Florida Regulations 59A-16.106: Supportive and Optional Services
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In addition to the minimum Basic Services, the Center may choose to provide Supportive and Optional Services. If provided, such services must be administered by Staff qualified to provide such services and within the criteria established by relevant Florida Statutes. The following are examples of such services:
(1) Health or social services such as assessment, counseling, treatment and referral.
(2) Speech therapy provided by or under the supervision of an individual licensed under chapter 468, part I, F.S., who has a certification of clinical competence from the American Speech and Hearing Association, and who has completed the equivalent education requirements and work experience necessary for certification, or who has completed the academic program and is acquiring supervised work experience to qualify for the certificate. Progress notes shall be maintained and must be written in the Participant’s File and signed by the speech therapist as services are provided.
(3) Physical therapy must be provided by, or under the supervision of, an individual who is a graduate of a program of physical therapy approved by both the Council on Medical Education of the American Medical Association and the American Therapy Association, or the equivalent, and licensed by the State. Progress notes shall be maintained and must be written in the Participant’s File and signed by the physical therapist as services are provided.
(4) Occupational therapy as an adjunct to treatment of persons with physical and mental limitations must be provided by, or under the supervision of, an individual who is registered by the American Occupational Therapy Association; or a graduate of a program approved by the Council on Medical Education of the American Medical Association and engaged in the supplemental clinical experience required before registration by the American Occupational Therapy Association. Progress notes shall be written in the Participant’s File and signed by the occupational therapist as services are provided.
(5) Modified diets or diets based on the normal diet and designed to meet the requirements of a given situation such as altering individual nutrients, caloric values, consistency, flavor, techniques of service or preparation, content of specific foods, or a combination of these factors, may be provided as an optional service. When modified diets are provided, a physician’s written or documented oral order for each Participant receiving a modified diet shall be on file. A menu including types and amounts of food to serve will be on file in the food service area. Diets shall be prepared and served as ordered by the physician.
(6) Adult day health care services for disabled adults or aged persons, provided the Center complies with the following:
(a) Make services available for a minimum of five hours per day five days per week, excluding legal holidays as posted by the facility. For purposes of this subsection, legal holiday shall mean any day which, by the laws of this state or the United States, is designated or recognized as a legal or public holiday or any day on which businesses or institutions are customarily closed.
(b) Provide or coordinate, in addition to the Basic Services specified in Fl. Admin. Code R. 59A-16.105, and Supportive and Optional Services, pursuant to subsections (1), (2), (3), (4) and (5), the following adult day health care services:
1. Medical screening emphasizing prevention and continuity of care which includes routine blood pressure checks or blood glucose diabetic maintenance checks,
2. Nursing services including a configuration of services at different levels of intensity as determined by the nursing assessment, Participant Care Plan, and physician’s orders. Services shall include:
a. Health education and counseling including nutritional advice, liaison with the Participant’s personal physician, and notification of the Participant’s physician, as well as the caregiver or family of any changes in the Participant’s health status,
b. Coordination of the provision of other health services provided outside the Center,
c. Supervision of health services provided by program aides.
3. Social services including: counseling for Participants’ families and caregivers; compilation of a social history and psychosocial assessment of formal and informal support systems; mental and emotional status; caregiver data; information on planning for discharge; and referral for persons not appropriate for adult day care.
4. Additional medical services such as dental, ophthalmological, optometric, hearing aid, or laboratory services.
5. Transportation Services to and from the adult day health care services.
(c) In addition to the minimum staffing required in chapter 59A-16, F.A.C., provide the following Staff:
1. The Operator shall: have a minimum of a Bachelor’s degree in a health or social services or related field, with one year of supervisory experience in a social or health service setting; hold a registered nurse license with one year of supervisory experience; or have 5 years of supervisory experience in a social or health service setting.
2. A registered nurse (RN) or licensed practical nurse (LPN) shall be on-site during the primary hours of program operation and on-call during all hours the Center is open. Arrangements shall be formalized for obtaining the services of an LPN or RN in anticipation of potential absences, planned and unplanned, of the regular nursing Staff.
3. A social worker with a minimum of a Bachelor’s degree in social work or a case worker with a minimum of a Bachelor’s degree in sociology, psychology, nursing, or gerontology, or a Bachelor’s degree with at least two years of experience in a human service field. Services provided by program aides in this service area must be provided under the direct supervision of a social worker or case manager who meets or exceeds these standards (e.g., a Master’s degree in a related field).
4. An activity director or Recreational Therapist with a Bachelor’s degree in a social or health service field or an Associate’s degree in a related field plus 2 years of experience. All services provided by program aides must be provided under the direct supervision of the activity director or recreation therapist. The recreation therapist may be retained as a consultant.
(d) Documentation of services provided under this section must be in the Participant Care Plan and stored in the Participant File. Participant Care Plans must be reviewed at least quarterly by a multidisciplinary team. At a minimum, narrative nursing, social work, and activity notes must be entered in the participant’s record quarterly, indicating the Participant’s progress toward achieving health goals. More frequent notes are required if indicated by the Participant’s condition.
Rulemaking Authority 429.929 FS. Law Implemented Florida Statutes § 429.929. History-New 7-8-81, Formerly 10A-6.10, 10A-6.010, 59A-16.010, Amended 11-9-95, 3-29-98, 8-3-15, Formerly 58A-6.010, 7-1-19.
(2) Speech therapy provided by or under the supervision of an individual licensed under chapter 468, part I, F.S., who has a certification of clinical competence from the American Speech and Hearing Association, and who has completed the equivalent education requirements and work experience necessary for certification, or who has completed the academic program and is acquiring supervised work experience to qualify for the certificate. Progress notes shall be maintained and must be written in the Participant’s File and signed by the speech therapist as services are provided.
(3) Physical therapy must be provided by, or under the supervision of, an individual who is a graduate of a program of physical therapy approved by both the Council on Medical Education of the American Medical Association and the American Therapy Association, or the equivalent, and licensed by the State. Progress notes shall be maintained and must be written in the Participant’s File and signed by the physical therapist as services are provided.
(4) Occupational therapy as an adjunct to treatment of persons with physical and mental limitations must be provided by, or under the supervision of, an individual who is registered by the American Occupational Therapy Association; or a graduate of a program approved by the Council on Medical Education of the American Medical Association and engaged in the supplemental clinical experience required before registration by the American Occupational Therapy Association. Progress notes shall be written in the Participant’s File and signed by the occupational therapist as services are provided.
(5) Modified diets or diets based on the normal diet and designed to meet the requirements of a given situation such as altering individual nutrients, caloric values, consistency, flavor, techniques of service or preparation, content of specific foods, or a combination of these factors, may be provided as an optional service. When modified diets are provided, a physician’s written or documented oral order for each Participant receiving a modified diet shall be on file. A menu including types and amounts of food to serve will be on file in the food service area. Diets shall be prepared and served as ordered by the physician.
(6) Adult day health care services for disabled adults or aged persons, provided the Center complies with the following:
(a) Make services available for a minimum of five hours per day five days per week, excluding legal holidays as posted by the facility. For purposes of this subsection, legal holiday shall mean any day which, by the laws of this state or the United States, is designated or recognized as a legal or public holiday or any day on which businesses or institutions are customarily closed.
(b) Provide or coordinate, in addition to the Basic Services specified in Fl. Admin. Code R. 59A-16.105, and Supportive and Optional Services, pursuant to subsections (1), (2), (3), (4) and (5), the following adult day health care services:
1. Medical screening emphasizing prevention and continuity of care which includes routine blood pressure checks or blood glucose diabetic maintenance checks,
2. Nursing services including a configuration of services at different levels of intensity as determined by the nursing assessment, Participant Care Plan, and physician’s orders. Services shall include:
a. Health education and counseling including nutritional advice, liaison with the Participant’s personal physician, and notification of the Participant’s physician, as well as the caregiver or family of any changes in the Participant’s health status,
b. Coordination of the provision of other health services provided outside the Center,
c. Supervision of health services provided by program aides.
3. Social services including: counseling for Participants’ families and caregivers; compilation of a social history and psychosocial assessment of formal and informal support systems; mental and emotional status; caregiver data; information on planning for discharge; and referral for persons not appropriate for adult day care.
4. Additional medical services such as dental, ophthalmological, optometric, hearing aid, or laboratory services.
5. Transportation Services to and from the adult day health care services.
(c) In addition to the minimum staffing required in chapter 59A-16, F.A.C., provide the following Staff:
1. The Operator shall: have a minimum of a Bachelor’s degree in a health or social services or related field, with one year of supervisory experience in a social or health service setting; hold a registered nurse license with one year of supervisory experience; or have 5 years of supervisory experience in a social or health service setting.
2. A registered nurse (RN) or licensed practical nurse (LPN) shall be on-site during the primary hours of program operation and on-call during all hours the Center is open. Arrangements shall be formalized for obtaining the services of an LPN or RN in anticipation of potential absences, planned and unplanned, of the regular nursing Staff.
3. A social worker with a minimum of a Bachelor’s degree in social work or a case worker with a minimum of a Bachelor’s degree in sociology, psychology, nursing, or gerontology, or a Bachelor’s degree with at least two years of experience in a human service field. Services provided by program aides in this service area must be provided under the direct supervision of a social worker or case manager who meets or exceeds these standards (e.g., a Master’s degree in a related field).
4. An activity director or Recreational Therapist with a Bachelor’s degree in a social or health service field or an Associate’s degree in a related field plus 2 years of experience. All services provided by program aides must be provided under the direct supervision of the activity director or recreation therapist. The recreation therapist may be retained as a consultant.
(d) Documentation of services provided under this section must be in the Participant Care Plan and stored in the Participant File. Participant Care Plans must be reviewed at least quarterly by a multidisciplinary team. At a minimum, narrative nursing, social work, and activity notes must be entered in the participant’s record quarterly, indicating the Participant’s progress toward achieving health goals. More frequent notes are required if indicated by the Participant’s condition.
Rulemaking Authority 429.929 FS. Law Implemented Florida Statutes § 429.929. History-New 7-8-81, Formerly 10A-6.10, 10A-6.010, 59A-16.010, Amended 11-9-95, 3-29-98, 8-3-15, Formerly 58A-6.010, 7-1-19.