Section 240.230  Adult Day Service (ADS)

 

Adult day service is the direct care and supervision of adults aged 60 and over in a community-based setting for the purpose of providing personal attention and promoting social, physical and emotional well-being in a structured setting. These services shall be provided pursuant to an ADS Addendum to the participant's person-centered plan of care.

 

a)         Required Service Components

 

1)         Assessment of the participant's strengths and needs and development of an individual written person-centered plan of care for each participant that establishes specific participant goals for all service components to be provided or arranged for by the service provider.

 

A)        The individual ADS Addendum will be developed  by the adult day service team consisting of participant/authorized representative, Program Coordinator/Director and Program Nurse, and may include other staff at the option of the program Coordinator/Director.

 

B)        The participant, caregiver and other service providers will have the opportunity to contribute to the development, implementation and evaluation of the individualized ADS Addendum.

 

C)        The individualized ADS Addendum is to be established not later than the fourth week of service.

 

D)        The individualized ADS Addendum shall address the needs identified by the CCU, as described in the comprehensive assessment.

 

E)        The individualized ADS Addendum to the person-centered plan of care shall address the need identified by the service provider's staff and participant/authorized representative/caregiver during the individualized ADS Addendum process.

           

F)         Reassessing the participant's needs and reevaluating the appropriateness of the individualized person-centered plan of care shall be done as needed, but at least annually.

 

2)         A balance of purposeful activities to meet the participant's interrelated needs and interests (social, intellectual, cultural, economic, emotional, physical and spiritual) designed to improve or maintain the optimal functioning of the participant.

 

A)        Activity programming shall take into consideration participant differences in age, health status, sensory deficits, lifestyle, ethnicity, religious affiliation, values, experiences, needs, interests and abilities by providing for a variety of types and levels of involvement.

 

B)        Time for rest and relaxation shall be provided as needed or prescribed.

 

C)        Activity opportunities shall be available whenever the service provider's facility is in operation and participants are in attendance.

 

D)        A monthly calendar of activities shall be prepared and posted in a visible place.

 

E)        Opportunities to participate in other activities outside of the ADS shall be provided.  The setting will be integrated in, and support access to, the greater community.

 

3)         Assistance with or supervision of activities of daily living (e.g., walking, eating, toileting and personal care), as needed.

 

4)         Provision of health-related services appropriate to the participant's needs as identified in the provider's assessment and/or physician's orders, including health monitoring, nursing intervention on a moderate or intermittent basis for medical conditions and functional limitations, medication monitoring, medication administration or supervision of self-administration, and coordination of health services.

 

5)         Provision of a daily meal that meets the Dietary Guidelines for Americans, 2015-2020, 8^th edition, published by the Secretary of Health and Human Services and the Secretary of Agriculture; and that provides each participant a minimum of 33.5% of the Dietary Reference Intakes (DRI) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. Supplementary nutritious snacks shall also be provided. Special diets shall be provided as directed by the participant's physician.

 

6)         Agency provision or arrangement for transportation, with at least one vehicle physically accessible, to enable participants to receive adult day service at the adult day service provider's site and participate in sponsored outings.

 

7)         Provision of emergency care as appropriate in accordance with established adult day service provider policies and Section 240.1510.

 

8)         Identifying and reporting critical events including critical incidents, service improvement program complaints, and requests for change of status in the Department's automated reporting system. Completing initial critical event reports will occur within 7 days after the date the event occurred or was identified to have occurred.  Assisting CCUs in their efforts to safeguard participant health, safety and welfare by demonstrating a willingness to collaborate, discuss and resolve issues that likely place a participant at increased risk for experiencing future critical events.  Supporting CCU risk mitigation efforts by demonstrating a willingness to communicate about necessary adjustments to a participant's person-centered plan of care or ADS Addendum in response to a critical event.

 

b)         Ancillary Service Components

 

1)         Ancillary services, including physical, occupational, speech and creative arts therapies may be provided by site staff or through contractual arrangements when needed by participants.  If provided, ancillary services shall be within the framework of the individualized person-centered plan of care and ADS Addendum and shall be in accordance with professional practice standards and applicable State and federal regulations.

 

2)         Skilled nursing services, including, but not limited to, catheter installation, irrigations and care, dressings, enemas, oxygen therapy, suction/posturing, ostomy care and restorative nursing such as bladder retraining.  (All these procedures/interventions require physician orders and shall be administered by a Registered Nurse or a Licensed Practical Nurse, in accordance with the Illinois Nursing Act [225 ILCS 65].)

 

3)         Shopping assistance.

 

4)         Escort to medical and social services.

AGENCY NOTE:  Reimbursement for costs of ancillary services is not included in the unit rate paid by the Department and will not be paid by the Department.

 

c)         Unit of Service

 

1)         One unit of adult day service is defined as one direct participant contact hour (excluding transportation time) provided to a participant.  A direct participant contact hour is defined as 60 consecutive minutes of active programming, i.e., providing one or a combination of the service components listed in subsections (a)(2) through (7).

 

2)         One unit of documented adult day service transportation, provided by the adult day service provider, is defined as a one-way trip per participant to or from the adult day service provider's site and the participant's home. No more than two units of transportation shall be provided per participant in a 24-hour period, and shall not include trips to a physician, shopping, or other miscellaneous trips.

 

3)         For services (including transportation, if specified in the individualized ADS Addendum) which the provider was unable to provide due to the participant's absence without prior notification (see Section 240.350), the provider shall be reimbursed as follows:

 

A)        Two and one half units of documented adult day service per occurrence to a maximum of 5 units per participant per State fiscal year.

 

B)        One unit of documented adult day service transportation, provided by the adult day service provider, per occurrence to a maximum of 2 units per participant per State fiscal year.

 

4)         Refer to Section 240.1950 for further information regarding reimbursement.

 

(Source:  Amended at 42 Ill. Reg. 20653, effective January 1, 2019)