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Key Concepts: Dementia

6 key concepts from Title 22, Division 6, Chapter 8, Article 12: Dementia, for the RCFE Administrator exam. For the searchable, bookmarkable version, use the interactive Study Guide.

Dementia Care: Applicability & Required Staff Training Topics
87705 p. 182
This section applies specifically to residents diagnosed with dementia; mild cognitive impairment (MCI) does not count as dementia for these purposes.

As part of the training required under 87208 (Plan of Operation), staff have to be trained in: dementia care generally (hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, environment, ADL assistance); recognizing symptoms that can create or worsen behavioral expression (like dehydration, UTIs, swallowing problems); and recognizing the effects of medications commonly used to reduce behavioral expression.
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(a) This section applies to the care of residents diagnosed with dementia. Mild cognitive impairment, as defined in Section 87101, Definitions, is not considered to be dementia.Part 4, Page 182
(b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation: (A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; (B) Recognizing symptoms that may create or aggravate behavioral expression, as defined in Section 87101, Definitions, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and (C) Recognizing the effects of medications commonly used to reduce behavioral expression.Part 4, Page 182
Night Supervision, Tracking Devices, Exit Monitoring & Delayed Egress
87705 p. 183
In facilities with fewer than 16 residents, if a dementia resident is determined (through appraisal, reappraisal, or observation) to need awake night supervision, the facility has to have at least one awake, on-duty night staff person, on top of the standard 87415 night supervision requirements.

With the resident's (or conservator's) prior written approval, and as long as it doesn't violate their personal rights (87468.1), the licensee can use egress alert and location-tracking devices for safety. The facility also needs an auditory device or other staff alert to monitor exterior doors/perimeter gates accessible to elopement-risk residents.

If a facility uses delayed egress devices, it has to: notify the licensing agency of the planned install date immediately after deciding it, get the fire clearance to cover the devices, have staff attempt to redirect an at-risk resident trying to leave (without violating their rights), and still let residents leave with staff supervision if they insist after redirection.
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(2) For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal, or observation, to require awake night supervision. This requirement is in addition to requirements specified in Section 87415, Night Supervision.Part 4, Page 183
(c) With the prior written approval of the resident or conservator and provided such devices do not violate the resident's rights as specified in Section 87468.1 Personal Rights of Residents in All Facilities, the licensee may use egress alert and location tracking devices as needed to ensure resident safety. (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions.Part 4, Page 183
(e) Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements: (1) The licensee shall notify the licensing agency immediately after determining the date that the device will be installed. (2) The licensee shall ensure that the fire clearance includes approval of delayed egress devices. (3) Facility staff shall attempt to redirect a resident at risk for elopement who may be attempting to leave the facility without violating Section 87468.1, Personal Rights of Residents in All Facilities. (4) Residents who continue to indicate a desire to leave the facility following redirection shall be permitted to do so with staff supervision.Part 4, Page 183
Elopement Safety, Reporting & Locked-Door Requirements
87705 p. 184
Staff have to keep residents safe if they wander off the property, without violating their personal rights (87468.1/87468.2). Every elopement incident has to be reported to the resident's representative (immediately, plus a written follow-up per 87211) and to the licensing agency's Officer of the Day (no later than the next working day). Delayed egress devices can never substitute for having enough trained staff to actually supervise residents.

If a facility locks exterior doors or perimeter gates, it has to: notify the licensing agency of that intent, get fire-clearance approval for the locks (with staff on every shift able to unlock them), and still attempt to redirect at-risk residents without violating their rights.
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(5) Facility staff shall ensure the continued safety of residents if they wander away from the facility without violating Sections 87468.1, Personal Rights of Residents in All Facilities and Section 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities. (6) For each incident of elopement, as defined in Section 87101, Definitions, the licensee shall report the incident to: (A) The resident's representative, if applicable, immediately upon becoming aware of the incident... (B) The licensing agency Officer of the Day, by telephone, e-mail, fax, or hand-delivery no later than the next working day following the incident. (7) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents, including staff needed to escort residents who need supervision to leave the facility.Part 4, Page 184
(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates. (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates. (3) Facility staff shall attempt to redirect a resident at risk for elopement who may be attempting to leave the facility without violating Section 87468.1, Personal Rights of Residents in All Facilities.Part 4, Page 184
Wandering Space & Staffing Can't Be Substituted With Locks
87705 p. 185
Facilities have to provide enough interior and exterior space for residents with dementia to wander freely and safely. And just like delayed egress devices, locked exterior doors or perimeter fences can never substitute for having enough trained staff to meet all residents' care and supervision needs.
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(5) Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely. (6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents.Part 4, Page 185
Dementia Special Care Advertising: Activity Program Description
87706 p. 186
A licensee that advertises/promotes dementia special care, programming, or environments has to include extra detail in its plan of operation, among other things, a description of the activity program for dementia residents, covering the types of activities offered (cognitive/mental stimulation, physical activities, reminiscence activities, per 87219).
Show Title 22 source text
(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall meet the following requirements:Part 4, Page 186
(D) Activity program for residents with dementia. 1. Types of activities include, but are not limited to, activities that support cognitive/mental stimulation, physical activities and reminiscence activities, as specified in Section 87219, Planned Activities.Part 4, Page 186
Discontinuing Dementia Special Care Advertising
87706 p. 188
If a licensee stops advertising/promoting dementia special care, it has to notify the licensing agency, residents, and (as applicable) residents' representatives at least 30 calendar days before stopping. On the date given in that notice, it has to stop all advertising referencing dementia special care (magazines, newspapers, directories, internet, radio/TV, etc.) and remove all written references to it from promotional material, admission agreements, and the plan of operation.
Show Title 22 source text
(b) The licensee who discontinues advertising, promoting, or otherwise holding themselves out as providing special care, programming, and/or environments for residents with dementia shall: (1) Provide written notification to the licensing agency, residents and, as applicable, the residents' representative, as defined in Section 87101, Definitions, at least 30 calendar days prior to discontinuing advertising or promoting dementia special care, programming, and/or environments.Part 4, Page 188
(2) On the date specified in the notification, cease all advertisements, publications, and/or announcements that pertain to dementia special care including, but not limited to, those in magazines, newspapers, consumer reports, professional or service directories, Internet, radio and/or television commercials. (3) On the date specified in the notification, remove all written references that indicate that the licensee provides dementia special care, programming, and/or environments from all promotional material, advertisements, and/or printed material, including admission agreements and the plan of operation.Part 4, Page 188

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