PRIOR PRINTER'S NO. 1986 PRINTER'S NO. 2653
No. 1629 Session of 2001
INTRODUCED BY WOJNAROSKI, PISTELLA, SCHULER, GRUCELA, B. SMITH,
C. WILLIAMS, ARMSTRONG, SAMUELSON, WATSON, PALLONE, YUDICHAK,
MELIO AND STETLER, MAY 21, 2001
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
OCTOBER 15, 2001
AN ACT
1 Providing for long-term care A CERTIFICATION PROGRAM IN CERTAIN <--
2 facilities and for facilities which offer cognitive support <--
3 services to persons with mental impairment COGNITIVE <--
4 IMPAIRMENTS AND FOR REPORT TO GENERAL ASSEMBLY.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. Short title.
8 This act shall be known and may be cited as the Cognitive
9 IMPAIRMENT Support Services Licensing CERTIFICATION Act. <--
10 Section 2. Definitions.
11 The following words and phrases when used in this act shall
12 have the meanings given to them in this section unless the
13 context clearly indicates otherwise:
14 "ADULT DAILY LIVING CENTER." AN OLDER ADULT DAILY LIVING <--
15 CENTER AS DEFINED IN SECTION 2 OF THE ACT OF JULY 11, 1990
16 (P.L.499, NO.118), KNOWN AS THE OLDER ADULT DAILY LIVING CENTERS
17 LICENSING ACT.
18 "CERTIFIED FACILITY." A FACILITY THAT HAS BEEN ISSUED A
1 COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE.
2 "Cognitive IMPAIRMENT support services." Assessment, program <--
3 planning, ongoing monitoring, personal care services, health
4 support services, dementia-care activity programming and OR <--
5 crisis management provided as part of a coordinated care plan to
6 residents who have memory impairments and other cognitive
7 problems that significantly interfere with their ability to
8 carry out activities of daily living without assistance and who
9 require that supervision, monitoring and programming be
10 available to them 24 hours per day, seven days per week, in
11 order for them to reside safely in the setting of their choice.
12 "Cognitive support services license." A permit issued under <--
13 section 3 which allows a long-term care facility to provide
14 "COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE." A <--
15 CERTIFICATE ISSUED UNDER THIS ACT THAT ALLOWS AN ADULT DAILY
16 LIVING CENTER OR A FACILITY TO PROVIDE cognitive IMPAIRMENT <--
17 support services.
18 "Department." The department that has the respective
19 licensing authority over a long-term care AN ADULT DAILY LIVING <--
20 CENTER OR A facility. For a long-term CARE nursing facility, the <--
21 term shall mean the Department of Health. For a personal care
22 home, the term shall mean the Department of Public Welfare. For
23 an adult daily living center, the term shall mean the Department
24 of Aging.
25 "Long-term care facility." A facility licensed by the <--
26 Commonwealth to provide long-term care. The term includes, but
27 is not limited to, a long-term nursing facility, a personal care
28 home and an adult daily living center.
29 "Long-term care specialty facility." A long-term care
30 facility that has been issued a cognitive support services
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1 license.
2 "FACILITY." ANY OF THE FOLLOWING: <--
3 (1) A LONG-TERM CARE NURSING FACILITY AS DEFINED IN
4 SECTION 802.1 OF THE ACT OF JULY 19, 1979 (P.L.130, NO.48),
5 KNOWN AS THE HEALTH CARE FACILITIES ACT, OR DESIGNATED WING
6 OR PORTION THEREOF.
7 (2) A PERSONAL CARE HOME AS DEFINED IN SECTION 1001 OF
8 THE ACT OF JUNE 13, 1967 (P.L.31, NO.21), KNOWN AS THE PUBLIC
9 WELFARE CODE, OR DESIGNATED WING OR PORTION THEREOF.
10 "Personal care services." Assistance or supervision in
11 dressing, bathing, diet, financial management or evacuation of a
12 consumer in a personal care home, in the event of an emergency
13 or medication prescribed for self-administration and shall
14 include prompting, cueing, monitoring and focusing on
15 maintaining functioning.
16 "Resident." A person with a cognitive impairment who
17 receives services in either a long-term care facility or a long- <--
18 term care specialty CERTIFIED facility. <--
19 "Restricted unit." A unit within a long-term care facility <--
20 that has received a long-term care specialty license under this
21 act and that provides services to people with cognitive
22 impairments.
23 Section 3. Cognitive support services license.
24 (a) Agency duties.--Within six months of the effective date
25 of this act, each department authorized to license a long-term
26 care facility shall meet to establish the requirements which a
27 long-term care facility must fulfill in order to obtain a
28 cognitive support services license. Only those long-term care
29 facilities that receive a cognitive support services license
30 shall be permitted to advertise that they offer cognitive
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1 support services and are a long-term care speciality facility.
2 (b) Regulations.--Within 90 days of enactment of this act,
3 each such department shall promulgate the rules and regulations
4 which are appropriate for a long-term care facility under its
5 authority that applies for a cognitive support services license.
6 SECTION 3. CERTIFICATION OF ADULT DAILY LIVING CENTER STAFF. <--
7 (A) COURSE DEVELOPMENT.--THE DEPARTMENT OF AGING SHALL, IN
8 ADDITION TO STAFF ORIENTATION AND TRAINING ALREADY REQUIRED,
9 PROMULGATE RULES AND REGULATIONS FOR THE ESTABLISHMENT OF A
10 COURSE ON CARING FOR INDIVIDUALS WITH COGNITIVE IMPAIRMENTS IN
11 ADULT DAILY LIVING CENTERS. THIS COURSE SHALL BE DEVELOPED WITH
12 INPUT FROM STAKEHOLDERS THAT REPRESENT ADULT DAILY LIVING
13 CENTERS AND SHALL INCLUDE MATERIALS ON DEMENTIA AND BEHAVIORAL
14 MANAGEMENT, DOCUMENTATION MANAGEMENT AND CARE PLANNING.
15 (B) AWARD OF CERTIFICATE.--THE DEPARTMENT OF AGING SHALL
16 AWARD A COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE TO
17 EACH STAFF MEMBER THAT SUCCESSFULLY COMPLETES THE REQUIRED
18 COURSE UNDER SUBSECTION (A).
19 (C) COPIES TO BE ON FILE.--AN ADULT DAILY LIVING CENTER
20 SHALL KEEP COPIES OF THE CERTIFICATION ON FILE.
21 (D) ADVERTISING.--EACH ADULT LIVING CENTER THAT EMPLOYS
22 STAFF THAT HAVE BEEN AWARDED COGNITIVE IMPAIRMENT SUPPORT
23 SERVICES CERTIFICATES FROM THE DEPARTMENT OF AGING IS PERMITTED
24 TO ADVERTISE THAT IT OFFERS COGNITIVE IMPAIRMENT SUPPORT
25 SERVICES.
26 SECTION 4. CERTIFICATION OF FACILITIES.
27 THE DEPARTMENT OF HEALTH AND THE DEPARTMENT OF PUBLIC WELFARE
28 SHALL PROMULGATE RULES AND REGULATIONS TO ESTABLISH THE
29 REQUIREMENTS WHICH A FACILITY UNDER ITS AUTHORITY MUST FULFILL
30 IN ORDER TO OBTAIN A COGNITIVE IMPAIRMENT SUPPORT SERVICES
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1 CERTIFICATE. ONLY THOSE FACILITIES THAT RECEIVE A COGNITIVE
2 IMPAIRMENT SUPPORT SERVICES CERTIFICATE SHALL BE PERMITTED TO
3 ADVERTISE THAT THEY OFFER COGNITIVE IMPAIRMENT SUPPORT SERVICES
4 AND ARE A CERTIFIED FACILITY. These rules and regulations shall
5 provide:
6 (1) Admission, DISCHARGE and transfer criteria for those <--
7 with cognitive services IMPAIRMENTS. <--
8 (2) Adequate indoor and outdoor wandering space
9 requirements.
10 (3) Requirements relating to provision of therapeutic
11 activities that meet the scheduled and unscheduled individual
12 needs of each resident, with services focusing on maximizing
13 independence and on the individual's strengths and abilities.
14 (4) Physical design and safety requirements, including
15 electronic monitoring.
16 (5) Additional and specialized training requirements for
17 staff in the area of cognitive IMPAIRMENT problems and care. <--
18 (6) Prearranged procedures for notification of
19 authorities should a resident wander away from the long-term <--
20 care speciality facility.
21 (7) Minimum staffing requirements that shall apply to a <--
22 long-term care specialty facility. FOR A FACILITY TO RECEIVE <--
23 A CERTIFICATE UNDER THIS ACT.
24 Section 4 5. Administrator training. <--
25 (a) Administrator proficiency to be tested.--In order for a <--
26 long-term care facility to receive a cognitive support services
27 license, its administrators shall receive training and pass a
28 test in a program approved by each department. Each
29 administrator shall demonstrate proficiency in the following
30 areas:
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1 IN ORDER FOR A FACILITY UNDER THE AUTHORITY OF EITHER THE <--
2 DEPARTMENT OF HEALTH OR THE DEPARTMENT OF PUBLIC WELFARE TO
3 RECEIVE A COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE, ITS
4 ADMINISTRATORS SHALL RECEIVE TRAINING AND PASS A TEST IN A
5 PROGRAM APPROVED BY EACH DEPARTMENT. THIS TRAINING SHALL BE IN
6 ADDITION TO THE STATUTORY AND REGULATORY TRAINING REQUIREMENTS
7 FOR AN ADMINISTRATOR OF THE FACILITY. EACH ADMINISTRATOR SHALL
8 DEMONSTRATE PROFICIENCY IN THE FOLLOWING AREAS:
9 (1) The definition and diagnosis of dementia,
10 description of the reversible and irreversible causes and
11 explanations of differences between dementia, delirium and
12 depression.
13 (2) An explanation of dementia and related disorders,
14 progression, stages and individual variability.
15 (3) Communication techniques.
16 (4) A description of behavioral symptoms of dementia and
17 how to approach residents when they display challenging
18 behaviors, including conflict avoidance and conflict
19 resolution techniques.
20 (5) The role of personality, culture and environmental
21 factors in behavioral symptoms and dementia care.
22 (6) Knowledge of community-based resources for consumers
23 with dementia and their families.
24 (b) Grandfather clause.--Administrators who are so employed <--
25 on the date this act is enacted shall have six months from the
26 date the initial cognitive support services license regulations
27 are promulgated to demonstrate proficiency in the areas
28 specified in subsection (a).
29 Section 5 6. Staff training. <--
30 (a) Requirements.--Staff working in a long-term care <--
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1 specialty (A) GENERAL RULE.--A FACILITY THAT HAS RECEIVED A <--
2 COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE UNDER SECTION
3 4 SHALL EMPLOY STAFF WHO HAVE RECEIVED TRAINING AND DEMONSTRATED
4 COMPETENCY IN EACH COMPONENT OF A TRAINING PROGRAM APPROVED BY
5 THE DEPARTMENT PRIOR TO THE START OF INDEPENDENT WORK IN THAT
6 COMPONENT. THIS TRAINING SHALL BE IN ADDITION TO THE STATUTORY
7 AND REGULATORY TRAINING REQUIREMENTS FOR A STAFF PERSON IN THE
8 FACILITY.
9 (B) REQUIREMENTS.--STAFF WORKING IN A CERTIFIED facility
10 shall receive training approved by the department which issued
11 its cognitive support services license IMPAIRMENT SUPPORT <--
12 SERVICES CERTIFICATE. Each staff member shall receive additional
13 training that includes, but is not limited to, the following:
14 (1) Assessment and reporting of health problems.
15 (2) Understanding dementia, including causes, symptoms,
16 treatments and management techniques.
17 (3) Changes in condition and appropriate responses.
18 (4) Dementia-capable activity programming, communication
19 skills and management of behavioral challenges.
20 (5) Mental health issues.
21 (6) Stress management.
22 (7) Awareness, identification, prevention and reporting
23 of abuse and neglect.
24 (b) Grandfather clause.--Staff who are employed in a long- <--
25 term care facility on the date this act is enacted shall have
26 six months from the date the initial cognitive support services
27 license regulations are promulgated to demonstrate proficiency
28 in the areas specified in subsection (a).
29 Section 6 7. Discharge and transfer. <--
30 Before a resident is discharged or transferred from a long- <--
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1 term care facility to a long-term care specialty CERTIFIED <--
2 facility, the following shall occur:
3 (1) The resident, a responsible family member or a legal
4 representative for the resident shall be informed by written
5 notice at least 30 days in advance of the long-term <--
6 facility's intent to discharge or transfer the resident. The
7 notice shall contain the following:
8 (i) A statement of the resident's rights to seek an
9 assessment from either the area agency on aging or
10 another qualified person ASSESSOR that is independent <--
11 from the long-term care facility. <--
12 (ii) A statement of the resident's right to appeal
13 to the specified department and use the facility's
14 internal grievance process to address the appropriateness
15 of the transfer or discharge.
16 (2) Notice shall be provided to the resident and to
17 either a responsible family member or a legal representative
18 of the resident. The long-term care facility making the <--
19 transfer shall keep as part of the resident's records proof
20 that a responsible family member or legal representative
21 received the written notice.
22 (3) The notice requirement under this section does not
23 apply if the transfer or discharge is necessary to meet a
24 resident's needs or when the resident is a danger to himself
25 or other residents. However, the long-term care facility <--
26 shall provide as much advance notice as possible to the
27 resident and to either a responsible family member or legal
28 representative of the resident.
29 (4) A physician shall approve the transfer or discharge
30 and the resident and either a responsible family member or
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1 legal representative shall also approve the transfer or
2 discharge.
3 (5) If the resident is not capable of understanding the
4 written notice for a transfer or discharge and there is no
5 responsible family member or a legal representative for the
6 resident, the long-term care facility shall refer the matter <--
7 to the local area agency on aging for review.
8 (6) The department EACH DEPARTMENT WITH AUTHORITY OVER A <--
9 FACILITY shall, through its inspection process, review
10 transfer and discharge cases that are based on cognitive
11 impairments for compliance.
12 Section 7 8. Disclosure. <--
13 A long-term care specialty CERTIFIED facility shall provide <--
14 each applicant with a disclosure form approved by the department
15 that contain the following:
16 (1) A mission statement on serving individuals with
17 cognitive impairments.
18 (2) The department regulations requiring physical space,
19 therapeutic activities, additional administrator and staff
20 training and security measures that must be met by a long- <--
21 term care specialty CERTIFIED facility. <--
22 (3) A statement that the long-term care specialty <--
23 CERTIFIED facility meets the requirements established by the <--
24 department.
25 (4) A description of the schedule and types of
26 individual and group activities, security measures and family
27 support programs.
28 SECTION 9. GRANDFATHER CLAUSE. <--
29 ADMINISTRATORS AND STAFF WHO ARE EMPLOYED IN A FACILITY ON
30 THE DATE THIS ACT IS ENACTED SHALL HAVE SIX MONTHS FROM THE DATE
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1 THE INITIAL COGNITIVE IMPAIRMENT SUPPORT SERVICES CERTIFICATE
2 REGULATIONS ARE PROMULGATED TO DEMONSTRATE PROFICIENCY IN THE
3 AREAS SPECIFIED UNDER THIS ACT.
4 SECTION 10. REPORT TO GENERAL ASSEMBLY.
5 WITHIN ONE YEAR OF THE EFFECTIVE DATE OF THIS SECTION, THE
6 DEPARTMENT SHALL PROVIDE TO THE GENERAL ASSEMBLY A REPORT ON
7 PROGRAMS WITHIN THIS COMMONWEALTH AND THROUGHOUT THE UNITED
8 STATES THAT SEEK TO MAXIMIZE THE EFFECTIVENESS OF CHARITABLE
9 PHARMACEUTICAL PROGRAMS AND TO PROVIDE RECOMMENDATIONS FOR NEW
10 LAWS AND INITIATIVES WITHIN THIS COMMONWEALTH TO ENHANCE THE
11 ABILITY OF PENNSYLVANIANS TO TAKE ADVANTAGE OF SUCH PROGRAMS.
12 Section 8 11. Effective date. <--
13 This act shall take effect in 180 days. AS FOLLOWS: <--
14 (1) SECTION 10 SHALL TAKE EFFECT IMMEDIATELY.
15 (2) THIS SECTION SHALL TAKE EFFECT IMMEDIATELY.
16 (3) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT IN 180
17 DAYS.
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