SSBG ADULT DAY SERVICES

SERVICE SPECIFICATION # I (2)
Revised 7/2/08


1.0	SERVICE DEFINITION
1.1	A therapeutic program for four or more community-living adults with 
functional and/or cognitive impairments in a protective non-residential 
setting. The individual’s impairments and needs cannot be appropriately 
met in other settings such as sheltered workshops, supported 
employment or unsupervised senior center activities. Such adults are not 
capable of full-time independent living but with certain activities can 
become more self-sufficient in the community. 

2.0	SERVICE UNIT
2.1	The unit of service for adult day services is one day of service for one 
participant.  At a minimum, participants should be scheduled for at least 
two days a week, with scheduled attendance based on a full day of 
services. 
2.2	If the program provides transportation, the adult day service begins when 
the participant is picked up at his/her home and ends when returned to 
his/her home.  In order to maximize time in the center, transportation 
routes should be limited to one hour.  If transportation is not provided, the 
day begins when the participant enters the facility and ends when he/she 
leaves. 

3.0	SERVICE GOAL
3.1	The goal of the day care program is to create a therapeutic environment in 
which functionally impaired persons maintain maximum functioning and 
independence, while preventing early and inappropriate 
institutionalization.  To obtain this goal, the program must provide high 
quality programming for the participants and support and information for 
the caregivers.

4.0	SERVICE AREA
4.1	Adult Day Services are available to all eligible residents of the State of 
Delaware.
4.2	Providers of Adult Day services are permitted to apply for sub-areas of 
service within the state.








5.0	ELIGIBILITY
5.1	To be eligible for adult day services, the participant:
5.1.1	Must be eighteen (18) years of age and above with priority given to 
those under fifty-nine (59) years of age.
5.1.2	Must be a resident of the State of Delaware 
5.1.3	Must be a U.S. Citizen or legal alien.
5.1.3.1	Alien status verification is required and the provider must 
follow the Division of Services for Aging and Adults with 
Physical Disabilities (DSAAPD) Procedures and 
Reporting Requirements for SSBG Alien Verification.
5.1.4	Must be able to benefit from the program
5.1.5	Must have documentation of a recent medical examination (within 
the last 6 months) certifying that the participant is free of 
contagious diseases
5.1.6	Must be assessed as requiring intermediate care (i.e., needing 
assistance with activities of daily living  (ADL) and/or assistance 
with prescribed medications)
5.1.7	Must be unable to be left alone at home
5.1.8	Must live with a caregiver who either works outside the home or 
needs temporary relief from caregiving
5.1.9	TANF recipient
5.1.10	SSI/SSDI recipient
5.1.11	Income eligible
5.1.11.1	Medicaid recipient (250% of nursing home standard)
5.1.12	Participant’s  functional assessment score indicates that he/she is 
appropriate for day services
5.2	Priority will be given to those participants who are:
5.2.1	At risk of institutionalization
5.2.2	On a waiting list for a bed in a nursing home
5.2.3	Referred by a hospital, doctor, or geriatric case manager
5.2.4	Referred from adult protective services 
5.3	The Adult Day Service program does not serve participants who are:
5.3.1	Assessed as capable of living independently, using the functional 
assessment tool;
5.3.2	Assessed as requiring skilled nursing care (i.e. 24-hour nursing 
care);
5.3.3	Assessed as capable of functioning in a less restrictive 
environment (i.e., senior  center); 
5.3.4	Currently residing in a nursing home or who is publicly subsidized 
in an assisted living facility or publicly subsidized foster care home.







6.0	SERVICE STANDARDS
6.1	Adult day services centers must be licensed as an Adult Day Care 
facility in Delaware.
6.2	Adult day services must meet or exceed the standards listed below:
6.2.1	Must comply with all applicable federal, state, and local laws, 
rules, policies, regulations and standards
6.2.1.1	Must follow DSAAPD Procedures and Reporting 
Requirements for SSBG Alien Verification.
6.2.2	The facility and grounds must be safe, clean and accessible to all 
participants.
6.2.3	The facility shall be open for operation at a minimum of eight (8) 
hours per day.  
6.2.4	The facility shall provide appropriate and locked storage for all 
medications stored at the center.
6.2.5	Through participant/caregiver interview and observation, the adult 
day service provider will complete a functional assessment of the 
participant's social circumstances, economic conditions, medical 
history, physical status, mental status, and ability to perform the 
activities of daily living (ADL), prior to admission, to determine if 
the applicant is appropriate for adult day services.
6.2.6	The provider will develop a written detailed care plan on each 
new participant within thirty (30) working days of enrollment that 
addresses the needs as identified in the functional assessment.
6.2.7	The provider will reassess participants every six (6) months or 
earlier if their needs change.  The plan of care will be 
reviewed/updated at that time.
6.2.8	The participant/caregiver should be included in the development of 
the care plan whenever possible.
6.2.9	The provider will maintain notes depicting the participant’s progress 
in the program, beginning with the first day of service and ending 
with the circumstances and date of discharge.  
6.2.10	Participant admission will be viewed as a 30-day trial basis for both 
parties, at which time a decision will be made about the 
participant’s continued attendance. 
6.2.11	Provider must maintain participant attendance, indicating time of 
arrival and departure for each participant.
6.2.12	The hands-on staff/participant ratio shall be a minimum of one (1) 
adult staff person (do not include the janitor, driver, etc.) on duty for 
each eight (8) participants (1:8).
6.2.12.1	A minimum of two (2) staff must be on duty while 
participants are present.
6.2.13	A registered dietitian or nutritionist must be available for 
consultation as needed.

6.2.14	When a participant’s needs no longer require or can no longer be 
met by the program and staff, discharge will be discussed with the 
caregiver.  
6.2.14.1	A 30-day written notice will be given to the caregiver 
when possible.
6.2.15	The provider must have written procedures for handling 
emergencies and participant/family preference regarding 
emergency care and ambulance transportation.
6.2.15.1	The name of the individual’s physician to call in an 
emergency must be on file.
6.2.16	Information and referral to other programs for which the 
participant might be eligible, referring the participant to proper 
services as necessary and providing assistance to the participant 
in gaining public benefits.
6.2.17	The provider must have written notice displaying fire procedures 
and emergency evacuation routes.
6.2.18	The provider will notify the participant’s family and physician, if 
necessary, of changes observed in the health status of a 
participant.
6.2.19	The provider will give health education/counseling to participants 
and families/caregivers.
6.3	Allowable Services
6.3.1	Services include, but are not limited to:
6.3.1.1	Health monitoring 
6.3.1.2	Medication administration and monitoring 
6.3.1.3	Daily nutritious meals and snacks 
6.3.1.3.1	Main meal should be well balanced and 
provide one-third of the Recommended Daily 
Allowance
6.3.1.3.2	Breakfast and lunch may be provided
6.3.1.4	Dietary supervision
6.3.1.5	Provision of special diets, based on physician’s orders, 
prepared through consultation with a qualified dietitian 
or nutritionist, when possible
6.3.1.6	Social, recreational, physical, rehabilitative, or other 
activities/therapies as part of the plan of care
6.3.1.7	Opportunities for walking in a safe environment 
6.3.1.8	Continued contact with the community, through outings, 
when appropriate.
6.3.1.9	Assistance with activities of daily living (ADL), as 
needed 
6.3.1.10	Transportation coordination, when possible. 
6.3.1.11	Caregiver support group and opportunities for 
caregivers to improve their care-giving skills through 
meetings, counseling, information and education 
6.3.1.12	Social service referrals, as needed
6.3.1.13	Social activities that include:  art, music, fitness 
exercise, gardening, mental stimulation, historic recall, 
cooking, games, outings, reminiscence activities, etc.
6.3.1.13.1	Activities are provided on both a group and 
individual basis. 
6.3.1.13.2	Activities are to be designed to give purpose 
and meaning to daily life.   
6.3.1.14	Encouragement of appointments with health 
professionals such as speech, physical, or occupational 
therapists, if necessary.
6.4	Prohibited Activities
6.4.1	Provision of nursing care, unless by a RN or LPN.
6.4.2	Provision of care outside of the adult day services facility, other 
than outings
6.4.3	Provision of medical services, unless provided by an MD
6.4.4	Provision of services to a participant who is a resident of a 
nursing home, foster care home, or assisted living facility. 
6.4.5	Provision of individual, group, or family counseling unless 
provided by a degreed professional with formal training  in 
counseling
6.4.6	Provision of services to out-of-state residents.
6.5	Staff Requirements
6.5.1	The Adult Day Care Center Director shall meet the following 
criteria:
6.5.1.1	Possession of a Bachelor’s Degree in health or social 
services or a related field, with one (1) year of 
supervisory experience (full-time or equivalent ) in a 
social or health service setting; have comparable 
technical and human service training with 
demonstrated competence OR
6.5.1.2	Be a registered nurse with two (2) years of supervisory 
experience (full-time or equivalent) in a social or 
healthcare setting.    
6.5.2	Paid staff and volunteers must demonstrate the following:
6.5.2.1	The sanitary handling of food
6.5.2.2	Fire safety
6.5.2.3	Basic first aid with an emphasis on choking and 
coronary attacks 








7.0	WAITING LISTS
7.1	When the demand for a service exceeds the ability to provide the service, 
a waiting list is required. Applicants will be placed on the waiting list until 
services can be provided; or, until the applicant no longer desires 
services.  The waiting list must be managed in accordance with DSAAPD 
policy X-K, Client Waiting Lists.  In all cases, the reason for the selection 
of an individual ahead of others on the waiting list must be documented 
(e.g. in writing and available for review).

8.0	CALCULATION FOR NUMBER OF SERVICE UNITS
8.1	The following calculations shall be used to determine the number of 
service units for Adult Day Services.
8.1.1	The program must first establish a minimum number of operating 
days per year using the following:

Example:        
         365 	days per year
        -104  	(less 104 weekend days)
-  12  	(less 12 holidays)
-    5  	(less 5 days for weather, miscellaneous)
 244  	operating days per year

8.1.2	After establishing the number of operating days (using the example 
in 8.1.1) use the following formula to determine the number of 
service units:

        # of oper. days/year x average daily census = # of service units.       
        
        Example:
        244  	operating days per year 
                                                   x   25  	participants per day
        6,100  	service units.
 

9.0	INVOICING REQUIREMENTS
9.1	The provider will invoice DSAAPD pursuant to the DSAAPD Policy Manual 
for Contracts, policy X-Q, Invoicing.
9.2	The following information will also be included on the invoice:
9.2.1	Number of operating days eligible for payment for the billing period.
9.2.2	Participant legal name.
9.2.3	Service Units provided per participant.
9.2.4	Total Service Units provided.
9.2.5	Service Unit Cost.
9.2.6	Total DSSAPD funds earned.



SSBG ADULT DAY SERVICE

PLANNED SERVICE UNITS AND PROPOSED OBJECTIVES


GRANTEE / AGENCY NAME:	     

 PROGRAM NAME:           	

PLANNED SERVICE UNITS
1st Qtr
2nd Qtr
3rd   Qtr
4th Qtr
Total
1.	Number of service units 
    
    
    
    
    
2.	Number of unduplicated clients 
served by the program 

    
    
    
    
    
3.	Number of clients assessed in 
person
      (including those not admitted)
    
    
    
    
    
4.	Number of plans of care 
developed
    
    
    
    
    
5.	Number of plans of care  
updated 
    
    
    
    
    
6.	Number of meals provided
    
    
    
    
    
7.	Number of one-way trips
    
    
    
    
    
8.	Number of Hours provided by 
volunteers
    
    
    
    
    
     
      * Definitions of the above categories found in the Quarterly Performance Report Instructions


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