Alzheimer’s and Dementia Special Care Unit

A. All Alzheimer’s/dementia special care units shall have a coordinator who is solely responsible for the coordination of the Alzheimer’s/dementia special care unit. The coordinator shall:

(1) Be a licensed or degreed health care professional, other than the delegating nurse; and

(2) Have completed a course, consisting of a minimum of 30 hours of training, by a nationally recognized Alzheimer’s/dementia caregiving resource or association; or

(3) Have substantially equivalent training and experience.

  1. The coordinator shall, in collaboration with the manager and delegating nurse/case manager, coordinate as needed outside psychiatric and psychosocial services to assist with behavior modification plans.
  2. Other Staff.

(1) In addition to the training described in Regulation .14 of this chapter, staff shall:

(a) Complete a minimum of 20 hours of documented initial training on the care of residents with Alzheimer’s disease and related dementia prior to providing direct resident care; and

(b) Complete a minimum of 8 hours of documented annual training on Alzheimer’s disease and related dementia;

(2) Direct care staff shall not have housekeeping, laundry, food preparation, or maintenance duties as primary responsibilities; and

(3) Certified medication technicians shall not be responsible for any direct care activities while administering medications during the assigned times.

D. Written Description. At the time of initial licensure, [an assisted living] a program with an Alzheimer’s special care unit shall submit to the Department a written description of the special care unit using a disclosure form adopted by the Department. The description shall explain how:

(1) The form of care and treatment provided by the Alzheimer’s unit is specifically designed for the specialized care of individuals diagnosed with Alzheimer’s disease or a related dementia; and

(2) The care in the special care unit differs from the care and treatment provided in the nonspecial care unit.

E. At the time of license renewal, [an assisted living] program with an Alzheimer’s special care unit shall submit to the Department a written description of any changes that have been made to the special care unit and how those changes differ from the description of the unit that is on file with the Department.

F. [An assisted living] A program with an Alzheimer’s special care unit shall disclose the written description of the special care unit to:

(1) Any person on request; and

(2) The family or resident’s representative before admission of the resident to the Alzheimer’s special care unit or program.

G.  The description of the Alzheimer’s special care unit shall include:

(1) A statement of philosophy or mission;

(2) How the services of the special care unit are different from services provided in the rest of the assisted living program;

(3) Staff training and staff job titles, including the number of hours of dementia-specific training provided annually for all staff by job classification and a summary of training content;

(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 6-month 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 and any unique design features appropriate to support the functioning of cognitively impaired individuals;

(8) A description of activities, including frequency and type, how the activities meet the needs of residents with dementia, and how the activities differ from activities for residents in other parts of the program;

(9) The program’s fee or fee structure for services provided by the Alzheimer’s special care unit or program as part of the disclosure form that is required in Regulation .10 of this chapter;

(10) Discharge criteria and procedures;

(11) Any services, training, or other procedures that are over and above those that are provided in the existing assisted living program; and

(12) Any other information that the Department may require.

 H.  The Department shall restrict admission or close the operation of a special care unit if the Department determines that the facility has not demonstrated compliance with this regulation or the health or safety of residents is at risk.

Alzheimer’s/Dementia Special Care

  1. The manager of a facility that provides care to one or more individuals with dementia, including a probable or confirmed diagnosis of Alzheimer’s disease or a related disorder, shall ensure the requirements of this regulation are met.
  2. An orientation manual with policies and procedures specific to Alzheimer’s/dementia special care shall be maintained on-site and accessible to all staff.
  3. The manager, or designee, shall ensure that an enhanced service plan is developed for all residents with Alzheimer’s/dementia. The service plan shall, at a minimum, include specific interventions that address:

(1) Persistent or repetitive behaviors that affect the health and well-being of the resident or present a danger to the resident or other individuals;

(2) Environment, safety, and security;

(3) Behavior management;

(4) Staffing; and

(5) Life enrichment activities.

  1. Delegating nurse/case manager.

(1) For residents receiving psychotropic or behavior-modifying medications, the delegating nurse/case manager during nursing assessments shall:

(a) Assess the resident’s functional level;

(b) Identify any potential adverse effects of the medication or medications; and

(c) Consult with the authorized prescriber or pharmacist, as necessary, to determine if medication dosages should be modified or discontinued.

(2) During nursing assessments the delegating nurse/case manager shall evaluate residents with persistent or repetitive behaviors that affect the health and well-being of the resident or present a danger to the resident or other individuals to determine:

(a) A baseline of the intensity, duration, and frequency of the behavior;

(b) Antecedent behaviors and activities;

(c) Recent changes or risk factors in the resident’s life;

(d) Environmental factors such as time of day, staff involved, and noise levels;

(e) The resident’s medical status;

(f) Alternative, structured activities or behaviors that have been successful or unsuccessful in the past; and

(g) The effectiveness of behavioral management approaches.

(3) The results of the enhanced assessments described in §D(1) and (2) of this regulation shall be reflected in the resident’s service plan.

  1. The manager and delegating nurse/case manager shall coordinate outside psychiatric and psychosocial services, if appropriate, to assist with behavior modification plans.
  2. When the resident census includes eight or more residents with Alzheimer’s/dementia, there shall be a minimum of one direct care staff on each shift for every eight residents.