Veterans State Adult Day Health Care

Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services outlined in Public Law 106-117 Section 101. (1) Adult day health services are only appropriate for adults with medical or disabling conditions that require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. (2) The adult day health center must offer and provide on site the following services: (a) All core services under PL 106-117 Section 101; (b) Skilled nursing services other than routine health monitoring with nurse consultation; (c) At least one of the following skilled therapy services: physical therapy, occupational therapy, or speech-language pathology or audiology, as those services are defined under PL 106-117 Section 101 respectively; and (d) Psychological or counseling services, including assessing for psycho-social therapy need, dementia, abuse or neglect, and alcohol or drug abuse; making appropriate referrals; and providing brief, intermittent supportive counseling. (a) The following personal care services as defined in PL 106-117 Section 101, "personal care services," or its successor: (i) Ambulation; (ii) Body care; (iii) Eating; (iv) Positioning; (v) Self-medication; (vi) Transfer; (vii) Toileting; (viii) Personal hygiene at a level that ensures client safety and comfort while in attendance at the program; and (ix) Bathing at a level that ensures client safety and comfort while in attendance at the program. (b) Social services on a consultation basis, which may include: (i) Referrals to other providers for services not within the scope of Medicaid reimbursed adult day care services; (ii) Caregiver support and education; or (iii) Assistance with coping skills. (c) Routine health monitoring with consultation from a registered nurse that a consulting nurse acting within the scope of practice can provide with or without a physician's order. Examples include: (i) Obtaining baseline and routine monitoring information on a client's health status, such as vital signs, weight, and dietary needs; (ii) General health education such as providing information about nutrition, illnesses, and preventive care; (iii) Communicating changes in the client's health status to the client's caregiver; (iv) Annual and as needed updating of the client's medical record; (v) Assistance as needed with coordination of health services provided outside of the adult day care program. (d) General therapeutic activities that an unlicensed person can provide or that a licensed person can provide with or without a physician's order. These services are planned and provided as an integral part of the client's plan of care and are based on the client's abilities, interests and goals. Examples include: (i) Recreational activities; (ii) Diversionary activities; (iii) Relaxation therapy; (iv) Cognitive stimulation; (v) Group range of motion or conditioning exercises. (e) General health education that an unlicensed person can provide or that a licensed person can provide with or without a physician's order, including but not limited to topics such as: (i) Nutrition; (ii) Stress management; (iii) Disease management skills; (iv) Preventive care. (f) A nutritional meal and snacks provided each four-hour period at regular times comparable to normal meal times, including modified diet if needed and within the scope of the program, as provided under Public Law 106-117 Section 101; (g) Supervision and/or protection for clients who require supervision or protection for their safety; (h) Assistance with arranging transportation to and from the program; and (i) First aid and provisions for obtaining or providing care in an emergency.