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(a) Introduction. In accordance with s. 49.45 (2) (a) 11. and (47) (a) and (b), Stats., this section is promulgated to establish regulations and standards for the care, treatment or services, and health, safety, rights, well-being and welfare of participants in certified adult day care centers (ADCCs). This section is promulgated to ensure that each ADCC provides a supportive environment in a community-based group setting that is the least restrictive of each participant’s freedom, and that care and services are provided in a manner that protects the rights and dignity of each participant.
(b) Definitions.
1. “Abuse” has the meaning given in s. DHS 13.03 (1) (a).
2. “Accessible” means barriers are not present that prevent a person from entering, leaving, or functioning within an ADCC without physical help.
3. “Activities of daily living” or “ADL” means bathing, eating, oral hygiene, dressing, toileting, incontinence care, mobility and transferring from one surface to another such as from a bed to a chair.
4. “Adult” means an individual who is at least 18 years of age.
5. “Adult day care center” or “ADCC” means an entity that provides services for part of a day in a group setting to adults who need an enriched health, supportive or social experience, and who may need assistance with activities of daily living, supervision, or protection.
6. “Applicant” means the person seeking certification of an ADCC.
7. “Assessment” means gathering and analyzing information about a prospective or existing participant’s needs and abilities as provided in sub. (7) (a).
8. “Caregiver” has the meaning given in s. 50.065 (1) (ag), Stats.
9. “Chemical restraint” means a psychotropic medication used for discipline or convenience, and not required to treat medical symptoms.
10. “Department” means the Wisconsin department of health services.
11. “Legal representative” means any of the following:
a. The health care agent under an activated power of attorney for health care under ch. 155, Stats.
b. A person appointed as a durable power of attorney under ch. 244, Stats.
c. A guardian, guardian of the estate, or guardian of the person, as defined in s. 54.01 (10), (11), or (12), Stats.
12. “Medication administration” means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to a participant, but does not include reminders to take the medication. Medication administration can be performed by any of the following:
a. A practitioner.
b. The practitioner’s authorized agent.
c. An ADCC caregiver, or the participant, at the direction of the practitioner.
13. “Misappropriation of property” has the meaning given in s. DHS 13.03 (12).
14. “Neglect” has the meaning given in s. DHS 13.03 (14).
15. “Nursing care” means nursing procedures, other than personal or supportive care, that a registered nurse or a licensed practical nurse performs directly on or to a participant.
16. “Occupant” means any of the following:
a. A person who lives and sleeps in the ADCC, but who is not a participant.
b. A non-client resident, as defined in s. 50.065 (1) (cn), Stats.
17. “Operator” means an individual or business entity to whom a certification is granted and is legally responsible for the operation of the ADCC.
18. “Participant” means an adult who attends the ADCC during listed hours of operation and receives care, treatment, or services.
19. “Participant group” means a group of participants who need similar services because of a common disability, condition, or status. “Participant group” includes a group of individuals who have any of the following:
a. Functional impairments commonly associated with advanced age.
b. Irreversible dementia, such as Alzheimer’s disease.
c. A developmental disability, as defined in s. 51.01 (5), Stats.
d. An emotional disturbance or a mental illness, as defined in s. 51.01 (13) (a), Stats.
e. A physical disability.
f. A traumatic brain injury.
20. “Physical restraint” means any manual method, article, device, or garment interfering with the free movement of the participant or the normal functioning of a portion of the participant’s body or normal access to a portion of the participant’s body, and which the participant is unable to remove easily, or confinement of a participant in a locked room.
21. “Program director” means an employee who is responsible for the management and day-to-day operation of the ADCC. A program director includes any of the following:
a. The operator.
b. An employee designated by the operator.
22. “Psychotropic medication” means a prescription drug, defined in s. 450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior.
23. “Qualified Caregiver” means an employee who is at least 18 years of age and has successfully completed all of the applicable orientation and training under sub. (4) (a) and (b).
24.
a. “Seclusion” means physical or social separation of a participant from others by actions of caregivers.
b. “Seclusion” does not include separation to prevent the spread of communicable disease or voluntary cool-down periods in an unlocked room.
25. “Serious injury” means an injury from any incident or accident which results in any of the following:
a. A temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
b. A fracture.
c. A pronounced decline in communication or cognitive abilities.
26. “Significant change” in a participant’s physical or mental condition means any of the following:
a. A decline in a participant’s medical condition that results in further impairment.
b. A decline in 2 or more ADLs.
c. A pronounced decline in communication or cognitive abilities.
d. A decline in behavior or mood which requires either a temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
27. “Standard precautions” are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are used when providing care to all individuals, whether or not they appear infectious or symptomatic.
28.
a. “Supervision” means oversight of a participant’s functioning.
b. “Supervision” includes keeping track of a participant’s whereabouts and providing guidance and intervention when needed by a participant.
28m. “Transferee” means the recipient of a property or business in a change of ownership process who will submit application for a new certification.
29. “Transferor” means the current operator in a change of ownership process who will voluntarily relinquish the current certification.
31. “Utensils” means dishes, silverware and pots and pans used for storing, preparing, serving, or consuming food.
32. “Variance” means an alternate means of meeting a requirement in this section, as approved by the department under par. (c).
33. “Volunteer” means any person who provides services for participants without compensation.
34. “Waiver” means an exemption from a requirement in this section, as approved by the department under par. (c).
(c) Variances and waivers.
1. The department may grant approval of a waiver or variance if the department determines that the proposed waiver or variance will not jeopardize the health, safety, welfare or rights of any participant.
2. A written request for a waiver or variance shall be sent to the department and include justification that the waiver or variance will not adversely affect the health, safety or welfare of any participant for the requested action.
3. A written request for a variance shall include a description of an alternative means planned to meet the intent of the requirement.
4. The department may terminate approval of a waiver or variance if any of the following occurs:
a. The department determines the waiver or variance has adversely affected the health, safety, well-being or welfare of a participant.
b. The ADCC fails to comply with any of the conditions of the waiver or variance as granted.
c. A change in circumstances from the time the waiver or variance approval was initially granted.
d. The ADCC failed to disclose a fact that is material to the approval.
(2) Certification.
(a) General requirements.
1. No person may receive reimbursement under s. 49.45 (7) (b), Stats., for the provision of services to a participant in an ADCC unless the ADCC is certified by the department. A person who assumes ownership interest in a certified ADCC, regardless of whether the transfer includes title to the real estate, or changes the location of the ADCC shall complete an application as required under this subsection.
2. An application for certification shall be on a form or web-based application provided by the department and shall include all of the following:
a. A program description as specified under par. (b).
b. A floor plan specifying dimensions of the ADCC, including exits and planned room usage.
c. A fire inspection report.
d. All required fees.
e. A balance sheet.
f. Evidence that the applicant has 60 days of projected operating funds in reserve.
g. Proof of transportation liability insurance if the ADCC provides transportation.
h. Well water test results if the ADCC uses well water.
i. A program evaluation plan.
j. Any additional information requested by the department.
3. An ADCC may not be located on a parcel of land zoned for industrial or manufacturing use.
(b) Program description.
1. The program description included as part of an application under par. (a) 2. shall include all of the following:
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.