§ 11.123. Core services.
The following essential, core services shall be offered or arranged in center programs: personal care, nursing, social services, therapeutic activities, nutrition and emergency care. The intensity of the services shall be modified to meet the functional needs of the clients. It is anticipated that the services will be on a continuum to meet the range of client needs, with appropriate staff persons to supply or arrange these services. Each essential core service shall be addressed during the care planning process. The center shall provide and maintain the essential space, materials and equipment necessary to provide these services and to protect the privacy of the clients receiving the services. Core services are as follows:
(1) Personal care. The center shall provide needed assistance and supervision with activities of daily living.
(2) Nursing services. The center shall directly provide, contract for or otherwise arrange for nursing services. The number of services provided by the nurse, the manner in which a center obtains nursing services (which may range from formal to informal), and the amount of time spent by the nurse in a center (which may, for example, range from the daily services of a registered nurse staffperson to a monthly or quarterly visit by a practical nurse) depend upon the needs of the center’s clients. Nursing service includes the following:
(i) Centers shall carry out the following standard nursing functions at least quarterly:
(A) Review of the client’s health status, including dietary needs.
(B) Review of medication procedures, if necessary.
(C) Review of policies and procedures for personal care.
(D) Training and education of staff persons regarding the needs of clients in centers, including infection control.
(ii) The following nursing functions may be added to subparagraph (i) if they are consistent with the goals of the center and the characteristics of persons admitted to the center, as determined through intake screening and client physical examination and medical reports:
(A) Provision or supervision of modified and therapeutic diets and supplemental feedings.
(B) Provision or supervision of observation, monitoring and intervention for unstable medical episodes.
(C) Preparation of the client for self-administration of medications.
(D) Provision of restorative or rehabilitative nursing.
(E) Provision of maintenance of respiratory aids, colostomy and ileostomy, urinary drainage devices, dressings, skin care, foot and nail care and routine care of incontinent clients.
(F) Response to emergencies.
(G) Administration of parenteral treatments.
(H) Provision of other skilled nursing care which can be safely done in the older adult daily living center.
(3) Social services. The center shall provide or arrange social services as needed. These services may be provided by center program staff persons or staff persons of community service providers. They may also be provided by a social worker, who may serve as a consultant or may be a full-time or part-time program staff member. They are provided to clients and their families/caregivers to help them deal with personal, family and adjustment situations as needed to enhance the effectiveness of the client’s individual care plan. Social service activities include the following:
(i) The following shall be carried out consistent with the needs of the client:
(A) Compilation of a social history and completion of an intake screening.
(B) Assistance with the client’s adaptation to the center program and active involvement in the individual plan of care, if appropriate.
(C) Arrangement for other community services not provided by the center and work with other agencies to coordinate needed services.
(D) Provision of discharge planning, and assistance in transition and follow-up.
(E) Provision of information and referral for persons not appropriate for older adult daily living centers.
(ii) The following may be added to subparagraph (i) if they are consistent with the goals of the center and the characteristics of persons admitted to the center:
(A) Facilitation of family conferences, serving as liaison between client, family/caregiver and center.
(B) Provision of individual or group counseling and support to families/caregivers and clients.
(C) Facilitation of the development of family support groups.
(4) Therapeutic activities. Activities shall be an integral part of the care plan for the individual. The planning of activities shall reflect professional understanding of the needs and abilities of the clients. Activities, while reflecting awareness of impairment, shall emphasize the individual client’s strengths and abilities so they can contribute to client feelings of accomplishment.
(i) Scope.
(A) The center shall provide for a balance of purposeful activities to meet the client’s interrelated needs and interests—including social, intellectual, cultural, economic, emotional, physical and spiritual.
(B) Provision shall be made for individuals to participate at their optimal level of functioning and to progress according to their own pace.
(C) Activities shall be designed in a holistic manner to promote personal growth and enhance the self-image or to improve or maintain the functioning level of clients, or both. Activities may offer opportunities to:
(I) Maintain lifelong skills.
(II) Learn new skills and gain knowledge.
(III) Challenge and tap potential abilities.
(IV) Participate in activities of interest.
(V) Improve capacity for independent functioning.
(VI) Develop interpersonal relationships.
(VII) Develop creative capabilities.
(VIII) Improve physical and emotional well-being.
(IX) Be exposed to and involved in activities and events within the greater community.
(X) Experience cultural enrichment.
(XI) Have fun and enjoyment.
(D) Activity programming shall take into consideration individual differences in health status, lifestyle, ethnicity, religious affiliation, values, experiences, needs, interests, abilities and skills by providing opportunities for a variety of types and levels of involvement. Activities may include:
(I) Individualized activities.
(II) Small and large group activities.
(III) Active and spectator participation.
(IV) Intergenerational experiences.
(V) Involvement in community activities and events.
(VI) Outdoor activities as appropriate.
(VII) Opportunities to voluntarily perform services for individuals and the center, and community groups and organizations.
(E) Clients shall be encouraged to take part in activities, but may choose not to do so or to choose another activity. Reasons for nonparticipation shall be evaluated to determine whether they are due to personal preference or indicate a need for change in activity.
(ii) Schedule.
(A) Planned activities shall be available whenever the center is in operation.
(B) A monthly calendar of activities shall be prepared and posted in a visible place.
(C) Group daily activities shall be posted in a prominent, convenient and visible place.
(D) The activities schedule shall be coordinated with other services offered at the center and with other staff persons.
(5) Nutrition and therapeutic diets. A center shall follow the nutrition standards set forth in § § 11.151 and 11.152 (relating to nutrition).
(6) Emergency care for participants. Procedures for handling emergencies are set forth in § 11.21 (relating to emergency procedures).
Cross References This section cited in 6 Pa. Code § 11.35 (relating to nurse); 6 Pa. Code § 11.36 (relating to activities coordinator); 6 Pa. Code § 11.122 (relating to assurance of service quality); 6 Pa. Code § 11.212 (relating to applicability); 6 Pa. Code § 11.402 (relating to specialized services); and 6 Pa. Code § 11.403 (relating to additional services).
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