December 13, 2010
ALZHEIMER'S LAWS AND REGULATIONS IN CONNECTICUT
By: Veronica Rose, Chief Analyst
You asked for information on Alzheimer's laws and regulations in Connecticut.
By law, the Department of Social Services (DSS) commissioner must operate a respite care program to provide respite services for caretakers of people suffering from Alzheimer's disease. Respite services include homemaker services, adult day care, home health care, and short-term medical facility care. DSS may administer the services directly, contract with service providers, or provide subsidies directly to caretakers to buy the services. The program's current appropriation is over $2 million.
DSS sets (1) program and provider standards, (2) provider qualifications and reimbursement levels, and (3) eligibility standards for and limits on services. Service providers must receive specialized training in dealing with people suffering from Alzheimer's disease. They do not have to be accredited, but DSS must give preference in contracting for services to providers accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO).
People suffering from Alzheimer's disease must pass income and asset tests to participate in the program. Income cannot exceed $41,000 annually, and assets cannot exceed $109,000. By law, participants are eligible for up to $3,500 of services annually or up to 30 days of out-of-home respite care (excluding adult day care). But DSS may provide up to
$7,500 for services to participants who demonstrate need for additional services. DSS must increase the income and asset limits annually to reflect Social Security cost-of-living adjustments.
The law (CGS § 17b-349e) sets disclosure standards that Alzheimer's special care units and programs must meet. These include nursing, assisted living, and adult congregate living facilities; residential care homes; adult day care centers; and hospices. The law also sets training requirements for unit and program staff who care for residents.
CONNECTICUT STATEWIDE RESPITE CARE PROGRAM
The law (CGS § 17b-349e) requires DSS to operate a Statewide Respite Care Program, within available appropriations, to provide respite for caregivers of people with Alzheimer's disease, or related disorders, regardless of age, who are not enrolled in the Connecticut Homecare Program for Elders (CHCPE). (CHCPE is a Medicaid waiver and state-funded program that provides home and community-based services for qualifying individuals age 65 and older who are, or at risk of being, institutionalized.)
Respite services include homemaker services, adult day care, short-term medical facility care, home health care, and personal care assistant and companion services. There is no age requirement for eligibility, but these diseases primarily affect seniors.
An individual is eligible to receive up to $3,500 for services or up to 30 days of out-of-home respite care services (excluding adult day care) annually. An eligible individual is a person (1) diagnosed with Alzheimer's or a related disease and (2) whose annual income does not exceed $41,000 and assets do not exceed $109,000. Income and asset limits are annually increased to reflect Social Security cost-of-living adjustments. DSS may allow participants who demonstrate need to receive up to $7,500 for additional services (CGS § 17b-349e).
DSS may require an individual with Alzheimer's disease who participates in the program to pay 20% of the cost of respite services provided but may waive this payment on hardship grounds.
DSS regulations establish:
1. eligibility standards for respite care services;
2. the basis for priority in receiving services;
3. provider qualifications and requirements, including specialized training in Alzheimer's disease, dementia, and related disorders;
4. a requirement that JCAHO- accredited providers, when available, receive preference in contracting for services;
5. provider reimbursement levels;
6. service limits and costs; and
7. a fee schedule for copayments (Conn. Agency Regs. § 17b-349e).
DSS administers the respite program in partnership with the Alzheimer's Association of Connecticut and the state's Area Agencies on Aging (AAA). AAAs are private, nonprofit elderly planning and service agencies that receive state and federal funds to carry out the requirements of the federal Older Americans Act. They employ care managers to arrange service delivery and award grants to community providers to deliver services. Care managers conduct an in-home assessment on prospective clients, who complete a brief application, to determine their eligibility for the program. The AAAs monitor the services, pay the bills, and collect the 20% copayments, if required.
ALZHEIMER'S SPECIAL CARE UNITS OR PROGRAMS
The law requires Alzheimer's special care units or programs to make disclosures to patients and provide Alzheimer's and dementia-specific training. The law defines an “Alzheimer's special care unit or program” as a nursing facility, residential care home, assisted living facility, adult congregate living facility, adult day care center, hospice, or adult foster home that:
1. locks, secures, segregates, or provides special programs or units for residents diagnosed with probable Alzheimer's disease, dementia, or other similar disorder and
2. prevents or limits a resident's access outside the designated or separated area or advertises or markets itself as providing specialized care or services for people with Alzheimer's disease or dementia (CGS § 19a-562).
Alzheimer's special care units or programs must provide written disclosures to patients. The disclosure must be signed by the patient or responsible party and include:
1. a written statement about the philosophy and mission of the unit or program that reflects the residents' needs;
2. the process and criteria for placement, transfer, or discharge;
3. the process used to assess, establish, and implement the care plan, including the method for modifying it or responding to changes in a resident's condition;
4. the nature and extent of staff coverage, including staff to patient ratios, staff training, and continuing education;
5. physical environment and design features appropriate to support the functioning of cognitively impaired adult residents;
6. the frequency and types of resident activities and the ratio of residents to recreation staff;
7. involvement of families and family support programs; and
8. cost of care and any additional fees.
The facilities or programs must develop a standard disclosure compliance form and annually review and verify the accuracy of the information provided. They must update any significant changes to the information reported no later than 30 days after such change.
Alzheimer's special care units or programs must annually provide Alzheimer's and dementia-specific training to (1) licensed and registered direct care staff and nurse's aides who provide direct patient care and (2) unlicensed and unregistered staff.
The training for licensed and registered staff must include (1) at least eight hours of dementia-specific training which must be completed within six months of the date of employment followed by at least three hours of such training annually and (2) at least two hours of annual training in pain recognition and administration of pain management techniques for direct care staff. Unlicensed and unregistered staff must get at least one hour of training. Staff hired after October 1, 2007 must complete the training within six months after they are hired (CGS § 19a-562a).
FUNDING FOR ALZHEIMER'S RESEARCH AND RESPITE
DSS provides funding for the Connecticut Statewide Respite Care Program through the state's five AAAs to pay for adult day care program staff for people with Alzheimer's disease. For FY 2011, the appropriation for the program was $2,294,388, according to the Office of Fiscal Analysis.
Under Public Act 10-136, which took effect July 1, 2010, the Biomedical Research Trust Fund, created with Tobacco Settlement Funds, can now be used to grant funds for biomedical research into Alzheimer's disease. Previously, the funds could be used only for heart disease, cancer, and other tobacco-related disease research.