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Adult
Day Service (ADS) Study Findings - (11-05-07)
ADS has
been identified as a cost-effective service for older adults and
people with disabilities. The expansion of ADS in Iowa has been
slow to occur, evident by the significant decline of service providers
since 2004. To identify the reasons for the lack of expansion
of ADS in Iowa, the Department of Elder Affairs (DEA) contracted
with the University of Iowa, School of Social Work to conduct
an evaluation of the ADS system. Here are the resulting documents:
Can an Adult Day Service Program help you family?
Read the answers to the following questions.
What exactly are Adult Day Service Programs?
Who utilizes adult day services?
How do I choose an Adult Day Service Program (ADS)?
Does a contract need to be signed?
What is "managed risk"?
How does an Arbitration Agreement apply to
my Occupancy Agreement?
What is the admissions process?
How will the coordination of my care be
determined?
How are medications managed?
What are the staff qualifications?
Why do I need to understand "level of care" requirements?
How are meals provided?
What happens in an emergency?
What kinds of activities will be offered?
What exactly are Adult Day
Service Programs?
321-24.1(231D)
Adult Day Service Programs are organized programs providing a variety
of health-related care, social services, and other related support
services for sixteen hours or less in a 24 hour period to two or
more persons with functional impairments on a regularly scheduled,
contractual basis. Individuals who receive adult day services are
referred to as participants.
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Who utilizes adult day services?
Adult day services can offer a break to the primary caregiver from
the often overwhelming tasks required in caring for an older adult
experiencing disabilities. Adult day services are ideal when the
caretaker works during the day and has no one to stay with the older
adult in need of supervision. Adult Day Services often allow an
adult experiencing disabilities to remain in their own home and
community and avoid premature or unnecessary placement into a facility.
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How do I choose an Adult Day Service Program (ADS)?
Request a program brochure, a price list, and a copy of the contractual
agreement (which providers are required by law to provide upon request)
so that you can review these items BEFORE you visit. You will also
want to visit as many different programs as you can. Take a tour,
talk independently with participants and staff and ask questions.
Bring a friend or family member along to be an extra set of eyes
and a source of support. If possible visit the program during the
morning and again in the afternoon to become familiar with the level
of staffing and activities that take place at different times of
the day.
Be aware that some agencies or providers may receive a referral
fee from an Adult Day Service provider for referring individuals
to their program. There are currently no laws preventing this practice.
The Department of Elder Affairs recommends you proceed with
caution if you are using an agency that accepts referral fees. You
may want to ask during your visit to the program if they pay referral
fees and to whom.
Educate yourself as much as you can on the laws that regulate ADS
programs in Iowa. The Iowa
Code and Iowa
Administrative Rules for adult day services are both available
online for your review.
Familiarize yourself with the terminology used in the adult day
services environment. The information provided on this website can
be a good starting point for building your knowledge.
You may also
want to visit the National
Adult Day Service Association website.
See the links to other websites with relevant consumer information
in the Self Advocacy Section
of this website.
Download the following checklist of things to survey when visiting
different programs: Adult
Day Services Checklist
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Does a contract need to be signed?
321-24.24(231D)
Yes, at the time of a participant's admission, the participant or
their legal representative (such as attorney-in-fact or guardian)
and the program must enter into a contractual agreement that clearly
describes the rights and responsibilities of the participant and
of the Adult Day Services Program. The contract is required to be
in a font that can be read and written in a clear and understandable
language. The contract is required to include a description of all
fees, scheduled days, transportation agreements, charges and rates.
It should also include information about the fee structure of third-party
payments (such as Medicaid, private insurance, etc.) and whether
third-party payments and resources will be accepted by the program
as payment.
The participant, or the participant's legal representative, should
receive a copy of the contract as well as: the admission and transfer
criteria, internal appeals process for involuntary transfer, emergency
response policy, staffing policy, services and programming provided,
and the program's statement on participants' rights.
If you are 60 or older, the Legal Hotline for Older Americans may
be of assistance and can be reached by phone at: 1-800-992-8161.
Your local Area Agency on Aging may also be able to provide information
on how to access legal assistance to review the contractual agreement.
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What is "managed risk"?
321-24.37(231D)
The managed or negotiated risk statement is a written agreement
to acknowledge all parties' agreement regarding the participant's
preferences should they be contrary to medical advice or raise safety
concerns and how they will be accommodated by the Adult Day Services
program. One of the most valuable aspects of the agreement is that
it enables all invested parties to discuss and come to agreement
on how to handle something a participant chooses to do that the
program may not agree with. A managed risk agreement may not circumvent
any local, state, or federal laws and is only initiated when there
is a perceived need on a case by case basis for a specific, narrowly
defined issue.
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How does an Arbitration Agreement
apply to my Occupancy Agreement?
Arbitration agreements require the participant to resolve disputes
that arise in binding arbitration, rather than in court before a
judge or jury. Binding arbitration involves the submission of a
dispute to a neutral party who renders a decision following a hearing.
Arbitration takes the place of a trial before a judge or jury. Grounds
for appealing or setting aside the arbitration decision are very
limited and may frequently not be available at all because the arbitration
is binding. ADS contracts may ask tenants to sign an arbitration
agreement as part of the contract. If a participant signs a contract
containing a binding arbitration agreement, he or she gives up the
right to go to court to have the claim resolved.
Some of the advantages to the participant of binding arbitration
are that it provides a private forum, is less formal and technical
than court and MAY result in a quicker resolution. The disadvantages
of binding arbitration are: it can be more expensive than court,
it waives the participant's right to have the claim decided in court,
it can be extremely hard to find a lawyer who will represent the
tenant on other than an hourly fee basis and it severely limits
the right to appeal.
If you are not willing to sign a pre-dispute arbitration agreement
as part of your occupancy agreement, you should request that the
arbitration clause be stricken. If the ADS is not willing to remove
the arbitration agreement from the contract, you may want to continue
looking at other Adult Day Service programs. The Department
of Elder Affairs recommends consumers proceed with caution and consider
seeking legal counsel before entering into an arbitration agreement
with an Adult Day Service Program.
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What is the admissions process?
321-24.25(231D)
Prior to a participant's admission to a program, an initial evaluation
of the participant's functional ability, cognitive ability and health
status will be completed to determine the participant's eligibility
for the program including whether services can be provided. This
evaluation must be conducted by a health care professional or a
human service professional.
After the participant's initial evaluation,
a program is required to evaluate each participant's functional
ability, cognitive ability and health status within 30 days and
then at least annually or more often as needed, to determine the
participant's continued eligibility for the program and to determine
if any modifications to services are needed.
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How will the coordination of
my care be determined?
321-24.29(231D)
A service plan will be completed by the participant or their legal
representative, others who they may choose to participate and the
program staff. The service plan is based on the initial evaluation
and is completed upon the participant's admission into the adult
day service program. This evaluation assesses the participant's
functional ability, cognitive ability and health status. All persons
who develop the plan, including the participant or their legal representative,
must sign the service plan. The service plan is required by law
to be updated: within 30 days of admission, annually, as needed
or upon the request of the participant or their legal representative.
Your service plan is very important as it specifies precisely what
services the participant will get, when they will get them, and
how.
The service plan is to be individualized and at minimum include:
- The participant's identified needs including any services and
care provided as identified in the contract
- The participant's or their legal representative's requests for
assistance and expected outcomes
- Who will provide the services if they will be contracted outside
of the program
- Planned and spontaneous activities based on the participant's
abilities and personal interests
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How are medications managed?
231D.13A
An Adult Day Service program cannot prohibit a participant from
self-administering medications. However, if the participant or the
participant's legal representative wishes they may delegate medication
setup to the ADS. Medication setup means assistance with various
steps of medication administration to support the participant's
autonomy, which may include but is not limited to routine prompting,
cueing and reminding, opening containers or packaging at the participant's
direction, reading instructions or other label information, or transferring
medications from the original container into suitable medication
dispensing containers, reminder containers, or medication cups.
If administration of medications (medication setup) is delegated
to the ADS program by the participant or the participant's legal
representative, the medications must be administered by a registered
nurse, licensed practical nurse, or advanced registered nurse practitioner
licensed or registered in Iowa or by the individual to whom such
licensed or registered individuals may properly delegate administration
of medications. This process is called nurse delegation and allows
for a universal worker to administer medications when trained and
supervised by a nurse described above.
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What are the staff qualifications?
321-24.34(231D) 321-24.35(231D)
Sufficiently trained staff are required by law to be available at
all times to fully meet participant's identified needs (both scheduled
and unscheduled). When two or more participants are present, there
must be a minimum of two staff available to monitor the participants
as indicated in each participant's service plan. All personnel of
the program must be able to implement the program's accident, fire
safety and emergency procedures. The owner of the program is responsible
for ensuring that all personnel receive training appropriate to
assigned tasks and the target population.
All personnel employed by a dementia-specific program shall receive
a minimum of six hours of dementia-specific education and training
prior to or within 90 days of employment. Two hours of dementia-specific
education is required annually. Direct-contact personnel are required
to receive a minimum of six hours of dementia-specific continuing
education annually.
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Why do I need to understand "level of care" requirements?
321-24.26(231D)
Over time a participant may come to require an increased level of
staff attention, such as requiring a three-person assist with standing
or transferring. At this point, Adult Day Service may no longer
continue to serve the participant and the contract would be terminated.
However, if the Adult Day Service program desires and is able to
continue providing care to the participant and if a participant
or their legal representative wishes to continue participating in
the Adult Day Services Program, a request can be made for waiver
of level of care.
The participant, their legal representative, or the ADS Program
Director can request for waiver of level of care and submit the
waiver to the Department of Inspections and Appeals. The DIA will
make a decision to grant the waiver based on whether or not: it
is the informed choice of the participant or their legal representative
to remain in the Adult Day Services program, the ADS Program Director
is able to provide appropriate care to the participant in addition
to adequate care of the other participants, and the waiver will
not jeopardize the care, health, safety or welfare of the participant
or others. There is no guarantee a waiver will be approved by the
State.
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How are meals provided?
321-24.33(231D)
The program must have the capacity to provide hot or other appropriate
meals and snacks or coordinate with other community providers to
arrange for meals and snacks. A meal or snack must be provided at
least every four hours. Meals are required by law to meet one third
of the daily nutritional standards as established by the Food and
Nutrition Board of the National Research Council. Staff is required
to have food safety training and the kitchens are required to have
a Food Establishment License for programs that provide their own
meals. If you have complaints regarding meal service, sanitation
or food safety you should direct your concerns to the Department
of Inspections and Appeals at 1-877-686-0027.
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What happens in an emergency?
321-24.38(231D)
The program must have written emergency policies and procedures
which include:
- An emergency plan
- Fire safety procedures
- Training employees
- Fire Drills
- Monitoring smoke detectors
- An Evacuation plan
If you have concerns regarding the program's life safety procedures
direct your concerns to the fire marshal's office by phone at (515)
281-5821.
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What kinds of activities will be
offered?
321-24.40(231D)
The program is required to provide appropriate activities for each
program participant. The type of activities shall reflect a participant's
preferences, abilities, desires, history, family system, ethnic
and cultural experiences, faith community, personal beliefs and
values by providing a variety of opportunities and experiences that
have meaning and purpose for the program participant. The participant's
service plan should be supported through the types of activities
provided. A monthly written schedule of activities is required to
be made available to all participants or their legal representatives.
Participants have the right to select the degree to which they choose
to become involved in the activities offered in the program.
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See the links to other websites with relevant
consumer information in the Self
Advocacy Section of this website.
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