, or threatens the health, safety, or welfare of the resident
or other residents.
2. Birds, cats, dogs, and other animals may be permitted in the Alzheimer’s Special Care Unit. Animals shall have appropriate
vaccinations and licenses. A veterinary record shall be kept on all animals to verify vaccinations and be made readily available for
review. Pets may not be allowed in food preparation, food storage or dining or serving areas.
3. Unmarried male and female residents shall not be housed in the same room unless either residents or their responsible parties have
given authorized consent.
b. General Program Requirements
1. Each long-term care facility that advertises or otherwise holds itself out as having one (1) or more special units for residents with
a diagnosis of probable Alzheimer’s disease or a related dementia shall provide an organized, continuous 24-hour-per-day program of
supervision, care and services that shall:
A. Meet all state, federal and ASCU regulations.
B. Requires the full protection of residents’ rights;
C. Promotes the social, physical and mental well-being of residents;
D. Is a separate unit specifically designed to meet the needs of residents with a physician’s diagnosis of Alzheimer’s
disease or other related dementia; and
E. Provides 24-hour-per-day care for those residents with a dementia diagnosis, and meets all admission criteria
applicable for that particular long-term care facility.
2. Documentation shall be maintained by the facility and shall include, but not be limited to, a signed copy of all training received
by the employee.
3. Provide for relief of direct care personnel to ensure minimum staffing requirements are maintained at all times.
4. Upon request, make available to the Department payroll records of all staff employed during recent pay periods.
5. Regardless of other policies or procedures developed by the facility, the ASCU will have specific policies and procedures
regarding:
A. Facility philosophy related to the care of ASCU residents;
B. Use of ancillary therapies and services;
C. Basic services provided;
D. Admission, discharge, transfer; and
E. Activity programming.
c. Residents’ Rights
For the purposes of these regulations, Resident’s Rights are those rights set forth in the Department’s numbered memorandum LTC-M-89-03.
d. Resident Record Maintenance
The ASCU shall develop and maintain a record-keeping system that includes a separate record for each resident, and that documents each
resident’s health care, individual support plan, assessments, social information, and protection of each resident’s rights.
e. Resident Records
The ASCU must follow the facility’s policies and procedures, and applicable state and federal laws and regulations governing:
1. The release of any resident information, including consent necessary from the client, parents or legal guardian;
2. Record retention;
3. Record maintenance; and,
4. Record content.
802 ASSESSMENTS
a. Psychosocial and Physical Assessments
1. Each resident shall receive a psychosocial and physical assessment which includes the resident’s degree or level of family support,
level of activities of daily living functioning, cognitive level, behavioral impairment, and that identifies the resident’s strengths
and weaknesses.
2. Prior to admission to the ASCU, the applicant must be evaluated by, and have received from a physician, a diagnosis of Alzheimer’s
or related dementia.
b. Individual Assessment Team (IAT)
1. Within 30 days after admission, the IAT shall prepare for each resident an individual support plan. The ISP shall address specific
needs of, and services required by, the resident resulting from the resident’s Alzheimer’s disease or related dementia.
2. The IAT shall perform accurate assessments or reassessments annually, and upon a significant change to a resident’s physical,
mental, emotional, functional, or behavioral condition or status in which the resident:
a. Is regressing in, or losing skills, already gained
b. Is failing to progress toward or maintain identified objectives in the ISP
c. Is being considered for changes in the resident’s ISP
c. Individual Support Plan (ISP)
1. The ISP shall include a family and social history. If the family and social history is unavailable, the ASCU personnel shall document
attempts to obtain the information, including but not limited to, the names and telephone numbers of individuals contacted, or whom
the facility attempted to contact, and the date and time of the contact or attempted contact.
2. Individual support plans shall be developed and written by the IAT and signed by each member of the team.
3. Individual support plans shall have the input and participation of the resident or his or her responsible party, and the resident’s
family. If the resident’s family or responsible party cannot be contacted, or refuses to participate, the facility shall document all attempts to notify the resident’s family or legal representative. The documentation shall include, but not be limited to, the names and
telephone numbers of individuals contacted, or whom the facility attempted to contact, and the date and time of the contact or
attempted contact.
4. The ISP shall be reviewed, evaluated for its effectiveness, and updated at least quarterly, and shall be updated when indicated by
changing needs of the resident, or upon any reassessments by the IAT. In the event that the reassessment by the IAT documents a
change of condition for which no change in services to meet resident needs are required, the ISP shall document the change of
condition, and the reason or reasons why no change in services are required.
5. The ISP shall include:
A. Expected behavioral outcomes;
B. All barriers to expected outcomes;
C. Services, including frequency of delivery, designed to
achieve expected behavioral outcomes;
D. Methods of assessment and monitoring. Monitoring shall occur no less than quarterly to determine progress toward
the outcome; and,
E. Documentation of results from services provided, and achievement towards expected outcomes or regression, and
reasons for the regression.
F. The resident’s likes, dislikes, and if appropriate, his or her choices.
6. A copy of the ISP shall be made available to all staff that work with the resident, and the resident or his or her responsible party.
7. The ISP shall be implemented only with the documented, written consent of the resident or his or her responsible party.
803 STANDARDS FOR ALZHEIMER’S SPECIAL CARE UNITS
a. General Requirements
1. It is the intent of these regulations that Alzheimer’s Special Care Units shall be designed to accommodate the complex and varied
needs of residents with dementia. The physical environment does not exist in isolation, but interacts with the activity program, level
of resident capability, staffing and social milieu of the unit.
2. The environment shall be designed and developed to meet the following objectives:
A. Maximize awareness and orientation;
B. Ensure safety and security;
C. Provide privacy and a sense of control;
D. Support functional abilities; and,
E. Develop environmental stimulation and challenge within a positive social milieu.
b. Physical Design
In addition to the physical design standards required for the facility’s license, an Alzheimer’s Special Care Unit shall include the following:
1. A floor plan design that does not require visitors or staff to pass
through the ASCU to reach other areas of the facility;
2. A multipurpose room or rooms for dining, group and individual activities, and family visits, which complies with the LTC
licensure requirements for common space;
3. Secured outdoor space and walkways that allow residents to ambulate, with or without assistive devices such as wheelchairs or
walkers, but prevents undetected egress. Such walkways shall meet the accessibility requirements of the most current LTC and
Americans with Disabilities Act (ADA) structural building codes or regulations. Unrestricted access to secured outdoor space and
walkways shall be provided, and such areas shall have fencing or barriers that prevent injury and elopement. Fencing shall be no
less than 72 inches high.
4. Prohibit the use of plants that are poisonous or toxic for human contact or consumption;
5. Visual contrasts between floors and walls, and doorways and walls, in resident use areas. Except for fire exits, exit doors and
access ways shall be designed to minimize contrast, and to obscure or conceal areas the residents should not enter;
6. Non-reflective floors, walls, and ceilings, to minimize glare;
7. Evenly distributed lighting, to minimize glare and shadows; and,
8. A monitoring or nurses’ station with:
A. A call system, to alert staff to any emergency needs of the residents; and,
B. A space for charting, and for storage of residents’ records.
c. Physical Environment and Safety.
The Alzheimer’s Special Care Unit shall:
1. Provide freedom of movement for the residents to common areas, and to their personal spaces. The facility shall not lock residents
out of, or inside, their rooms;
2. Provide plates and eating utensils which provide visual contrast between the utensils and the table, and that maximizes the
independence of the residents;
3. In common areas, provide comfortable seating sufficient to seat all residents at the same time. The seating shall consist of a ratio of
one (1) gliding or rocking chair for every five (5) residents;
4. Encourage and assist residents to decorate and furnish their rooms with personal items and furnishings, based on the resident’s needs
and preferences as documented by the ASCU in the social history;
5. Individually identify each resident’s rooms based on the resident’s cognitive level, to assist residents in locating their rooms, and to
permit them to differentiate their room from the rooms of other residents;
6. Keep corridors and passageways through common-use areas free of objects which may cause falls, or which may obstruct passage
by physically impaired individuals; and,
7. Only use public address systems in the unit for emergencies.
804 EGRESS CONTROL
a. Egress Policies
The Alzheimer’s Special Care Unit shall develop policies and procedures to deal with residents who wander or may wander. The procedures shall include actions to be taken by the facility to:
1. Identify missing residents;
2. Notify all individuals or institutions that require notification under law or regulation when a resident is missing; and,
3. Attempt to locate the missing resident.
b. Locking Devices
1. All locking devices used on exit doors shall be approved by the OLTC, building code agencies, and the fire marshal having
jurisdiction over the facility, shall be electronic, and shall release upon activation of the fire alarm or sprinkler system.
2. If the unit uses keypads to lock and unlock exits, directions for the keypad’s operations to allow entrance shall be posted on the
outside of the door.
3. The keypads and locks shall meet the under IBC applicable to
Level II Assisted Living Facilities.
4. Staff shall be trained in all methods of releasing, or unlocking, the locking device.
805 STAFFING
Alzheimer’s Special Care Units shall staff according to the Rules and Regulations for Assisted Living Facilities II. However, staffing for the ASCU shall be determined separately from the Assisted Living facility, based upon the census for the ASCU only; likewise, the staffing for the Assisted Living facility shall be based on the census of the Assisted Living facility, excluding the ASCU census. It is the intent of this regulation that ASCU staff be separate and distinct from the Assisted Living facility staff. In addition, the following staffing requirements are established for Alzheimer’s Special Care Units.
a. Professional Program Services
A social worker or other professional staff e.g., physician, Registered Nurse, or Psychologist currently licensed by the State of Arkansas shall be utilized to perform the following functions:
1. Complete an initial social history evaluation on each resident on admission;
2. Development, coordination, and utilization of state or national resources and networks to meet the needs of the residents or their
families;
3. Offering or encouraging participation in monthly family support group meetings with documentation of meetings offered; and,
4. Assist in development of the ISP, including but not limited to:
A. Assuring that verbal stimulation, socialization and reminiscing is identified in the ISP as a need;
B. Defining the services to be provided to address those needs identified above; and,
C. Identifying the resident’s preferences, likes, and dislikes.
b. Staff and Training
1. All ASCU staff members and consultants shall have the training specified in these regulations in the care of residents with
Alzheimer’s Disease and other related dementia. The facility shall maintain records documenting what training has been received, the
date it was received, the subject of the training, and the source of the training.
2. Within six (6) months of the date that the long-term care facility first advertises or otherwise holds itself out as having one (1) or
more special units for residents with a diagnosis of probable Alzheimer’s disease or a related dementia, the facility shall have
trained all staff who are scheduled or employed to work in the ASCU.
3. Subsequent to the requirements set forth in Section 805(b)(2), fifty percent (50%) of the staff working any shift shall have completed
requirements as set forth in Section 805(b)(5)(a), (b), and (c).
4. After meeting the requirements of Section 805(b)(2), all new employees shall be trained within five (5) months of hiring, with
no less than eight (8) hours of training per month during the five
(5) month period.
5. In addition to any training requirements for any certification or licensure of the employee, training shall consist of, at a minimum:
A. Thirty (30) hours on the following subjects:
i. One (1) hour of the ASCU’s policies;
ii. Three (3) hours of etiology, philosophy and treatment of dementia;
iii. Two (2) hours on the stages of Alzheimer’s disease;
iv. Four (4) hours on behavior management;
v. Two (2) hours on use of physical restraints, wandering, and egress control;
vi. Two (2) hours on medication management;
vii. Four (4) hours on communication skills;
viii. Two (2) hours of prevention of staff burnout;
ix. Four (4) hours on activity programming;
x. Three (3) hours on ADLs and Individual-Centered Care
xi. Three (3) hours on assessments and creation of ISPs
B. On-going in-service training consisting of at least 2 hours every quarter. The topics to be addressed in the in-service
training shall include the following, and each topic shall be addressed at least once per year:
i. The nature of Alzheimer’s disease and other dementia, including:
1. The definition of dementia;
2. The harm to individuals without a correct diagnosis; and,
3. The stages of Alzheimer’s disease.
ii. Common behavior problems resulting from
Alzheimer’s or related dementia, and recommended
behavior management for the problems;
iii. Communication skills to facilitate improved staff
relations with residents;
iv. Positive therapeutic interventions and activities,
such as:
a. Exercise;
b. Sensory stimulation; and,
c. Activities of daily living.
v. The benefits of family interaction with the resident,
and the need for family interaction;
vi. Developments and new trends in the fields of
Alzheimer’s or related dementia, and treatments for
same;
vii. Environmental modifications to minimize the
effects and problems associated with Alzheimer’s or
related dementia; and,
viii. Development of ISPs, including but not limited to
instruction on the method of updating and
implementing ISPs across shifts.
C. If the facility identifies or documents that a specific
employee requires training in areas other than those set
forth in 805(b), the facility may provide training in the
identified or documented areas, and may be substituted for
those subjects listed in Section 805(b)(5).
c. Trainer Requirements
The individual providing the training shall have:
1. A minimum of one (1) year uninterrupted employment in the care
of Alzheimer’s residents, or
2. Shall have training in the care of individuals with Alzheimer’s disease and other dementia, or
3. Is designated by the Alzheimer’s Association or its local chapter as being qualified to meet training requirements.
d. Training Manual
The ASCU shall create and maintain a training manual consisting of thee
topics listed in Section 805(b). Further, the trainer shall provide training
consistent with the training manual.
806 ADMISSIONS, DISCHARGES, TRANSFERS
a. Criteria for Services
1. Each Alzheimer’s Special Care Unit shall have written policy setting forth pre-admission screening, admission, and discharge
procedures.
2. Prior to admission into the Alzheimer’s Special Care Unit, the facility shall provide a copy of the disclosure statement and
Residents’ Rights policy to the applicant or the applicant’s responsible party. A copy of the disclosure statement signed by
the resident or the resident’s responsible party shall be kept in the resident’s file.
3. Admission criteria shall require:
A. A physician’s diagnosis of Alzheimer’s disease or related dementia;
B. The facility’s assessment of the resident’s level of needs; and,
C. A list of the services that the ASCU can provide to address the needs identified in 806(a)(3)(B).
4. Any individual admitted to the ASCU must also meet admission criteria for the facility.
5. The ASCU shall not maintain a resident who requires a level of care greater than for which the facility is licensed to provide, or for
whom the ASCU is unable to provide the level or types of services to address the needs of the resident. Discharge from the ASCU
shall occur when:
A. The resident’s medical condition exceeds the level of care for which the facility is licensed or is able to provide;
B. The resident’s medical condition requires specialized nursing procedures that constitute more than limited nursing services, or nursing services the facility is unable to provide;
C. The resident has a loss of functional abilities (e.g. ambulation) that results in the resident’s level of care
requirements being greater than the level of care for which the facility is licensed or able to provide;
D. Behavioral symptoms that results in the resident’s level of care requirements being greater than the level of care for
which the facility is licensed or able to provide;
E. The resident requires a level of involvement in therapeutic programming that is greater than the level of care for which
the facility is licensed or able to provide.
6. If the resident, or the resident’s responsible party, does not comply with, or refuses to accept, the requirements of the ISP, the resident
shall be discharged from the ASCU. The facility shall document the refusal or non-compliance with the ISP. The documentation
shall include, but not be limited to:
A. The identity of the person who is not willing or able to comply with the requirements of the ISP; i.e., the resident
or the resident’s responsible party;
B. The date and time of the refusal;
C. The consequences of the unwillingness or inability to comply with the requirements of the ISP, and the name of
the person providing this information to the resident or the resident’s responsible party.
b. Resident Movement, Transfer or Discharge When a resident is moved, transferred or discharged, measures shall be
taken by the facility to minimize confusion and stress to the resident until discharge. Further, the discharge shall comply with the regulations applicable to the facility housing the ASCU, and Arkansas law.
807 THERAPEUTIC ACTIVITIES
a. Intent and General Requirements.
Therapeutic activities can improve a resident’s eating or sleeping patterns; lessen wandering, restlessness, or anxiety; improve socialization or cooperation; delay deterioration of skills; and improve behavior management. Therapeutic activities shall be designed to meet the resident’s current needs.
1. All facilities with Alzheimer’s Special Care Units shall provide activities appropriate to the needs of individual residents. The
activities shall be provided and directed by direct care staff under the coordination of a program director.
2. Each resident’s daily routine shall be structured or scheduled so that activities are provided seven days a week.
3. A professional with specialized training in the care of Alzheimer’s shall be utilized or contracted to:
A. Develop required daily activities;
B. Train direct care staff in those programs; and,
C. Provide ongoing consultation.
b. Required Daily Activities
The following activities shall be offered daily:
1. Gross motor activities (e.g., exercise, dancing, gardening, cooking, etc.);
2. Self-care activities (e.g., dressing, personal hygiene, or grooming);
3. Social activities (e.g., games, music, socialization); and,
4. Sensory enhancement activities (e.g., reminiscing, scent and tactile stimulation)