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Regulations and Standards Governing
Alzheimer's Assisted Living Care Facilities*
| Manager qualifications and
training. |
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(1) The manager of the certified
Alzheimer facility or the supervisor of the certified
Alzheimer unit must be 21 years of age, and have: |
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(A) an associate's degree in
nursing, health care management;
(B) a bachelor's degree in psychology, gerontology, nursing,
or a related field; or
(C) proof of graduation from an accredited high school or
certification of equivalency of graduation and at least one
year of experience working with persons with dementia. |
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(2) The manager or supervisor
must complete six hours of annual continuing education
regarding dementia care. |
| Staff training |
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(1) All staff members must
receive four hours of dementia-specific orientation prior to
assuming any job responsibilities. Training must cover, at a
minimum, the following topics: |
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(A) basic information about the
causes, progression, and management of Alzheimer's disease;
(B) managing dysfunctional behavior; and
(C) identifying and alleviating safety risks to residents
with Alzheimer's disease. |
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(2) Direct care staff must
receive 16 hours of on-the-job supervision and training
within the first 16 hours of employment following
orientation. Training must cover: |
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(A) providing assistance with
the activities of daily living;
(B) emergency and evacuation procedures specific to the
dementia population;
(C) managing dysfunctional behavior; and
(D) behavior management, including prevention of aggressive
behavior and de-escalation techniques, or fall prevention,
or alternatives to restraints. |
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(3) Direct care staff must
annually complete 12 hours of in-service education regarding
Alzheimer's disease. One hour of annual training must
address behavior management, including prevention of
aggressive behavior and de-escalation techniques, or fall
prevention, or alternatives to restraints. Training for
these subjects must be competency-based. Subject matter must
address the unique needs of the facility. Additional
suggested topics include: |
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(A) assessing resident
capabilities and developing and implementing service plans;
(B) promoting resident dignity, independence, individuality,
privacy and choice;
(C) planning and facilitating activities appropriate for the
dementia resident;
(D) communicating with families and other persons interested
in the resident;
(E) resident rights and principles of self-determination;
(F) care of elderly persons with physical, cognitive,
behavioral and social disabilities;
(G) medical and social needs of the resident;
(H) common psychotropics and side effects; and
(I) local community resources. |
| Staffing |
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A facility must employ
sufficient staff to provide services for and meet the needs
of its Alzheimer's residents. In large facilities or units
with 17 or more residents, two staff members must be
immediately available when residents are present. |
| Pre-admission |
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The facility must establish
procedures, such as an application process, interviews, and
home visits, to ensure that prospective residents are
appropriate and their needs can be met.
(1) Prior to admitting a resident, facility staff must
discuss and explain the disclosure statement with the family
or responsible party.
(2) The facility must give the required Texas Department of
Human Services (DHS) disclosure statement to any individual
seeking information about the facility's care or treatment
of residents with Alzheimer's disease or a related disorder.
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| Assessment |
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The facility must make a
comprehensive assessment of each resident within 14 days of
admission and annually. The assessment must include the
items listed in §92.41(c)(1)(A)-(T) of this chapter
(relating to Standards for Type A, Type B, and Type E
Assisted Living Facilities). |
| Service plan |
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Facility staff, with input from
the family, if available, must develop an individualized
service plan for each resident, based upon the resident
assessment, within 14 days of admission. The service plan
must address the individual needs, preferences, and
strengths of the resident. The service plan must be designed
to help the resident maintain the highest possible level of
physical, cognitive, and social functioning. The service
plan must be updated annually and upon a significant change
in condition, based upon an assessment of the resident. |
| Activities |
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A facility must encourage
socialization, cognitive awareness, self-expression, and
physical activity in a planned and structured activities
program. Activities must be individualized, based upon the
resident assessment, and appropriate for each resident's
abilities. |
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(1) The activity program must
contain a balanced mixture of activities addressing
cognitive, recreational, and activity of daily living (ADL)
needs. |
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(A) Cognitive activities
include, but are not limited, to arts, crafts, story
telling, poetry readings, writing, music, reading,
discussion, reminiscences, and reviews of current events.
(B) Recreational activities include all socially interactive
activities, such as board games and cards, and physical
exercise. Care of pets is encouraged.
(C) Self-care ADLs include grooming, bathing, dressing, oral
care, and eating. Occupational ADLs include cleaning,
dusting, cooking, gardening, and yard work. Residents must
be allowed to perform self-care ADLs as long as they are
able to promote independence and self worth. |
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(2) Residents must be
encouraged, but never forced, to participate in activities.
Residents who choose not to participate in a large group
activity must be offered at least one small group or
one-on-one activity per day.
(3) Facilities must have an employee responsible for leading
activities. |
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(A) Facilities with 16 or fewer
residents must designate an employee to plan, supply,
implement, and record activities.
(B) Facilities with 17 or more residents must employ, at a
minimum, an activity director for 20 hours weekly. The
activity director must be a qualified professional who: |
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(i) is a qualified therapeutic recreation
specialist or an activities professional who is eligible for
certification as a therapeutic recreation specialist,
therapeutic recreation assistant, or an activities
professional by a recognized accrediting body, such as the
National Council for Therapeutic Recreation Certification,
the National Certification Council for Activity
Professionals, or the Consortium for Therapeutic
Recreation/Activities Certification, Inc.; or
(ii) has two years of experience in a social or recreational
program within the last five years, one year of which was
full-time in an activities program in a health care setting;
or
(iii) has completed an activity director training course
approved by the National Association for Activity
Professionals or the National Therapeutic Recreation
Society. |
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(4) The activity director or
designee must review each resident's medical and social
history, preferences, and dislikes, in determining
appropriate activities for the resident. Activities must be
tailored to the residents' unique requirements and skills.
(5) The activities program must provide opportunities for
group and individual settings. On weekdays, each resident
must be offered at least one cognitive activity, two
recreational activities and three ADL activities each day.
The cognitive and recreational activities (structured
activities) must be at least 30 minutes in duration, with a
minimum of six and a half hours of structured activity for
the entire week. At least an hour and a half of structured
activities must be provided during the weekend and must
include at least one cognitive activity and one physical
activity.
(6) The activity director or designee must create a monthly
activities schedule. Structured activities should occur at
the same time and place each week to ensure a consistent
routine within the facility.
(7) The activity director or designee must annually attend
at least six hours of continuing education regarding
Alzheimer's disease or related disorders.
(8) Special equipment and supplies necessary to accommodate
persons with a physical disability or other persons with
special needs must be provided as appropriate. |
*From: Texas Department of Aging and Disability
Services (DADS) Licensing Standards for Assisted Living Facilities
Subchapter A, §92.41
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