Dementia Care

WAC 388-78A-2370  Dementia care.  (1) The assisted living facility must, to the fullest extent reasonably possible, obtain for each resident who has symptoms consistent with dementia as assessed per WAC 388-78A-2090(7):

(a) Information regarding the resident’s significant life experiences, including:

  • Family members or other significant relationships;
  • Education and training;
  • Employment and career experiences;
  • Religious or spiritual preferences;
  • Familiar roles or sources of pride and pleasure.
  • Information regarding the resident’s ability or inability to:(i) Articulate his or her personal needs; and (ii) Initiate activity.
  • Information regarding any patterns of resident behavior that express the resident’s needs or concerns that the resident is not able to verbalize. Examples of such behaviors include, but are not limited to:
  • Agitation;
  • Wandering;
  • Resistance to care;(iv) Social isolation; and (v) Aggression.

(2) The assisted living facility, in consultation with the resident’s family or others familiar with the resident, must evaluate the significance and implications of the information obtained per subsection (1) of this section and integrate appropriate aspects into an individualized negotiated service agreement for the resident.

[Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2370, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2370, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2371  Investigations.  The assisted living facility must:

  • Report to the local law enforcement agency and the department any individual threatening bodily harm or causing a disturbance, that threatens any individual’s welfare and safety;
  • Identify, investigate, and report incidents involving resi-dents according to department established assisted living facility guidelines;
  • Protect residents during the course of the investigation; and
  • Comply with “whistle blower” laws as defined in chapter 74.34 RCW.

[Statutory Authority: Chapters 18.20 and 74.39A RCW. WSR 20-02-104, §

388-78A-2371, filed 12/31/19, effective 1/31/20.]

WAC 388-78A-2380  Freedom of movement.  An assisted living facility must ensure all of the following conditions are present before moving residents into units or buildings with exits that may restrict a resident’s egress:

  • Each resident, or a person authorized under RCW 7.70.065 to provide consent on behalf of the resident, consents to living in such unit or building.
  • Each resident assessed as being cognitively and physically able to safely leave the assisted living facility is able to do so independently without restriction consistent with the resident’s negotiated service agreement.
  • The assisted living facility must have a system in place to inform and permit visitors, staff persons and appropriate residents how they may exit without sounding the alarm.
  • The installation of access and egress controls that does not restrict the movement of residents who are cognitively and physically able to safely leave the facility independently;
  • In new construction, access and egress controlled doors that are installed as permitted by the building code adopted by the Washington state building code council;
  • Existing access and egress controlled doors that meet and are maintained to the requirements of the building code at the time of construction; and
  • Buildings from which egress is restricted have:
  • A system in place to inform and permit visitors, staff per-sons, and appropriate residents freedom of movement; and
  • A secured outdoor space per WAC 388-78A-2381.

[Statutory Authority: Chapters 18.20 and 74.39A RCW. WSR 20-02-104, § 388-78A-2380, filed 12/31/19, effective 1/31/20. Statutory Authority: Chapter 18.20 RCW. WSR 13-13-063, § 388-78A-2380, filed 6/18/13, effective 7/19/13. Statutory Authority: RCW 18.20.090. WSR 06-01-047, § 388-78A-2380, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. WSR 04-16-065, § 388-78A-2380, filed 7/30/04, effective 9/1/04.]

WAC 388-78A-2381  General design requirements for memory care. (1) When planning for new construction, renovations or change of service to include memory care services, the facility must document design considerations appropriate to residents with dementia, mental health issues, or cognitive and developmental disabilities within its functional program consistent with WAC 388-78A-2380.

(2) The facility must provide common areas, including at least one resident accessible common area outdoors. Such common areas should accommodate and offer the opportunity of social interaction, stimulate activity, contain areas with activity supplies and props to encourage engagement, and have safe outdoor paths to encourage exercise and movement.

(a) These areas must have a residential atmosphere and must accommodate and offer opportunities for individual or group activity including:

  • Giving residents opportunities for privacy, socialization, and common spaces that account for wandering behaviors;
  • Ensuring any public address system in the area of special-ized dementia care services is used only for emergencies;
  • Encouraging residents’ individualized spaces to be furnish-ed and decorated with personal items based on resident needs and preferences; and
  • Ensuring residents have access to their own rooms at all times without staff assistance.

(b) Unless an alternative viewing area is provided as described in (c) of this subsection and written policies and procedures are created as described in (e) of this subsection, the facility must provide an outdoor area for residents that:

  • Is located on the floor on which the resident resides;
  • Is designed with a minimum of twenty-five square feet of space per resident served;
  • Has areas protected from direct sunshine and rain through-out the day;
  • Has walking surfaces that are firm, slip-resistant and free from abrupt changes, and suitable for individuals using wheelchairs and walkers;
  • Has outdoor furniture;
  • Has plants that are not poisonous or toxic to humans; and
  • Has areas appropriate for outdoor activities of interest to residents, such as walking paths, raised garden, flowerbeds, or bird feeders.

(c) If a facility does not provide an outdoor area located on the floor on which the resident resides in compliance with subsection (b)(i) of this subsection, then a facility must provide an alternative viewing area that:

  • Is not obstructed by indoor furniture, storage areas, clean-ing equipment, trash receptacles, snack food/drink tables, and other such encumbrances that would minimize access to the viewing area;
  • Must not serve as a hallway, or an additionally required community space such as a dining area, activity room, mobile healthcare services (such as home health, podiatrist, and dental services), or other purposes;
  • Must be a community space, not within the residents’ room; and
  • Has windows that have an unobstructed and viewable height accessible by wheelchair.

(d) The required outdoor area must be accessible to residents with minimal staff assistance in a manner consistent with the residents’ individual negotiated service agreement, except where pursuant to a facility policy, and consistent with WAC 388-78A-2600, the facility administrator or other appropriate staff reasonably believe that the health or safety may be at risk, including, but not limited to, instances of:

  • Inclement weather;
  • Dangerous construction or maintenance activities; or
  • Other temporary environmental factors that create an unsafe environment.

(e) If a facility does not provide an outdoor area located on the floor on which the resident resides in compliance with subsection (b)(i) of this subsection, a facility must put in place and maintain a written policy and procedure that documents how the facility provides residents with access to an outdoor area on a floor other than the floor on which the resident resides. Upon request the facility shall present that plan to the department for review. Such a plan must include:

  • The location of the outdoor space;
  • A description of any assistance necessary for the resident to reach the outdoor space at any time, and documented in the negotiated service agreement plan per WAC 388-78A-2140(2);
  • The facility’s plan for providing any necessary staff as-sistance described in (e)(ii) of this subsection;
  • A plan to maintain safety and security to prevent wandering or exit seeking while the resident is using the outdoor space; and

(f) Facilities licensed prior to date of implementation of this rule that have an outdoor area on each floor, may not eliminate the required outdoor space.

[Statutory Authority: Chapters 18.20 and 74.39A RCW. WSR 20-02-104, § 388-78A-2381, filed 12/31/19, effective 1/31/20.]