22 VAC 40-61-330 Part D Activities:

Comment:  Existing regulations have no stipulation for a "designated staff person" assigned to activities.  Adding the requirement for a "designated" activity staff will create an extreme hardship of financial and staffing challenges.

Proposed regulations on who can qualify as a "designated" activities staff person are too confining from an educational point of view.  It will be challenging to secure the qualified staff person and be hardship to the facilities budget.

CTRS according to Bureau of Labor Statistics garners annual wages of $45,890,  These wages are exorbitant for centers who are publicly funded with LOA and EDCD Medicaid Waiver.  The Medcaid reimbursement rate is $57.04 per day which equals an hourly rate of $5.19 for our center which is open 11 hours per day.

CTRS training is difficult to access in Southwest Virginia and rural communities.  The Activity Director's course via the Virginia Health Care Association is only offered in a week-long yearly course with a fee of $695.  Applicants would incur travel expenses, meals, and overnight accomodations.

Requirement for having at least an Associate Degree in "a discipline focusing on provision of activities for adults" needs to be clarified (Section D4).

Requirement for 1-yr experience in an activities program in an adult care setting would be challenging to meet in smaller communities that support 1 or 2 long-term care settings.

Assisted Living regulations have an option for 40-hour department-approved activities training.  This would be an excellent choice for Adult Day Care Centers.

Recommendation:  The proposed regulations 22 VAC10-61-330 Activities, Part D should either be eliminated or amended as follows:

22VAC10-61-330 Activities, Part D

1.  Be a qualified therapeutic recreation specialist, activities professional, or related field in recreation, creative arts specialist, or related health care clinician.

2. Be eligible for certification as a therapeutic recreation specialist, activities professional or related field in recreation, creative arts specialist, or related health care clinician.

3. No change

4. Have at least an Associates degree in human service, health care, education physical education, recreation, humanities, psychology, social sciences, social work, disability studies, fine arts or a related field.

5. Have one-year full-time experience within the last 5 years in a health care or disability services program (omit activities program) or

6. Prior to or within 6 months or employment, have successfully completed 40 hours of department-approved training in adult group activities and in recognizing and assessing the activity needs of participants.

22VAC40-61-160.  First Aid and CPR Certification.

Part A First Aid

Comment:  This regulation is confusing and conflicting.

Recommendation:  The regulation should read as follows:

1.  There shall be at least one direct care staff member on premises at all times who has current certification in first aid from:  American Red Cross, American Hearth Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire dept.  The certification must be in adult first aid or include adult first aid. To be considered current, the certification shall have been issued within the past 3 years.

2.  A direct care staff member who is a registered nurse or licensed practical nurse doesn't have to meet the requirements of subdivisions 1 and 2 of this subsection.

22VAC40-61-1 Definitions:

Comment:  Clarification is needed to see who would count as direct care staff and who would need direct care staff training,

Recommendation:  "Direct Care Staff" means supervisors, assistants, aides, or other staff of a center who assist participants with the performance of personal care or ADLs and counted in the staff to participant ratio.