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Regulators define rules for care of dementia patients

Workers in nursing home dementia care units will have to receive eight hours of initial training and four additional hours annually, under final rules state regulators adopted Wednesday.

The regulations, approved nearly two years after Massachusetts lawmakers passed legislation mandating minimum standards for these specialized units, also require that the facilities have at least one “therapeutic activities director” dedicated to the dementia unit to ensure meaningful and appropriate activities for residents.

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The rules close a loophole that had allowed nursing homes to advertise dementia units without any specific training for their workers, specialized activities for residents, or safety measures in place, such as high fences, to prevent residents from wandering.

“These regulations have really been a labor of love for thousands of people affected by this difficult disease,” James Wessler, chief executive of the Alzheimer’s Association of Massachusetts and New Hampshire, said in a statement.

Few changes were made in the dementia care standards since they were unveiled last August by the Massachusetts Department of Public Health. They were finalized Wednesday by the Public Health Council, an appointed body of academics and health advocates that sets public policy.

One of the few changed provisions concerns the height of fences required around facilities with dementia care units. The health department proposed that such facilities be required to have a 6-foot fence surrounding outdoor areas to prevent residents from wandering off and getting lost.

But some nursing home operators objected, saying that facilities in urban areas may never be able to meet the requirement for outdoor space if a fence is mandated. Others felt that such a high fence might diminish residents’ enjoyment while outdoors.

The Alzheimer’s Association urged that secure fences be required for patient safety.

As a compromise, the Public Health Council dropped the 6-foot requirement, and instead required a “fence or barrier to prevent injury and elopement.”

Another change was made to the care standards that would have prohibited overhead paging systems, which can be jarring to patients.

“Several providers said overhead paging systems have been designed to operate throughout the building, and it would be too costly to shut off in this one unit,” Dr. Madeleine Biondolillo, associate public health commissioner, told the council.

The council decided to allow nursing homes to use the paging systems in an emergency.

A number of nursing home leaders had objected to a provision that requires nursing homes with dementia units to provide the specialized new training within 90 days after the rules go into effect.

But the Alzheimer’s Association and other patient advocates contended that the time frame was too long. The rules also require licensed nursing homes, and not just those with special dementia units, to provide dementia-specific training for all direct-care workers within 180 days.

Regulators said it was important to mandate the training because roughly 60 percent of nursing home residents have some form of dementia.

The council made no changes to the deadlines for worker training.

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