PRINTER'S NO. 735
No. 464 Session of 2007
INTRODUCED BY WOJNAROSKI, BENNINGTON, CALTAGIRONE, DeLUCA,
FABRIZIO, FREEMAN, GERGELY, GRUCELA, HENNESSEY, KOTIK, MELIO,
PETRONE, PRESTON, READSHAW, REICHLEY, STABACK, THOMAS, WALKO,
YOUNGBLOOD, SIPTROTH, GEIST, JAMES AND TANGRETTI,
MARCH 9, 2007
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
MARCH 9, 2007
AN ACT
1 Providing for a certification program in certain facilities
2 which offer cognitive support services to persons with
3 cognitive impairments and for report to General Assembly.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Cognitive
8 Impairment Support Services Certification Act.
9 Section 2. Definitions.
10 The following words and phrases when used in this act shall
11 have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Adult daily living center." An older adult daily living
14 center as defined in section 2 of the act of July 11, 1990
15 (P.L.499, No.118), known as the Older Adult Daily Living Centers
16 Licensing Act.
1 "Certified facility." A facility that has been issued a
2 cognitive impairment support services certificate.
3 "Cognitive impairment support services." Assessment, program
4 planning, ongoing monitoring, personal care services, health
5 support services, dementia-care activity programming or crisis
6 management provided as part of a coordinated care plan to
7 residents who have memory impairments and other cognitive
8 problems that significantly interfere with their ability to
9 carry out activities of daily living without assistance and who
10 require that supervision, monitoring and programming be
11 available to them 24 hours per day, seven days per week, in
12 order for them to reside safely in the setting of their choice.
13 "Cognitive impairment support services certificate." A
14 certificate issued under this act that allows an adult daily
15 living center or a facility to provide cognitive impairment
16 support services.
17 "Department." The department that has the respective
18 licensing authority over an adult daily living center or a
19 facility. For a long-term care nursing facility, the term shall
20 mean the Department of Health. For a personal care home, the
21 term shall mean the Department of Public Welfare. For an adult
22 daily living center, the term shall mean the Department of
23 Aging.
24 "Facility." Any of the following:
25 (1) A long-term care nursing facility as defined in
26 section 802.1 of the act of July 19, 1979 (P.L.130, No.48),
27 known as the Health Care Facilities Act, or designated wing
28 or portion thereof.
29 (2) A personal care home as defined in section 1001 of
30 the act of June 13, 1967 (P.L.31, No.21), known as the Public
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1 Welfare Code, or designated wing or portion thereof.
2 "Personal care services." Assistance or supervision in
3 dressing, bathing, diet, financial management or evacuation of a
4 consumer in a personal care home, in the event of an emergency
5 or medication prescribed for self-administration and shall
6 include prompting, cuing, monitoring and focusing on maintaining
7 functioning.
8 "Resident." A person with a cognitive impairment who
9 receives services in either a facility or a certified facility.
10 Section 3. Certification of adult daily living center staff.
11 (a) Course development.--The Department of Aging shall, in
12 addition to staff orientation and training already required,
13 promulgate rules and regulations for the establishment of a
14 course on caring for individuals with cognitive impairments in
15 adult daily living centers. This course shall be developed with
16 input from stakeholders that represent adult daily living
17 centers and shall include materials on dementia and behavioral
18 management, documentation management and care planning.
19 (b) Award of certificate.--The Department of Aging shall
20 award a cognitive impairment support services certificate to
21 each staff member that successfully completes the required
22 course under subsection (a).
23 (c) Copies to be on file.--An adult daily living center
24 shall keep copies of the certification on file.
25 (d) Advertising.--Each adult living center that employs
26 staff that have been awarded cognitive impairment support
27 services certificates from the Department of Aging is permitted
28 to advertise that it offers cognitive impairment support
29 services.
30 Section 4. Certification of facilities.
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1 The Department of Health and the Department of Public Welfare
2 shall promulgate rules and regulations to establish the
3 requirements which a facility under its authority must fulfill
4 in order to obtain a cognitive impairment support services
5 certificate. Only those facilities that receive a cognitive
6 impairment support services certificate shall be permitted to
7 advertise that they offer cognitive impairment support services
8 and are a certified facility. These rules and regulations shall
9 provide:
10 (1) Admission, discharge and transfer criteria for those
11 with cognitive impairments.
12 (2) Adequate indoor and outdoor wandering space
13 requirements.
14 (3) Requirements relating to provision of therapeutic
15 activities that meet the scheduled and unscheduled individual
16 needs of each resident, with services focusing on maximizing
17 independence and on the individual's strengths and abilities.
18 (4) Physical design and safety requirements, including
19 electronic monitoring.
20 (5) Additional and specialized training requirements for
21 staff in the area of cognitive impairment problems and care.
22 (6) Prearranged procedures for notification of
23 authorities should a resident wander away from the facility.
24 (7) Minimum staffing requirements that shall apply for a
25 facility to receive a certificate under this act.
26 Section 5. Administrator training.
27 In order for a facility under the authority of either the
28 Department of Health or the Department of Public Welfare to
29 receive a cognitive impairment support services certificate, its
30 administrators shall receive training and pass a test in a
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1 program approved by each department. This training shall be in
2 addition to the statutory and regulatory training requirements
3 for an administrator of the facility. Each administrator shall
4 demonstrate proficiency in the following areas:
5 (1) The definition and diagnosis of dementia,
6 description of the reversible and irreversible causes and
7 explanations of differences between dementia, delirium and
8 depression.
9 (2) An explanation of dementia and related disorders,
10 progression, stages and individual variability.
11 (3) Communication techniques.
12 (4) A description of behavioral symptoms of dementia and
13 how to approach residents when they display challenging
14 behaviors, including conflict avoidance and conflict
15 resolution techniques.
16 (5) The role of personality, culture and environmental
17 factors in behavioral symptoms and dementia care.
18 (6) Knowledge of community-based resources for consumers
19 with dementia and their families.
20 Section 6. Staff training.
21 (a) General rule.--A facility that has received a cognitive
22 impairment support services certificate under section 4 shall
23 employ staff who have received training and demonstrated
24 competency in each component of a training program approved by
25 the department prior to the start of independent work in that
26 component. This training shall be in addition to the statutory
27 and regulatory training requirements for a staff person in the
28 facility.
29 (b) Requirements.--Staff working in a certified facility
30 shall receive training approved by the department which issued
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1 its cognitive impairment support services certificate. Each
2 staff member shall receive additional training that includes,
3 but is not limited to, the following:
4 (1) Assessment and reporting of health problems.
5 (2) Understanding dementia, including causes, symptoms,
6 treatments and management techniques.
7 (3) Changes in condition and appropriate responses.
8 (4) Dementia-capable activity programming, communication
9 skills and management of behavioral challenges.
10 (5) Mental health issues.
11 (6) Stress management.
12 (7) Awareness, identification, prevention and reporting
13 of abuse and neglect.
14 Section 7. Discharge and transfer.
15 Before a resident is discharged or transferred from a
16 facility to a certified facility, the following shall occur:
17 (1) The resident, a responsible family member or a legal
18 representative for the resident shall be informed by written
19 notice at least 30 days in advance of the facility's intent
20 to discharge or transfer the resident. The notice shall
21 contain the following:
22 (i) A statement of the resident's rights to seek an
23 assessment from either the area agency on aging or
24 another assessor that is independent from the facility.
25 (ii) A statement of the resident's right to appeal
26 to the specified department and use the facility's
27 internal grievance process to address the appropriateness
28 of the transfer or discharge.
29 (2) Notice shall be provided to the resident and to
30 either a responsible family member or a legal representative
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1 of the resident. The facility making the transfer shall keep
2 as part of the resident's records proof that a responsible
3 family member or legal representative received the written
4 notice.
5 (3) The notice requirement under this section does not
6 apply if the transfer or discharge is necessary to meet a
7 resident's needs or when the resident is a danger to himself
8 or other residents. However, the facility shall provide as
9 much advance notice as possible to the resident and to either
10 a responsible family member or legal representative of the
11 resident.
12 (4) A physician shall approve the transfer or discharge
13 and the resident and either a responsible family member or
14 legal representative shall also approve the transfer or
15 discharge.
16 (5) If the resident is not capable of understanding the
17 written notice for a transfer or discharge and there is no
18 responsible family member or a legal representative for the
19 resident, the facility shall refer the matter to the local
20 area agency on aging for review.
21 (6) Each department with authority over a facility
22 shall, through its inspection process, review transfer and
23 discharge cases that are based on cognitive impairments for
24 compliance.
25 Section 8. Disclosure.
26 A certified facility shall provide each applicant with a
27 disclosure form approved by the department that contains the
28 following:
29 (1) A mission statement on serving individuals with
30 cognitive impairments.
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1 (2) The department regulations requiring physical space,
2 therapeutic activities, additional administrator and staff
3 training and security measures that must be met by a
4 certified facility.
5 (3) A statement that the certified facility meets the
6 requirements established by the department.
7 (4) A description of the schedule and types of
8 individual and group activities, security measures and family
9 support programs.
10 Section 9. Grandfather clause.
11 Administrators and staff who are employed in a facility on
12 the effective date of this act shall have six months from the
13 date the initial cognitive impairment support services
14 certificate regulations are promulgated to demonstrate
15 proficiency in the areas specified under this act.
16 Section 10. Report to General Assembly.
17 Within one year of the effective date of this section, the
18 department shall provide to the General Assembly a report on
19 programs within this Commonwealth and throughout the United
20 States that seek to maximize the effectiveness of charitable
21 pharmaceutical programs and to provide recommendations for new
22 laws and initiatives within this Commonwealth to enhance the
23 ability of Pennsylvanians to take advantage of such programs.
24 Section 11. Construction.
25 Nothing in this act shall be construed to invalidate or
26 supersede department regulations insofar as they are not
27 inconsistent with this act.
28 Section 12. Effective date.
29 This act shall take effect as follows:
30 (1) Section 10 shall take effect immediately.
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1 (2) This section shall take effect immediately.
2 (3) The remainder of this act shall take effect in 180
3 days.
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