048-12 Wyo. Code R. § 12-10

Current through April 27, 2019

Section 12-10 - Secure Dementia Units

Level 2 assisted living facilities require adherence to all Level 1 requirements with the following additional criteria for a Level 2 Assisted Living Facility License.

(a) Level 2 Core Management requirements.

(i) The facility manager shall have at least three (3) years experience in working in the field of geriatrics or caring for disabled residents in a licensed facility;

(ii) Certified as a residential care/assisted living facility administrator or have equivalent training.
- (A) Certification requirements include a training program covering topics referenced in the regulations. The course work must take place in a college, vocational training, state or national certification program, which is approved by the Department of Health. Licensed nursing home administrators, for the purpose of these rules, meet the qualifications.
- (B) Administrators must complete at least sixteen (16) hours of continuing education annually. At least eight (8) of the 16 hours of annual continuing education shall pertain to caring persons with severe cognitive impairments.
  A full time manager with the above qualifications must be on duty, on the premises.

(b) Level 2 Staffing Requirements.

(i) Nursing Staff.
- (A) A licensed nurse must be on duty on all shifts.
  - (1) May be an LPN if an RN is available on premises or by telephone.
  - (2) To administer P.R.N. medications.
  - (3) To perform ongoing resident evaluations in order to ensure appropriate, timely interventions.

(c) Level 2 Direct Care Staff.

In addition to meeting all other requirements for direct care staff stated in this Chapter, assisted living Level 2 direct care staff must receive additional documented training in:

(i) The facility or units philosophy and approaches to providing care and supervision of persons with severe cognitive impairment;

(ii) The skills necessary to care for, intervene, and direct residents who are unable to independently perform activities of daily living;

(iii) Techniques for minimizing challenging behaviors:
- (A) Wandering;
- (B) Hallucinations, illusions, and delusions; and
- (C) Impairment of senses;

(iv) Therapeutic programming to support the highest level of residents function including:
- (A) Large motor activity;
- (B) Small motor activity;
- (C) Appropriate level cognitive tasks; and
- (D) Social/emotional stimulation;

(v) Promoting residents dignity, independence, individuality, privacy, and choice;

(vi) Identifying and alleviating safety risks to residents;

(vii) Recognizing common side effects and reactions to medications; and

(viii) Techniques for dealing with bowel and bladder aberrant behavior.
At least one staff member with this specialized training must be available on the unit at all times to provide supervision and care to the residents, as well as to assist the residents in evacuation of the facility.

Staff must have at least twelve (12) hours of continuing education annually related to care of persons with dementia.

(d) Level 2 additional core services.

In addition to the previously listed Core Services increased assistance may be required with activities of daily living depending upon assessed resident functional and cognitive ability:

(i) Assistance as needed with dressing, grooming, bathing, mobility, toileting;

(ii) Assistance as needed to maintain nutrition and hydration status based individual assessed needs:

(iii) Services necessary to maintain the highest continence level and skin integrity; and

(iv) Activity program developed by an activities professional, at least on a consultation basis, who has been trained in dementia specific activities. The program must be evaluated and revised as needed to meet the needs of the unit residents.

(e) Level 2 Resident Assessments.

In addition to all other required assessments Level 2 facilities must provide a Mini-Mental State Examination ((MMSE) for each resident considered for admittance to the secure unit.

(i) The resident shall score between 20 and 10 points on the MMSE exam;
- (A) The exam shall be performed and documented at least annually and upon any significant change in the resident's mental or physical condition..

(ii) Assistance Plans for residents of secure units must, at a minimum, address the following:
- (A) Memory;
- (B) Judgment;
- (C) Self-care ability;
- (D) Ability to solve problems;
- (E) Mood and character changes;
- (F) Behavioral patterns;
- (G) Wandering; and
- (H) Dietary needs.

(f) Level 2 Discharge Requirements.

In addition to Level 1 discharge criteria residents of Level 2 facilities must be discharged when one or more of the following situations exist:

(i) They score less than 10 on the MMSE;

(ii) When it has been determined that intermittent nursing care has become ongoing; or

(iii) When the resident requires more than limited assistance to evacuate the building.

048-12 Wyo. Code R. § 12-10