Specialized care for the dementia disease process

The goal of a specialized community for Alzheimer’s and other dementia-related diseases is to provide those people with a safe and secure area for them to thrive in midst of their disease process. While there may be many similarities to typical ALF communities these areas are designed to meet the unique physical and mental attributes of disease. Providing care to residents who may have dementia-related diseases shall be inclusive and give them the opportunity to have a fruitful remainder of life. See the following regulation provided by the California Community Care Licensing Division to determine if you are in compliance with providing care to residents with dementia:

87706 ADVERTISING DEMENTIA SPECIAL CARE, PROGRAMMING, AND ENVIRONMENTS

(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall meet the following requirements:

(1) The licensee shall ensure that direct care staff who provide care to any resident(s) with dementia meet the training requirements in Section 87707, Training Requirements if Advertising Dementia Special Care, Programming, and Environments, including six hours of resident care orientation within the first four weeks of employment and eight hours of inservice training per year on the subject of serving residents with dementia.

(A) Direct care staff includes staff used for staff mealtime and break relief.

(B) Direct care staff may provide dementia special care to residents in the facility or in designated areas of the facility.

(2) In addition to the requirements specified in Sections 87208(a) and 87705(b), the licensee shall include in the plan of operation a brief narrative description of the following facility features:

(A) Philosophy, including, but not limited to, program goals/objectives in relation to meeting the needs of residents with dementia.

(B) Pre-admission assessment, including the types of assessment tools used to determine residents’ dementia care needs and who will participate in the assessment.

(C) Admission, including the following items that must be addressed when admitting a resident who requires dementia special care:

  1. Specification of the designated areas in the facility where dementia special care is provided, which may be the entire facility or only parts of it.
  2. Services available specific to residents with dementia.
  3. Procedures in place to ensure that the plan of operation is available for review upon request, as required by Section 87706(a)(3).

(D) Assessment(s), including the following as they pertain to residents receiving dementia special care:

  1. Types of assessments used;
  2. Who will participate in resident assessments and procedures for ensuring the opportunity for resident and family involvement; and
  3. Frequency of assessments.

(E) Activity program for residents with dementia, including, but not limited to:

  1. Types of activities;
  2. Activities may include cognitive/mental stimulation (e.g., crafts, reading, writing, music, current events, reminiscences, movies); physical activities (e.g., gross and fine motor skills); work activities and life skills; social activities; cultural/religious activities; sensory activities; individual/group activities (e.g., games); pet care; and outdoor activities (e.g., field trips, gardening).
  3. Frequency of activities; and
  4. The process to determine what types of activities shall be planned to encompass residents’ needs.
  5. These needs are based on personal preferences, age, beliefs, culture, values, attention span, and life experiences (e.g., family and friend involvement, favorite pastimes, occupations, and geographic areas lived in and visited).

(F) Staff qualifications. Describe the experience and education required for prospective direct care staff who will provide dementia special care.

(G) Staff training. Describe the required training for direct care staff who provide dementia special care. At a minimum, the description shall include information on the time frame for training, as specified in Section 87707(a)(2), and the training topics, as specified in Section 87707(a)(2)(A).

(H) Physical environment, including environmental factors that ensure a safe, secure, familiar, and consistent environment for residents with dementia.

  1. Environmental factors that may be considered include bedroom decor; architectural and safety features (e.g., wide hallways, handrails, delayed egress, secured perimeters); lighting; colors and visual contrasts; types of furniture; signs; noise factors; memory boxes; nourishment and hydration stations; and functional outdoor space and exercise pathways.

(I) Changes in condition. Procedures to be followed when a resident’s condition changes, including, but not limited to, an explanation of:

  1. When a new care plan is required;
  2. At what point a physician (if any) is involved in developing a care plan;
  3. Special techniques/programs (if any) used for managing specific types of behavior; and
  4. The conditions that would require a resident to be relocated.

(J) Success indicators, including procedures to:

  1. Ensure an ongoing review of facility programs pertaining to the care of residents with dementia;
  2. Make necessary adjustments to better meet residents’ needs; and
  3. Assess the program’s overall effectiveness/success.
  4. Examples of areas that may be reviewed include incident reports, staffing levels, input from others, and resident participation in program activities.

(3) The admission agreement, as specified in Section 87507(c), shall inform the resident or representative and the resident’s responsible person, if any, or the conservatory, that the facility features, as specified in Section 87706(a)(2), are described in the facility’s plan of operation and that the plan of operation is available for review upon request.

(4) The licensee shall maintain copies of all facility advertisements and marketing/promotional material that indicate the licensee provides special care, programming, and/or environments for residents with dementia or related disorders, and shall maintain the information for a minimum of three years

(5) The licensee shall provide a description of the program and services, as specified in Health and Safety Code section 1569.628.

Health and Safety Code section 1569.628 provides:

A licensee of a residential care facility for the elderly that advertises or promotes special care, programming, or environments for persons with a health-related condition, except as specified in Section 1569.72, shall provide to each prospective resident an accurate narrative description of these programs and services. The description shall be provided in writing prior to admission. All reasonable efforts shall be made to communicate the information in the narrative description to a person who is unable to read it himself or herself, including, but not limited to, reading the description out loud.

(A) This material shall be available to the public upon request.

(B) This material shall also be available to the licensing agency to inspect, audit, copy, and remove (if necessary for copying) upon demand during normal business hours as specified in Section 87755(c).

(b) Licensees who will discontinue advertising, promoting, or otherwise holding themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall:

(1) Provide written notification to the licensing agency and to the resident and the responsible person, if any, or the conservator, at least 30 calendar days prior to discontinuing advertising or promoting dementia special care, programming, and/or environments.

(A) The notification shall specify the date that the licensee will cease advertising or promoting dementia special care, programming, and/or environments; and, therefore, shall no longer be required to meet the requirements specified in Section 87706(a) and the training requirements in Section 87707, Training Requirements if Advertising Dementia Special Care, Programming, and Environments.

(B) The licensee shall maintain a copy of the written notification in each resident’s records.

(2) On the date specified in the notification, cease all advertisements, publications, and/or announcements that pertain to dementia special care including, but not limited to, those in magazines, newspapers, consumer reports, telephone directory yellow pages, professional or service directories, Internet, radio and/or television commercials.

(A) Long-term advertisements, such as yellow pages, shall be removed at the next renewal date.

(3) On the date specified in the notification, remove all written references that indicate that the licensee provides dementia special care, programming, and/or environments from all promotional material, advertisements, and/or printed material, including admission agreements and the plan of operation.

Top Takeaways:

  • (1) The licensee shall ensure that direct care staff who provide care to any resident(s) with dementia meet the training requirements in Section 87707, Training Requirements if Advertising Dementia Special Care, Programming, and Environments, including six hours of resident care orientation within the first four weeks of employment and eight hours of inservice training per year on the subject of serving residents with dementia.

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 these training.

  • (2) In addition to the requirements specified in Sections 87208(a) and 87705(b), the licensee shall include in the plan of operation a brief narrative description of the following facility features:

(A) Philosophy, including, but not limited to, program goals/objectives in relation to meeting the needs of residents with dementia.

(B) Pre-admission assessment, including the types of assessment tools used to determine residents’ dementia care needs and who will participate in the assessment.

(C) Admission, including the following items that must be addressed when admitting a resident who requires dementia special care:

This Memory Care unit should not just be an area to hold residents suffering from a terrible illness. This unity shall be a community in itself with dignified meaning for residents who need specialized care. You should include services based upon each individual resident’s needs as well as having fruitful programming of activities.