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<regulation prefix="Regulation" num=".32" citation="COMAR 10.07.14.32" title_num="10" subtitle_num="07" chapter_num="14" heading="Alzheimer’s Special Care Unit.">
  <paragraph num="A.">
    <text>Initial Approval of an Alzheimer’s Special Care Unit. An assisted living program requesting the initial approval to operate an Alzheimer’s Special Care Unit shall submit to the Department a written description of the Alzheimer’s Special Care Unit using a disclosure form developed by the Department. The description shall explain how:</text>
    <paragraph num="(1)">
      <text>The form of care and treatment provided by the Alzheimer’s Special Care Unit is specifically designed for the specialized care of individuals diagnosed with Alzheimer’s disease or a related dementias; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The care in the Alzheimer’s Special Care Unit differs from the care and treatment provided in the nonspecial care unit.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Approval of an Alzheimer’s Special Care Unit.</text>
    <paragraph num="(1)">
      <text>An assisted living program shall have written approval from the Department prior to operating an Alzheimer’s Special Care Unit.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An assisted living program shall have written approval from the Department of an Alzheimer's Special Care Unit prior to advertising or marketing the unit.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Department will either approve or not approve the operation of the Alzheimer’s Special Care Unit.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Substantive Changes to the Alzheimer’s Special Care Unit.</text>
    <paragraph num="(1)">
      <text>The written description of the Alzheimer’s Special Care Unit shall accurately reflect the current operation of the unit.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If any substantive changes are made to the Alzheimer’s Special Care Unit, the revised written description shall be submitted to the Department for review and approval.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Department shall inform the provider of the decision of the review within 30 calendar days from the Department’s receipt of the revised written description.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>An assisted living program with an Alzheimer’s Special Care Unit shall disclose the written description of the unit to:</text>
    <paragraph num="(1)">
      <text>Any person on request;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The resident, as appropriate; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The family or resident representative before admission of the resident to the Alzheimer’s Special Care Unit.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The description of the Alzheimer’s Special Care Unit shall include:</text>
    <paragraph num="(1)">
      <text>A statement of philosophy or mission;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>How the services of the unit are different from services provided in the rest of the assisted living program;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Staff training and staff job titles, including:</text>
      <paragraph num="(a)">
        <text>A description of a minimum of 6 hours of advanced cognitive impairment training for any staff who is licensed, certified, or registered under Health Occupations Article, Annotated Code of Maryland, or any staff whose job duties include providing personal care on the Alzheimer’s Special Care Unit, including:</text>
        <paragraph num="(i)">
          <text>2 hours related to effective communication;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>2 hours related to behavioral interventions; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>2 hours related to making activities meaningful; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The number of hours of dementia-specific training provided annually for all staff by job classification and a summary of training content;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Admission procedures, including screening criteria;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Assessment and service planning protocol, including criteria to be used that would trigger a reassessment of the resident’s status before the customary 6-month review;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Staffing patterns, including:</text>
      <paragraph num="(a)">
        <text>The ratio of direct care staff to resident for a 24-hour cycle;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A description of how the staffing pattern differs from that of the rest of the assisted living program; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Use of awake overnight staff on the unit;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>A description of the physical environment and any unique design features appropriate to support the functioning of cognitively impaired individuals;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>A description of activities, including frequency and type, how the activities meet the needs of residents with dementia, and how the activities differ from activities for residents in other parts of the assisted living program;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>The assisted living program’s fee or fee structure for services provided by the Alzheimer’s Special Care Unit;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Discharge criteria and procedures;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Any services, training, or other procedures that are over and above those that are provided in the existing assisted living program; and</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Any other information that the Department may require.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Department shall restrict admission or close the operation of an Alzheimer’s Special Care Unit if the Department determines that the assisted living program has not demonstrated compliance with this regulation or the health or safety of residents is at risk.</text>
  </paragraph>
</regulation>