Veterans State Adult Day Health Care

To provide a community-based program designed to meet the needs of adults with impairments through individual plans of care. This type of structured, comprehensive, nonresidential program provides a variety of health, social, and related support serv

Adult day health care means a therapeutic outpatient care program that includes one or more of the following services, based on patient care needs: Medical services, rehabilitation, therapeutic activities, socialization, and nutrition. Services are provided in a congregate setting.

51.52 A veteran is an eligible veteran for payment of per diem to a State for adult day health care if VA determines that the veteran: (a) Is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12); (b) Is enrolled in the VA health care system; (c) Would otherwise require nursing home care; and (d) Needs adult day health care because the veteran meets any one of the following conditions: (1) The veteran has three or more Activities of Daily Living (ADL) dependencies. (2) The veteran has significant cognitive impairment. (3) The veteran has two ADL dependencies and two or more of the following conditions: (i) Seventy-five years old or older; (ii) High use of medical services, i.e., three or more hospitalizations per calendar year, or 12 or more visits to an outpatient clinic or to an emergency evaluation unit per calendar year; (iii) Diagnosis of clinical depression; or (iv) Living alone in the community. (4) The veteran does not meet the criteria in paragraph (d)(1), (2), or (3) of this section, but nevertheless a licensed VA medical practitioner determines the veteran needs adult day health care services.

A veteran eligible for care in a VA facility needing adult day health care and meeting one of the following conditions: (a) has a service-connected disability for which such care is being provided; (b) has a non-service connected disability and sates under oath his inability to defray the expenses of necessary adult day health care; (c) was discharged or related from active military, naval and air services for a disability incurred or aggravated in the line of duty; or (d) is in receipt of, or but for the receipt of retirement pay would be entitled to receive disability compensation. A veteran must also meet State admission criteria.

Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services outlined in Public Law 106-117 Section 101. (1) Adult day health services are only appropriate for adults with medical or disabling conditions that require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. (2) The adult day health center must offer and provide on site the following services: (a) All core services under PL 106-117 Section 101; (b) Skilled nursing services other than routine health monitoring with nurse consultation; (c) At least one of the following skilled therapy services: physical therapy, occupational therapy, or speech-language pathology or audiology, as those services are defined under PL 106-117 Section 101 respectively; and (d) Psychological or counseling services, including assessing for psycho-social therapy need, dementia, abuse or neglect, and alcohol or drug abuse; making appropriate referrals; and providing brief, intermittent supportive counseling. (a) The following personal care services as defined in PL 106-117 Section 101, "personal care services," or its successor: (i) Ambulation; (ii) Body care; (iii) Eating; (iv) Positioning; (v) Self-medication; (vi) Transfer; (vii) Toileting; (viii) Personal hygiene at a level that ensures client safety and comfort while in attendance at the program; and (ix) Bathing at a level that ensures client safety and comfort while in attendance at the program. (b) Social services on a consultation basis, which may include: (i) Referrals to other providers for services not within the scope of Medicaid reimbursed adult day care services; (ii) Caregiver support and education; or (iii) Assistance with coping skills. (c) Routine health monitoring with consultation from a registered nurse that a consulting nurse acting within the scope of practice can provide with or without a physician's order. Examples include: (i) Obtaining baseline and routine monitoring information on a client's health status, such as vital signs, weight, and dietary needs; (ii) General health education such as providing information about nutrition, illnesses, and preventive care; (iii) Communicating changes in the client's health status to the client's caregiver; (iv) Annual and as needed updating of the client's medical record; (v) Assistance as needed with coordination of health services provided outside of the adult day care program. (d) General therapeutic activities that an unlicensed person can provide or that a licensed person can provide with or without a physician's order. These services are planned and provided as an integral part of the client's plan of care and are based on the client's abilities, interests and goals. Examples include: (i) Recreational activities; (ii) Diversionary activities; (iii) Relaxation therapy; (iv) Cognitive stimulation; (v) Group range of motion or conditioning exercises. (e) General health education that an unlicensed person can provide or that a licensed person can provide with or without a physician's order, including but not limited to topics such as: (i) Nutrition; (ii) Stress management; (iii) Disease management skills; (iv) Preventive care. (f) A nutritional meal and snacks provided each four-hour period at regular times comparable to normal meal times, including modified diet if needed and within the scope of the program, as provided under Public Law 106-117 Section 101; (g) Supervision and/or protection for clients who require supervision or protection for their safety; (h) Assistance with arranging transportation to and from the program; and (i) First aid and provisions for obtaining or providing care in an emergency.

There is no length limitation; grant payments are made monthly to the state.

Recognition by the Secretary of Veterans Affairs for purposes of VA aid pursuant to Title 38 U.S.C. Section 1741.

From 30 to 60 days.