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Early

Onset

Dementia

Alberta

Foundation


Continuing Care Health Service Standards


Table of contents of CCHSS

The following is a list of the table of contents so you can look at here, specifically, to see what it is you would like to know about for the EOD person or yourself. Areas are covered briefly here:

Table of Contents:

Continuing Care Health Service Standards Information Guide.......................3

About the Continuing Care Health Service Standards (CCHSS)
Information Guide ...........................................................................................5

Updates...........................................................................................................7

Continuing Care Health Service Standards....................................................8

1.0 Standardized Assessment and Person-Centered Care Planning...........8

2.0 Case Management...................................................................................13

3.0 Access to Physician or Nurse Practitioner Services................................14

4.0 EOD Person Access to Information........................................................15

5.0 Palliative and End-of-Life Care................................................................18

6.0 Assistive Equipment, Technology and Medical/Surgical Supplies..........20

7.0 Sharing of EOD Person Information .......................................................23

8.0 Health Care Providers..............................................................................24

9.0 Staff Training ...........................................................................................27

10.0 Risk Management..................................................................................30

11.0 Infection Prevention and Control (IPC)...................................................31

12.0 Medication Management........................................................................35

13.0 Nutrition and Hydration Management.....................................................38

14.0 Oral Care Assistance and Bathing Frequency in
Publicly Funded Supportive Living and Long-Term Care Facilities................40

15.0 Safe Bath and Shower Water Temperature ...........................................42

16.0 Restraint Management...........................................................................44

17.0 Continuity of Health Care.......................................................................47

18.0 Concerns Resolution on Health Care and Forming a Council...............48

19.0 Quality Improvement Reporting..............................................................51

Continuing Care Resources...........................................................................54


1.0 Standardized Assessment and Person-Centered Care

Planning Standard 1.1

An Operator must ensure that a EOD Person’s Health Care needs are assessed using the appropriate InterRAI Instrument upon the EOD Person’s commencement of services provided in the Co-Ordinated Home Care Program, or upon admission to a Publicly Funded Supportive Living Facility or Long-Term Care Facility and:

a) Where an InterRAI Instrument is not appropriate, AHS must designate the Standardized Assessment Tool to be used;

b) The assessment is conducted by a Regulated Health Care Provider trained in the appropriate InterRAI Instrument or Standardized Assessment Tool;

c) EOD Persons receiving services in a Long-Term Care Facility must be reassessed:

i) quarterly; and ii) upon a Significant Change in the Client’s Health Status;

d) EOD Persons receiving services in the Co-Ordinated Home Care Program or in a Publicly Funded Supportive Living Facility must be reassessed:

i) annually; and

ii) upon a Significant Change in the EOD Person’s Health

Status.: An assessment using the appropriate InterRAI Instrument / Standardized Assessment Tool Assessments / reassessments by a Regulated Health Care Provider within the timelines stated in Standard 1.

Standard 1.2

An Operator must ensure that care planning begins upon the EOD Person’s commencement of services provided in the Co-Ordinated Home Care Program, or upon admission to a Publicly Funded Supportive Living Facility or Long-Term Care Facility and that the Care Plan:

a) Reflects the findings of the assessment in 1.1.

b) Is kept up to date and relevant to the EOD Person’s Health Status.

c) Is revised by a Regulated Health Care Provider based on any reassessments.

Evidence of compliance may include, but is not limited to, the following: Care Plans and health records are initiated on the date of admission / commencement and are current and relevant Results of the assessments are reflected in the Care Plans Revisions to Care Plans based on any reassessments are completed by a Regulated Health Care Provider Alberta Health Continuing Care Health Service Standards

Standard 1.3

An Operator must ensure that the Care Plan addresses:

a) An EOD Person's physical, mental, emotional, social, intellectual and spiritual Health Care needs and corresponding goals

b) A description of the necessary interventions related to the assessment in 1.1 and which Interdisciplinary Team member is responsible for providing those interventions;

c) Where an EOD Person has a legal representative:

i) Identification of the Client’s legal representative

ii) Identification of the source of their legal authority

iii) Contact information for the legal representative.

Evidence of compliance may include, but is not limited to, the following: Client needs and corresponding goals are addressed in the Care Plan (e.g., clinical assessment protocols) A description in the Care Plan of the necessary interventions and which Interdisciplinary Team member is providing the necessary interventions Documented identification of a Client’s legal representatives, if any, and their contact information.

Where there is a legal representative, evidence of the source of their legal authority as demonstrated by one or more of: Personal directive Guardianship or Enduring power of attorney Trusteeship Capacity assessments

Standard 1.4

An Operator of a Long-Term Care Facility must have documented processes in place that ensure a Physician or Nurse Practitioner conduct:

a) A Medical Status assessment of a Client upon admission;

b) Reassessments of an EOD Person’s Medical Status on an annual basis and when there is a significant change in the EOD Person’s Medical Status.

Evidence of compliance may include, but is not limited to, the following: Medical Status assessments are completed by a Physician or a Nurse Practitioner upon admission Reassessments are completed by a Physician or a Nurse Practitioner annually and upon a significant change in the Client’s Medical Status

3.0 Access to Physician or Nurse Practitioner Services

Standard 3.1

An Operator of a Long-Term Care Facility must ensure the following is in place:

a) A documented procedure available to all Regulated Health Care Providers on how to access the on-call Physician or Nurse Practitioner outside of regular daytime or evening shifts;and b) a Physician to act as a medical director and who is responsible for:

i) Overseeing the Quality of Medical Care

ii) Providing expertise in the provision of Medical Care

iii) Advising on medical program policies and medical follow-up processes.

Notes: Standard 3.1 applies to Long-Term Care Facilities only. Evidence of compliance may include, but is not limited to, the following: Name of medical director Process for accessing the on-call Physician or Nurse Practitioner

4.0 Client Access to Information

Standard 4.1 Upon the EOD Person’s commencement of services provided in the Co-Ordinated Home Care Program, or upon admission to a Publicly Funded Supportive Living Facility or Long-Term Care Facility, an Operator must ensure that an EOD Person and the EOD Person’s legal representative, if applicable, are provided written information:

a) About the Health Care or Medical Care available within the setting where the EOD Person resides or where the EOD Person’s Health Care or Medical Care is provided.

b) Summarizing the Health Care and Medical Care to be provided to the EOD Person.

c) Describing the funded and unfunded services and any costs assigned to the EOD Person.

d) About the responsibilities of the Operator in the provision of Health Care and Medical Care to the EOD Person.

e) About the EOD Person’s responsibilities regarding their Health Care and Medical Care, if any.

Evidence of compliance may include, but is not limited to, the following: Written information, as listed in Standard 4.1, is provided to the EOD Person and the EOD Person’s legal representative as demonstrated by one or more of: Admission or service agreements EOD Person’s handbook / Information package Admission package.

Standard 4.2

An Operator must ensure that any updates to the information in 4.1 are provided and made readily available to an EOD Person or the EOD Person’s legal representative. Evidence of compliance may include, but is not limited to, the following: Documentation that EOD Persons or their legal representatives are informed of updates to the information in Standard 4.1. As demonstrated by one or more of: Progress / Case notes Client / family Council minutes or Correspondence (email, fax, letter) . . .

Notes: Standard 4.3 is only applicable where an EOD Person requires Health Care or Medical Care that the Operator does not provide or is not publicly funded.

Evidence of compliance may include, but is not limited to, the following: EOD Persons and their legal representative are provided with information on accessing the required Health Care or Medical Care as demonstrated by one or more of: Admission package Brochures / posters Admission and conference checklists EOD Person’s handbook / Information packages Progress / case notes Auditor conversations with EOD Persons or their legal representatives.

Standard 4.4

Where an Operator has assessed an EOD Person as requiring information on Personal Directives, Enduring Power of Attorney, guardianship orders, trusteeship orders, or Advance Care Planning, the Operator must ensure that the relevant information is provided to the EOD Person and the EOD Person’s legal representative, if applicable:

a) Upon the EOD Person’s commencement of services provided in the Co-Ordinated Home Care Program, or upon admission to a Publicly Funded Supportive Living Facility or Long-Term Care Facility.

b) When the EOD Person transfers between different publicly funded Operators.

c) When the EOD Person transfers between different levels of care within the same Operator.

d) Following any Interdisciplinary Team conference.

Palliative and End-of-Life Care

Standard 5.1

Where an Operator provides Palliative and End-of-Life Care services, an Operator must:

a) Establish, implement and maintain documented policies and procedures identifying what specific Palliative and End-of-Life Care services it provides.

b) Make these policies and procedures available to the EOD Person, the EOD Person’s legal representative, if applicable, and Staff.

Notes: Standard 5.1 is only applicable where the Operator provides Palliative and End-of-Life Care services. Evidence of compliance may include, but is not limited to, the following: Policies and procedures outline the Palliative and End-of-Life Care services provided by the Operator Staff are made aware of policies and procedures on Palliative and End-of-Life Care services As demonstrated by one or more of: In-service material and attendance sheets Staff access to Palliative and End-of-Life Care resources EOD Persons and their legal representatives are made aware of policies and procedures on Palliative and End-of-Life Care services As demonstrated by one or more of: EOD Person / family Council minutes EOD Person handbook / Information packages Admission conference document or admission check list.

Standard 5.2

An Operator must ensure that a EOD Person and the EOD Person’s legal representative, if applicable, are provided with information on Palliative and End-of-Life Care based on the EOD Person’s Health Status and assessed Health Care needs. Evidence of compliance may include, but is not limited to, the following: The EOD Person and the EOD Person’s legal representative are provided with information on Palliative and End-of Life Care based on the EOD Person’s Health Status and assessed Health Care needs.

Standard 5.3

An Operator must ensure the following are documented in a EOD Person’s Care Plan:

a) The EOD Person’s Palliative and End-of-Life Care goals

b) Any relevant instructions pertaining to Palliative and End-of-Life Care listed in any legal documents made known to the Operator.

Evidence of compliance may include, but is not limited to, the following: Palliative and End-of-Life Care goals are documented in the Care Plan as appropriate to the EOD Person’s Health Status, the EOD Person’s Care Plan contains relevant instructions for Palliative and End-of-Life Care goals as per legal documents.

6.0 Assistive Equipment, Technology and Medical/Surgical Supplies

Standard 6.1

An Operator must ensure that a Client is:

a) Provided with any Assistive Equipment, Technology or Medical/Surgical Supplies that the EOD Person has been assessed as requiring

b) Referred to a service which can provide the Assistive Equipment, Technology or Medical/Surgical Supplies

Notes: Depending on the Assistive Equipment, Technology or Medical/Surgical Supplies required by the EOD Person, an Operator may either: assess and provide the Client with the required items; or• refer the EOD Person to a service that can provide the items.• Evidence of compliance may include, but is not limited to, the following: Assessments of Clients completed for Assistive Equipment, Technology or Medical/Surgical Supplies Documentation that the Operator has provided the Assistive Equipment, Technology or Medical/Surgical Supplies that the EOD Dementia has been assessed as requiring Documentation of the referral of a EOD Person to the service which can provide the required Assistive Equipment,

As demonstrated by one or more of: Referrals List of service providers: Documented process Alberta Aids to Daily Living (AADL) forms

Standard 6.2

Where an Operator uses Assistive Equipment that it does not own for the purpose of providing Health Care to an EOD Person, the Operator must establish, implement and maintain documented policies and procedures for Health Care Providers to identify and report unsafe Assistive Equipment being used.

Notes: Standard 6.2 is only applicable where the Operator uses Assistive Equipment that it does not own. Evidence of compliance may include, but is not limited to, the following: Policies and procedures for identifying and reporting unsafe Assistive Equipment Implementation of policies and procedures to identify and report unsafe Assistive Equipment As demonstrated by one or more of: Lock out tags Log books Maintenance records Auditor conversations with Health Care Providers regarding the process for reporting

Standard 6.3

Where an Operator owns and provides the Assistive Equipment, Technology, Reusable Medical Devices, or Non-Critical Medical Devices for the purpose of providing Health Care to an EOD Person, the Operator must establish, implement and maintain documented policies and procedures for:

a) regular routine maintenance for the purposes of general upkeep against wear and tear;

b) regular preventative maintenance and repairs for the purposes of addressing wear and tear or sudden failure of equipment components;

c) documentation of the routine maintenance, preventative maintenance and repairs performed by the Operator;

d) identification and reporting of any unsafe Assistive Equipment, Technology, Reusable Medical Devices or Non-Critical Medical Devices by the Staff using it.

Notes: Standard 6.3 is only applicable to the Assistive Equipment, Technology, Reusable Medical Devices or Non-Critical Medical Devices owned and provided by the Operator. Evidence of compliance may include, but is not limited to, the following: Policies and procedures related to Assistive Equipment, Technology, Reusable Medical Devices and Non-Critical Medical Devices, as listed in Standard 6.3 Manufacturer’s instructions for Assistive Equipment, Technology, Reusable Medical Devices and Non-Critical Medical Devices Documentation of regular routine maintenance, regular preventative maintenance and repairs As demonstrated by one or more of: Tracking and schedules Records of repairs Preventative maintenance and regular routine records Inspection certificates Implementation of policies and procedures to identify and report unsafe Assistive Equipment, Technology, Reusable Medical Devices or Non-Critical Medical Devices. As demonstrated by one or more of: Lock out tags Log books Maintenance records Auditor conversations with Staff regarding the process for reporting

Standard 6.4

An Operator must ensure that instruction on the appropriate and safe use of the Operator owned Assistive Equipment, Technology or Medical/Surgical Supplies is provided to each Staff, volunteer, EOD Person, and the EOD Person’s designated care partners required to use them.

Notes: Standard 6.4 is only applicable to the Assistive Equipment, Technology or Medical/Surgical Supplies owned by the Operator, but used by Staff, volunteers, EOD Persons and the EOD Person’s care partner.

Evidence of compliance may include, but is not limited to, the following: Information and/or training materials on the use of Assistive Equipment, Technology or Medical/Surgical Supplies are available to Staff and volunteers As demonstrated by one or more of: In-service materials and attendance sheets Equipment manuals Manufacturer’s instructions Auditor conversations with Staff and volunteers Education on the use of Assistive Equipment, Technology or Medical/Surgical Supplies has been provided to the EOD Person and the EOD Person’s designated care partners as demonstrated by one or more of: Progress / case notes Education materials Attendance sheets Checklists Auditor conversations with EOD Persons and care partners.

Standard 6.5

For the purpose of 6.4, the ’s designated care giver is an individual who consistently provides unpaid support, care and assistance in a variety of ways to the Client and is documented in the Care Plan.

Notes: Standard 6.5 provides a definition; no evidence is required

7.0 Sharing of Client Information

Standard 7.1 To the extent allowed for by law, an Operator must ensure that the following is communicated to other Operators providing Health Care to a Client:

a) The EOD Person’s necessary Health Information;

b) The EOD Person’s Personal Directive, Enduring Power of Attorney, guardianship, trusteeship order, or Advance Care Planning document.

Notes: When sharing the EOD Person’s information, the following provincial legislation should be considered for applicability: Freedom of Information and Protection of Privacy Act• Health Information Act• Personal Information Protection Act• Personal Information Protection and Electronic Documents Act• Evidence of compliance may include, but is not limited to, the following: Process to ensure appropriate information accompanies the Client at points of transfer.

9.0 Staff Training

Standard 9.1

An Operator must ensure that the training materials used to provide training are current in relation to the legislation, regulations, standards, and guidelines listed in 9.2 and 9.3 Evidence of compliance may include, but is not limited to, the following: Training materials for the training listed in Standards 9.2 and 9.3 Standard 9.2 An Operator must establish, implement and maintain documented policies and procedures to ensure:

a) Training for all Staff in: i) Person Centered Care; ii) prevention, recognition and management of Responsive Behaviours; iii) infection prevention and control practices; and iv) emergency preparedness, pandemic preparedness and service continuity.

b) Training for Health Care Aides involved in the provision of Medication Management are trained in Medication Reminders and Medication Assistance;

c) Training for any Staff working with a Client with dementia are trained in care of Clients with dementia

d) Training for Health Care Providers in: i) Risk Management; ii) fall prevention and management; iii) cardiopulmonary resuscitation (CPR) where their job description requires they must be trained in CPR; iv) Palliative and End-of-Life Care where providing such care; v) safe lifts and transfers where providing such care; vi) restraint use and management where they may be required to implement or manage Restraints; and vii) methods to ensure safe bath and shower water temperatures where involved in assisting Clients with bathing;

e) Training in nutrition and hydration assistance techniques, including choking prevention and response, for any Unregulated Health Care Provider or volunteer involved in assisting an EOD Person in meeting the EOD person’s nutrition and hydration needs;

f) The training in 9.2(a) through 9.2(e) occurs within six months from the date of hire, and every two years thereafter. Notes Auditors will require access to Staff and volunteer files for evidence of compliance with this Standard. As of April 1, 2016, all current Staff will require training within 6 months. All new Staff hired after April 1, 2016 will be required to meet the timelines noted in the CCHSS.

Standard 9.3

An Operator must establish, implement and maintain documented policies and procedures to ensure: a) training for all Health Care Providers in; i) the CCHSS; ii) Health Information management; iii) the Health Information Act and the Freedom of Information and Protection of Privacy Act; iv) the prevention and reporting of EOD Person abuse; and v) incident reporting pursuant to 19.2, 19.3 and 19.4;

a) Training for registered nurses, licensed practical nurses and Health Care Aides

b) Personal Directives, Enduring Power of Attorney, guardianship and trusteeship in the provision of Health Care

c) The training in 9.3(a) and 9.3(b) occurs within six months of the date of hire and within three months of any significant update or revisions to the related training materials

12.0 Medication Management

Standard 12.1 Operators must establish, implement and maintain documented policies and procedures for Medication Management that must, at a minimum, include the following:

a) Pharmacy services;

b) Quality improvement

c) Medication reconciliation to ensure complete and accurate transfer of medication information and reduce medication errors and adverse drug events: i) upon the EOD Person’s commencement of services provided in the Co-ordinated Home Care Program, or upon admission to a Publicly Funded Supportive Living Facility or Long-Term Care Facility; ii) when the EOD Person transfers between different publicly funded Operators; iii) as the EOD Person transfers between different levels of care within the same Operator; and iv) following any Interdisciplinary Team conference; d) assessment of a EOD Person’s medication knowledge; e) access to medication information by an EOD Person or their legal representative, if applicable; f) assessment, ongoing monitoring and reassessment of an EOD Person’s physical ability and cognitive ability to competently self-administer medications; g) Medication Review; h) monitoring and reporting of adverse drug events; i) management and documentation of willful or inadvertent non-adherence to the Medication Management program including: i) failure to fill a prescription; ii) failure to take a prescription; iii) omitting doses or overdosing; iv) improperly storing medication; or v) improper use of medication administration devices; j) medication labeling, packaging and storage; k) safe disposal of medication; l) the “8 Rights” of Medication Administration principles that Health Care Providers must adhere to when administering or assisting with medication: i) right medication; ii) right EOD Person; iii) right dose; iv) right time; v) right route; vi) right reason; vii) right documentation; and viii) right to refuse a medication; m)roles and responsibilities of Regulated Health Care Providers; and n) roles and responsibilities of Unregulated Health Care Providers.

Notes Best practices for medication management can be found at: Decision Making Standards for Nurses in the Supervision of Health Care Aides

Decision Standards

Assignment of EOD Person Care Guidelines for Registered Nurses

Medication Guidelines

Evidence of compliance may include, but is not limited to, the following: Policies and procedures related to Medication Management as listed in Standard 12.1 Assessment of an EOD Person’s medication knowledge upon admission and introduction of new medications as demonstrated by one or more of: Progress / case notes Admission assessment Care Plan Medication Review EOD Person or the EOD Person’s legal representative has access to the EOD person’s medication information (i.e. medication list) Review of InterRAI/Standardized Assessment Tool assessment and reassessment outcome scores related to physical and cognitive ability to competently self-administer medications Medication reconciliation completed Tracking, root cause analysis and action taken for reporting medication errors and near misses Documentation of quality initiatives related to Medication Management (i.e. tracking and trending of medication errors and near misses) Documentation of Client’s non-adherence to the Medication Management program As demonstrated by one of more of: Managed risk agreement Care Plan Progress / case notes behavior support plan Coding on medication administration records (MAR) Medication Reviews completed Review of Medication Management processes (i.e. medication administration records, narcotic tracking sheets, Physician order sheets and progress / case notes) Job descriptions for Regulated and Unregulated Health Care Providers outlining their roles and responsibilities Auditor conversations with Staff regarding: medication errors;• roles and responsibilities; and• the “8 rights”.• Observation of: locked medication carts, cupboards and/or rooms;• secured dead drug box;• clear medication labelling;• safe disposal of unused or expired medications;• Staff medication administration and Medication Assistance, as per requirements of.

Standard 12.2

An Operator must ensure that an EOD Person is provided with the option of Medication Reminders or Medication Assistance to support and enable the EOD Person to competently self-administer some or all of the EOD Person’s medications for as long as possible.

Notes: Standard 12.2 is applicable where EOD Persons have been assessed as being able to self-administer medications Evidence of compliance may include, but is not limited to, the following: Documentation of an assessment indicating the EOD Person is able to competently self-administer and the options provided to eligible EOD Persons as demonstrated by one or more of: Care Plan Service authorization EOD Person’s handbook / information package Capacity assessment Progress / case notes.

Standard 12.3

Where an EOD Prson is assessed as being unable to competently self-administer their medication, an Operator must ensure that the EOD Person is provided with a plan for assistance in accordance with the Medication Management policies and procedures.

Notes: Standard 12.3 is applicable where EOD Persons have been assessed as being unable to self-administer medications.

Evidence of compliance may include, but is not limited to, the following: Documentation that an EOD Person has been assessed as unable to self-administer, and is provided with a plan for medication assistance/administration as demonstrated by one or more of: Care Plan Service authorization Capacity assessment Progress / case notes.

Standard 12.4

An Operator must ensure that an EOD Person’s plan for Medication Management will be reassessed at the EOD Person’s Interdisciplinary Team conference and updates documented in the Care Plan. Evidence of compliance may include, but is not limited to, the following: Reassessment of a EOD Person’s plan for Medication Management occurs during Interdisciplinary Team conferences. Updates are included in the EOD Person’s Care Plan.

Prepared by:
Moira Cairns
April 2017