Section 144-117-9 - Adult Day Services Programs9.1Adult Day Services Programs. Adult Day Services Programs include a Social Adult Day Services Program and an Adult Day Health Services Program, which are differentiated by the intensity and scope of service delivery. Each program shall comply with all the general licensing standards as well as the program specific requirements outlined herein. A provider may be licensed for more than one (1) program, as long as the record keeping is distinct.9.2Therapeutic Activities. Therapeutic activity is the emphasis and focus of Adult Day Service Programs. The plan for therapeutic activity should be an integral part of the overall service plan, promoting a consumer's optimal functioning. Activities should be meaningful, have a purpose, be voluntary, and reflect positively the consumer's sense of self. Activities shall be varied to meet the needs of consumers, as reflected in the service plan, providing a structure of daily activities combined with the ability of staff to adapt activities to meet the needs of the consumer group and provide individual programming, if necessary. The therapeutic activities program should provide quieting and stimulating activities at varied times of the day, activities that are age appropriate, activities that provide opportunities for physical fitness, for creative self expression and exploration of interests, for stimulation of recent and long term memory and for consumers to participate in community outings and/or events.9.3Social Adult Day Services Program. A Social Adult Day Services Program is designed to meet the social and supportive service needs of individuals attending the program. This may include socialization, supervision, supportive services and/or limited assistance with activities of daily living (ADLs).
9.3.1Required Services. A Social Adult Day Services provider shall provide the following services:9.3.1.2 Social, leisure, physical, therapeutic and/or educational activities appropriate to the consumer's ability and interest;9.3.1.3 Assistance with ADLs;9.3.1.4 A morning and afternoon refreshment.9.3.2Optional Services.9.3.2.1 Meals may be provided as part of the service delivery. Meal preparation and menus shall adhere to standards described in Chapter 6 of these regulations.9.3.2.2 Medication administration services may be offered provided the requirements of Section 5.12 are met. Providers may assist with medication if requested in writing by a consumer or their designated representative on a form approved by the Department. Medications shall be in original containers as labeled by a pharmacist. Consumers may keep possession of medications for self-administration as long as it poses no danger to other consumers and the consumer is able to self-administer medications appropriately. Medications administered by program staff must be stored in a locked cabinet. Licensed nurses may transfer medications from original containers to pill boxes for convenience of administration. Pill boxes shall contain the consumer's name, days of the week and times of day. In such instances, the licensed nurse shall date and sign in the record which medications were transferred, the dosage and for which intended dates and times of administration. Both original containers and pill boxes shall be kept in a locked cabinet.9.3.2.3 Telephone orders shall be accepted only by a registered or licensed nurse or pharmacist. Facsimile orders are acceptable legal orders as long as they are in compliance with the Commission on Pharmacy rules and regulations. Written dated telephone orders must be signed by the duly authorized licensed practitioner within ten (10) working days.9.3.2.4 Medications left at the program site by consumers who have been discharged from the Adult Day Services Program shall be destroyed by the program administrator and witnessed by one competent person who is not a consumer no later than thirty (30) days after the consumer's discharge. Discontinued medications unused for sixty (60) days shall either be destroyed within sixty (60) days of discontinued use or returned to the consumer or guardian in person. The destruction shall be conducted so that no person can use, administer, sell or give away the medication. Individual unit doses may be returned to the responsible party and a credit or rebate from the pharmacy made to the person who originally paid for the medication. Amounts destroyed or returned shall be recorded in the consumer's record, with the signature of the program administrator or program director and witness.9.4Adult Day Health Services Program. In addition to the services provided by a Social Adult Day Services Program, an Adult Day Health Services Program provides health monitoring services and more extensive assistance with ADLs. 9.4.1Required Services. An Adult Day Health Services Program shall provide the following services, based on individual needs:9.4.1.1Health monitoring;9.4.1.2At least one meal that satisfies one-third of the required dietary allowance in compliance with the meal preparation and menu requirements described in Chapter 6 of these regulations;9.4.1.3Nursing Services, carried out by a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN);9.4.1.4 Medication administration as outlined in Section 9.3.2.29.5Combined Program. An Adult Day Services provider may meet licensure requirements to deliver both Social Adult Day Services and Adult Day Health Services Programs simultaneously or on different days of the week, to identified different consumers, at the same program site. The service delivery shall be commensurate with the consumer's identified needs. The record shall clearly reflect which program the consumer is enrolled in and that the program services meet the needs of the consumer.9.6Night Program. A night program is an Adult Day Services Program staffed by awake staff, offered between 5 PM and 7 AM to consumers with dementia who are often awake during the night time hours. The scope of services offered by either the Adult Day Health Services Program or the Social Adult Day Services Program shall be the same as if offered during the hours between 7 AM to 5 PM. Activities are provided while the consumer is awake and the consumer is encouraged to sleep. The record shall reflect the daily hours the consumer is awake and the hours the consumer sleeps while at the program.
A consumer may attend a Night Program up to seven (7) times per week if a consumer is not attending the day time program for either Adult Day Health or Social Adult Day Services Programs, Consumer participation in a day time program and night time program is limited to seven (7) dates of participation in a seven (7) day period. At no time should an Adult Day Services Program provide twenty-four (24) consecutive hour services to a consumer.
References:
1. Statutory authority for these regulations is found under the following Titles in the Maine Revised Statutes Annotated: 22 M.R.S.A §§42; 5106(10); 6203(1); 7802; 8602
2. Additional references of use are: The Department of Health and Human Services, Bureau of Medical Services, Maine Medical Assistance Manual; Chapter II, Sections 19 and 26.
10-144 C.M.R. ch. 117, § 9