Subchapter B. STATEMENT OF POLICY
Sec.
11.401. Advisory committees.
11.402. Specialized services.
11.403. Additional services.
11.404. Program staff training guidelines.
Source The provisions of this Subchapter B adopted July 2, 1993, effective July 3, 1993, 23 Pa.B. 3229, unless otherwise noted.
Cross References This subchapter cited in 6 Pa. Code § 11.13 (relating to administration and organization); and 6 Pa. Code § 11.124 (relating to specialized and additional services).
§ 11.401. Advisory committees.
(a) Centers should establish advisory committees which meet at least twice a year to assure compliance with § 11.13 (relating to administration and organization) which provides written policies and procedures which are responsive to the needs of their clients.
(b) Center advisory committees should review program policies and procedures and make recommendations for improvements at least once a year.
§ 11.402. Specialized services.
(a) To supplement the core services required in § 11.123 (relating to core services), centers should consider providing the following specialized services:
(1) Physical therapy.
(i) Physical therapy services are provided to restore or maintain maximum mobility, with programs for restoration and maintenance of muscle function.
(ii) The services may range from consultation regarding group exercise to one-on-one skilled restorative therapy. Based on a physical therapy assessment, the plan of care and physician’s orders, the services include the following:
(A) Assessment of the client’s mobility level, strength, range of motion, endurance, balance, gait, ability to transfer, coordination, posture and pain level.
(B) Provision of treatment to relieve pain, and develop, restore or maintain functioning.
(C) Assistance to achieve and maintain maximum performance using physical means such as active or passive exercise, massage, heat, moist heat, ultrasound, hydrotherapy and ice.
(D) Establishment of a maintenance program and provision of written and verbal instructions to the center staff persons and the family/caregiver to assist the client with implementation.
(E) Recommendation of adaptive or assistive devices.
(F) Training other staff persons to lift, move and otherwise assist the client.
(G) Evaluation of the home for environmental barriers and changes needed for greater client independence.
(H) Provision of skilled rehabilitation services when indicated.
(I) Assistance in obtaining assistive ambulatory devices, such as canes, walkers, crutches, wheelchairs, leg braces and prosthetic devices.
(J) Physical therapy procedures including ambulation, gait training, active and passive exercises, orthotics training, prosthesis training, massage and neuromuscular reeducation.
(2) Occupational therapy. Occupational therapy services are services designed to increase physical status and independence in activities of daily living and to prevent further deterioration. The intensity of services provided may range from consultation for group services to one-on-one acute rehabilitative therapy. Depending on the occupational therapy assessment, plan of care and physician orders, occupational therapy services include the following:
(i) Administering diagnostic and prognostic tests to determine integrity of upper extremities, ability to transfer, range of motion, balance, strength and coordination, endurance, activities of daily living and cognitive-perceptual functioning.
(ii) Teaching clients adaptive techniques to overcome barriers and impediments in activities of daily living.
(iii) Teaching and training staff persons in the use of therapeutic, creative and self-care activities to improve or maintain the client’s capacity for self-care and independence, and increase the range of motion, strength and coordination.
(iv) Training the client in the use of supportive and adaptive equipment and assistive devices.
(v) Evaluating the home for environmental barriers and recommending changes for greater client independence.
(vi) Providing restorative therapy when indicated, establishing a maintenance program when needed to prevent deterioration and providing written and verbal instructions to center staff persons and the family/caregiver to assist the client with implementation.
(vii) Occupational therapy procedures, including:
(A) Training or retraining in activities of daily living.
(B) Training in work simplification.
(C) Exercises and graded activities to improve strength and range of motion.
(D) Sensory stimulation techniques to minimize sensory deficits.
(E) Coordination activities to promote increased manual dexterity.
(F) Evaluation and provision of needed slings or splints to increase or maintain functional use of upper extremities.
(3) Speech therapy. Speech services are provided to restore impaired speech and language disorders due to stroke, laryngectomy, head trauma and neurological diseases. Speech therapy services, when indicated by the plan of care, the speech therapist’s assessment and physician orders, include the following:
(i) The establishment of a treatment program to improve communication ability and correct disorders.
(ii) The provision of written and verbal instruction to center staff persons and family members in methods to assist the client to improve and correct speech disorders.
(iii) Speech therapy procedures, including the following:
(A) Auditory comprehension tasks.
(B) Visual or reading comprehension tasks, or both.
(C) Language intelligibility tasks.
(D) Language expression tasks.
(E) Training involving the use of alternative communication devices.
(4) Medical services.
(i) Medical services by a staff physician, the client’s personal physician or a certified registered nurse practitioner (CRNP) are provided or arranged by an older adult daily living center providing nursing or physical, speech or occupational therapy.
(ii) Medical services may be direct, indirect or a combination of both. Centers may have a physician or CRNP on a part-time basis who serves as a consultant and authorizes the medical plan of care. The physician may also serve as medical director or directly provide hands-on assessment or treatment, or both. Medical services may also be provided by the client’s personal physician who is contacted when changes or emergencies occur, provides medical assessment and treatment, is informed on a regular basis of the client’s status and retains primary responsibility for medical care. In centers where a medical director or consultant is available to act as a member of the team and authorize care, information is usually supplied to the personal physician, who may still provide the ongoing medical treatment.
(b) Specialized services may be provided directly or through contractual or other arrangements if appropriate for the center and needed by clients.
(c) If offered, services shall be delivered by licensed persons according to the standards of the relevant specialty.
§ 11.403. Additional services.
(a) To supplement the core services required in § 11.123 (relating to core services), centers should consider providing the following additional services:
(1) Dentistry. The dentist:
(i) Provides basic dental services, including examination and, as necessary, oral prophylaxis and emergency dental care to relieve pain and infection.
(ii) Develops and implements written dental services and oral hygiene policies and procedures.
(2) Laboratory, radiological and diagnostic services.
(i) The center establishes written policies to ensure that laboratory, radiological and diagnostic services are provided as ordered by a physician.
(ii) The findings of these services are reported in writing to the physician ordering the services. The center should also keep a record of findings.
(3) Pharmacy. A pharmacist:
(i) Assists in the development and review of written policies and procedures regarding medication storage, distribution, recording and disposal in the center.
(ii) Monitors at least quarterly the implementation of policies and procedures related to medication at the center.
(iii) Furnishes the administrator periodically with a written report on the status of medication-related services.
(4) Psychiatric or psychological services.
(i) The psychiatrist, psychologist, licensed clinical social worker or psychiatric nurse clinician:
(A) Provides assessments and reassessments when indicated by the plan of care.
(B) Acts as liaison with family members and referral sources that may yield information for psychiatric or psychological treatment.
(C) Provides group counseling and techniques as indicated by client need.
(D) Provides consultation to staff persons regarding behavioral management, motivation strategies and management of stressful situations such as the death of a client.
(E) Supervises implementation of a treatment plan.
(ii) Consultant services are indicated when the assessment indicates apparent mental, emotional or behavioral problems that need further assessment/treatment.
(5) Podiatry. A podiatrist provides:
(i) Examination, diagnosis and treatment when indicated by the plan of care.
(ii) Consultation to center staff persons about foot care.
(6) Ophthalmology/optometry. An ophthalmologist or optometrist provides:
(i) Vision testing and eye examinations.
(ii) Prescription of appropriate treatment or vision aids, or both.
(iii) Consultation with the center staff regarding techniques for working with clients with visual impairments.
(7) Audiology. An audiologist provides:
(i) An audiological evaluation.
(ii) Prescription of appropriate treatment such as a hearing aid.
(iii) Consultation with the center staff persons regarding techniques for working with clients with visual impairments.
(8) Other. Other services offered in the center shall meet applicable State and local requirements and professional standards. These services may include, for example, those of a licensed cosmetologist or barber.
(b) Additional services may be provided directly or through contractual or other arrangements if appropriate for the center and needed by clients.
(c) If offered, services shall be delivered by licensed persons according to the standards of the relevant specialty.
§ 11.404. Program staff training guidelines.
(a) To assist centers in complying with § 11.33 (relating to program staff orientation and training) and to ensure that they provide general orientation, annual and enhancement training designed to ensure basic skills and knowledge, to introduce new skills and knowledge and to enhance professional competencies, centers should consider using the following training topics:
(1) Program assistant/aide recommended topics.
(i) Special needs due to normal changes in the aging process—sensory changes, hydration, developmental needs, and the like.
(ii) Special needs due to disability and chronic illness—rehabilitation, psychosocial aspects, orientation strategies, remotivation, and the like.
(iii) Facilitating functions of clients with: sensory changes, decreased ability to perform activities of daily living, physical, emotional and cognitive problems, and the like.
(iv) Recreational activities.
(v) Death and dying; the grief process.
(vi) Communication and interpersonal skills—active listening, documentation, stress management for staff, clients, and caregivers, coping skills, and the like.
(vii) The older adult daily living centers (OADLC) working environment—safety issues (protecting clients and staff members), handling emergencies, fire safety, and the like.
(viii) Personal care—dietary needs, body mechanics, medications and substance abuse, and the like.
(ix) The interdisciplinary team approach to OADLC.
(x) Confidentiality and the rights of the older person.
(2) Activities coordinator recommended topics.
(i) Group process and group dynamics.
(ii) Supervisory skills development.
(iii) Therapeutic intervention skills—awareness therapy, reality orientation, sensory stimulation, fantasy validation therapy, and the like.
(iv) Arts and crafts project training.
(v) Leisure counseling—pet therapy, horticultural activities, and the like.
(vi) Community relations—public relations, outreach, fundraising, newsletters, and the like.
(vii) Volunteer supervision.
(3) Nurse recommended topics:
(i) Geriatric medicine—the normal aging process, diseases, body systems, medications, therapies, and the like.
(ii) Information, referral and community outreach.
(iii) Health education—intervening with clients and families or other caregivers.
(iv) Counseling skills.
(v) Training OADLC staff persons in personal care skills.
(vi) Geriatric assessments.
(4) Social/Supportive service worker recommended topics.
(i) Psychosocial aspects of aging.
(ii) Geriatric medicine—medical terminology, the normal aging process, diseases, therapies, understanding effects of medication, and the like.
(iii) Rehabilitation process—preventative care, understanding needs and abilities of clients, therapies, and the like.
(iv) Information and referral community outreach, including fundraising.
(v) Leisure/therapeutic recreation.
(vi) Reality orientation.
(vii) Facilitator skills for the interdisciplinary team.
(viii) Interpersonal skills.
(ix) Staff education—Advocacy for clients, confidentiality, understanding motivation and change, evaluative techniques to prioritize client problems in social, physical and mental health areas, and the like.
(5) Program director/administrator recommended topics.
(i) Medical and psycho-social needs of clients.
(ii) Legal and ethical issues in program management (living wills, avoiding litigation, client rights, and the like).
(iii) Policy and procedures development.
(iv) Management Information Systems.
(v) Sensitivity to cultural diversity.
(vi) Human resources management.
(vii) Marketing and community relations.
(viii) Records and documentation.
(ix) Supervision of staff persons.
(x) Financial management, budgeting and grantsmanship.
(xi) Strategic planning.
(xii) Time management and delegation.
(xiii) Quality assurance.
(xiv) Government relations.
(xv) Board relations.
(xvi) Stress management.
(xvii) Research and publication.
(b) Recommended topics are intentionally stated in broad terms so that they may include many specific subtopics, chosen by a particular center to meet its own needs.
(c) Topics which have been recommended for a specific job function are not necessarily unique to that function, and may also be appropriately chosen for program staff persons performing other job functions.
(d) Suitable training topics are not limited to those recommended under each OADLC staff function. Centers may appropriately choose others.
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