Section 240.230 Adult Day Service


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.


a) Required Service Components


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


A) The individual plan of care is to be established by the adult day service team consisting of Program Coordinator/Director and Program Nurse, and may include other staff at the option of the program Coordinator/Director.


B) The individualized plan of care is to be established not later than the fourth week of service.


C) The individualized plan of care shall address the needs identified by the Case Coordination Unit (CCU), as described in the Determination of Need (DON), Client Agreement Plan of Care and approved by the client's physician/Nurse Practitioner/Registered Nurse/Christian Science Practitioner in accordance with Section 240.730 of this Part.


D) The individualized plan of care shall address the need identified by the service provider's staff and client/caregiver during the individualized plan of care process.


E) The client, caregiver and other service providers shall have the opportunity to contribute to the development, implementation and evaluation of the individualized plan of care.


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


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


A) Activity programming shall take into consideration individual 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 clients are in attendance.


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


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 client'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) A daily meal meeting one-third of the adult "Recommended Daily Dietary Allowances" established by the Food and Nutrition Board of the National Research Council National Academy of Sciences, 10th Revised Edition, 1989, no later amendments or editions are included. Supplementary nutritious snacks shall also be provided. Special diets shall be provided as directed by the client's physician.


6) Agency provision or arrangement for transportation, with at least one vehicle physically accessible, to enable clients 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 of this Part.


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 clients. If provided, ancillary services shall be within the framework of the individualized plan of care and 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 client contact hour (excluding transportation time) provided to a client. A direct client 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 client to or from the adult day service provider's site and the client's home. No more than two units of transportation shall be provided per client 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 plan of care) which the provider was unable to provide due to the client's absence without prior notification (see Section 240.350 of this Part), the provider shall be reimbursed as follows:


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


4) Refer to Section 240.1950.


(Source: Amended at 35 Ill. Reg. 8919, effective June 2, 2011)