Health & wellness

Adult day services may get new rules

Thousands of older Massachusetts residents, many with dementia, receive health care and participate in social activities in adult day programs that are not licensed and routinely inspected, but proposed rules unveiled by state regulators Wednesday would change that.

The rules would require the programs to be inspected every other year by the state Department of Public Health, and mandate minimum staffing levels, infection control measures such as showers and hand-washing stations, and separate spaces to provide activities for those with advanced dementia.

“This is a community-based service, and we believe these regulations can represent a potential quality improvement . . . preventing hospitalization and extending the time before it’s necessary to institutionalize folks from the community,” Dr. Madeleine Biondolillo, director of the state Bureau of Health Care Safety and Quality, told the Public Health Council, an appointed body of academics and health advocates.


The council is scheduled to vote later this fall to finalize the rules, after a public hearing.

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There are 150 adult day health programs that get Medicaid funding, but Biondolillo said officials are unsure of how many other programs may be operating, adding that some estimates put it as high as 50 more. About 11,500 residents are enrolled in the programs, according to 2011 state figures, the most recent available.

MassHealth, the state Medicaid program, does certify the adult day health programs that it reimburses, and that process includes proof of fire inspections, criminal background checks on all employees, and some minimum staffing and training requirements.

The new rules incorporate some from MassHealth on staff training and activities for Alzheimer’s patients, but go further, such as mandating separate spaces for those with advanced dementia.

Peter Ham, vice president of programs and services at the Alzheimer’s Association of Massachusetts and New Hampshire, said the changes will benefit patients and caregivers.


“The state realizes this is an epic disease, and they’re being proactive in making sure people have the right tools, and education, to address this,” Ham said.

Adult day health programs were facing significant cuts in state funding in 2011, which the industry said would force most to close. Instead, lawmakers preserved the funding but passed a law that required programs to become licensed and directed the health department to create rules.

Darcey Adams, president of the board of directors of the Massachusetts Adult Day Services Association, said the industry welcomes oversight but worries about costs.

Medicaid reimburses program operators between $58 and $74 daily for each participant, depending on care required, but the association said true costs run about $10 a day more per patient. Association and state health officials said it is not clear how much the proposed changes may increase costs.

Kay Lazar can be reached at Follow her on Twitter @GlobeKayLazar.