Initial RCFE Administrator Certification€¦ · and deserves to be punished preoccupation with health problems. Assisted Living Education 21 Poor Eating Habits o Vitamin B deficiencies

Initial RCFE Administrator Certification

Part 1 of 10

Assisted Living Education 1


This Course Material has been copyrighted © 2009 byAssisted Living Education

All rights reserved. No part of this coursematerial/content may be reproduced or utilized in anyform, by any means, electronic or mechanical, includingphotocopying, recording, emailing, or any informationstorage and retrieval system, without permission inwriting from Assisted Living Education.

Assisted Living Education has attempted to offer usefulinformation and assessment tools that have beenaccepted and used by professionals within this industry,including the California Department of Social Services.Nevertheless, changes in health/medical care and healthcare regulations may change the application of sometechniques and perceptions in this course material.Assisted Living Education thereby disclaims any liabilityfor loss, injury or damage incurred as a consequence,either directly or indirectly, from the use and applicationof any of the contents of this course material.

Online Class RulesSome required rules for this online classare:

• You can always navigate back to a prior slide forreview.

• There is a 20 question test that you must pass inorder to complete this section of the onlineCertification course. You must score at least70%, which is 14 or more correct answers, topass the test.

• If you do not pass, you will be directed to retakethe test.


DSS Training Requirements

Per DSS requirements, this 2 hoursegment of the 20 hour online RCFE InitialCertification Program will focus on:

Dementia andAlzheimer’s disease


Definitions

“DSS” = Department of Social Services“AB” = Assembly Bill“SB” = Senate Bill“LPA” = Licensing Program Analyst“RCFE” = Residential Care Facility for theElderly“AD” = Alzheimer’s disease


Sources

Many sources were consulted to create this course content. They include:

• California Department of Social Services• Alzheimer’s Association• Wikipedia• WebMD• Mayoclinic



Course ObjectivesThe Live portion of this Certification Coursefocuses on the difference between dementia andAlzheimer’s disease, the stages of each and howto care for your residents with AD.

Another Online portion of this Course focuses onthe irreversible dementias other than Alzheimer’sdisease.

This Online portion will focus on the reversibledementias, how dementia and Alzheimer’s diseaseis detected, treatment options and possible causesof Alzheimer’s disease.


Course Objectives

This Online portion will also discuss theDepartment of Social Services regulationsas they pertain to dementia residents andhow to assist your resident with dining.


What is a “reversible dementia?”

Many factors can cause symptoms thatmimic Alzheimer’s disease. Thesesymptoms are known as reversibledementias. Unlike Alzheimer’s disease,they can be cured with proper treatment.


Reversible Dementias

1) Substance abuse2) Medications3) Infections4) Metabolic disorders5) Depression6) Poor eating habits7) Brain tumor or subdural hematoma8) Normal pressure hydrocephalus


Substance AbuseConsuming excessive amounts ofalcohol for a decade or more canalso cause a dementia thatresembles Alzheimer's disease.Memory, orientation and attentionare impaired, although verbalskills are not always severelyaffected. In this type of dementia,abstinence may partly restoremental functioning.


Substance Abuse (cont’d)

Alcohol withdrawal syndrome presents theclassic picture of delirium. Similarly,delirium can occur from abrupt withdrawalfrom barbiturates or benzodiazepines, agroup of anti-anxiety drugs that includesdiazepam (Valium), chlordiazepoxide(Librium) and alprazolam (Xanax).


Medications

Adverse drug reactionsare one of the most commonreasons older personsexperience symptoms that

mimic dementia. All medications, prescriptions, over-the-counterpills and herbal remedies shouldbe monitored by a physician toreduce the possibility of side effects.


Medications (cont’d)

With aging, the liver becomes lessefficient at metabolizing drugs, and thekidneys eliminate them from the bodymore slowly. As a result, drugs tend toaccumulate in the body.

Elderly people in poor health andthose taking several differentmedications are especially vulnerable.


Medications (cont’d)The list of drugs that can cause delirium anddementia-like symptoms is long.

It includes:

antidepressants antihistaminesnarcotics anti-Parkinson drugsanti-anxiety medications cardiovascular drugsanticonvulsants corticosteroidssedatives


Infection

Confusion can be asymptom of an infection andneeds to be brought to theattention of the physician.

Possible infections include:urinary tract infections, coldand flu, staph, etc. Also,dehydration can causeconfusion.


Metabolic Disorder

Confusion or appetite, sleepand emotional changes canbe caused by medicalconditions including renal andliver failure, electrolyteimbalances (blood chemistrylevels), hypoglycemia (lowblood sugar), hypercalcemia(high calcium) and diseasesof the liver and pancreas.


Depression

Depression or major lifechanges such the loss of aspouse, moving from a long-time home or divorce canaffect one’s physical andmental health. A physicianshould be informed aboutmajor stressful life events.


Depression (cont’d)

A memory problem may improve when the depression is treated, whether or not the depression is caused by the dementia.


Depression (cont’d)Signs of depression:

frequent crying weight loss complaints of fatigue change in sleep patterns feelings that one has done something bad

and deserves to be punished preoccupation with health problems


Poor Eating Habits

o Vitamin B deficiencies

o Anemia

o Anorexia

o Bulimia


Brain Tumor or Subdural Hematoma

Brain Tumors• Can interfere with cognitive functioning

and cause personality changes.• Depending on their location, they can

trigger other symptoms, such asheadaches, seizures, or vomiting.

• However, the first symptoms of slow-growing tumors frequently resembledementia, especially in older people.


Subdural Hematomas:

Hematomas = blood clots caused bybruising.

When located in the subdural area,between the brain surface and the thinmembrane that covers it (the dura),they can cause symptoms that mimicAlzheimer's disease.

Such subdural hematomas can also belife-threatening, causing coma anddeath.


Subdural Hematomas:

Most caused by severe head traumasustained in automobile crashes.

Elderly people sometimes develop subduralhematomas after a very minor (and,therefore, often forgotten) head injury.

As blood oozes into a closed space, thehematoma enlarges and begins to interferewith brain function. Removing the clot withinweeks of the injury may restore mentalfunction.

However, the symptoms often evolve soslowly that diagnosis is delayed for months.


Normal Pressure Hydrocephalus

Hydrocephalus = "water on the brain“ An excess of cerebrospinal fluid around

the brain; normal-pressure hydrocephalusoccurs in a small number of elderly people.

Can result from head trauma, brainhemorrhage, or meningitis (inflammation ofthe membrane covering the brain), butmost cases occur spontaneously without anobvious preceding illness.


Normal Pressure Hydrocephalus

In addition todeveloping dementia,people with thiscondition losebladder control andwalk in a slow,hesitant manner, asif their feet are stuckto the floor.


DETECTING DEMENTIA

AND AD


Detecting Dementia and AD

Today, the only definite way to diagnoseAlzheimer's disease is to find out whetherthere are plaques and tangles in braintissue.

To look at brain tissue, doctors must waituntil they do an autopsy, which is anexamination of the body done after aperson dies.


Detecting Dementia and AD (cont’d)

Therefore, doctors must make a diagnosisof "possible" or "probable" Alzheimer'sdisease.

At specialized centers, doctors candiagnose Alzheimer's disease correctly upto 90% of the time.


Tools to diagnose “probable” AD

o a complete medical history, includinginformation about the person's generalhealth, past medical problems, and anydifficulties the person has carrying out dailyactivities;

o medical and neuropsychological tests;and/or

o brain scans allow the doctor to look at apicture of the brain to see if anything doesnot look normal.


Physical Exam

1. Test for muscle tone and strength =reflexes may become sluggish ornonexistent, loss of muscle tone andbody strength.

2. Evaluating coordination and eyemovements = decrease in movingobjects with their eyes, tracking items,difficulty walking


Physical Exam (cont’d)3. Performing routine tasks, like brushing the

hair = AD patients have difficulty in thesefunctions

4. Checking speech = speech involves thebrain coordinating the movement of lips,tongue, teeth and vocal cords to produceintelligible sounds.

5. Understanding language = taking directions


Physical Exam (cont’d)

6. Checking sensory abilities = can yousee this and explain what it is?

7. Ruling out stroke, Parkinson’s, or anyother diseases


CAT ScansComputer Axial Tomography: A series of X-raysthat show the human body in slices.

The X-ray mechanism, which surrounds thebody, "inches" its way along the area beingexamined, taking multiple tomograms (slices).The computer is used to turn the tomogramsinto pictures.

These scans can offer physicians theopportunity to differentiate, for example,between Alzheimer's disease and multi-infarctdementia.


MRI’sMagnetic resonance imaging (MRI) is the newest, and perhaps most versatile, medical imaging technology available. Doctors can get highly refined images of the body's interior without surgery, using MRI.


PET Scans

Positron emission tomography (PET) is ahighly specialized imaging techniqueusing short-lived radiolabeled substancesto produce powerful images of the body'sbiological function. This has become thetechnique of choice for investigatingAlzheimer’s disease.


PET Scans


Mini-mental State Exams

Also known as the Folstein Test, thisoffers a quick (30 questions) and simpleway to quantify cognitive function andscreen for cognitive loss. It tests theindividual’s orientation, attention,calculation, recall, language and motorskills.

Mini-mental State ExamsThe Folstein Test:

30 questions. Takes about 5 minutes to administer. Generally, 25 points out of 30 points

indicates some impairment. Done consecutively over a period of time

can identify decline in cognitivefunctioning.

ASSISTED LIVING EDUCATION39

ASSISTED LIVING EDUCATIONASSISTED LIVING EDUCATIONASSISTED LIVING EDUCATION

Mini-mental State ExamsThe Folstein Test:Orientation:

What is the year, season, date and month? = 5 points

Where are we: state, country, town or city, hospital, floor? = 5 points

Registration:

Repeat the following: apple, table, penny. = 3 points

Attention and Calculation:

Serial 7s: 93, 86, 79, 72, 65 or spell world backwards. = 5 points

Recall:

What were the three objects above? = 3 points



Mini-mental State ExamsThe Folstein Test (cont’d):Language:

Name a pencil and watch. = 2 points

Repeat the following: No ifs, ands or buts = 1 point

3-step command: take this piece of paper in your right hand, fold it in halfand put it on the floor. = 3 points

Read and obey: close your eyes. = 1 point

Write a sentence. = 1 point

Copy the design: = 1 point

TOTAL = 30 POINTS




POSSIBLE CAUSES


Possible Causes

Researchers are investigating genetic and lifestyle factors such as:

a) Ageb) Heredityc) Head traumad) Educational levelse) Dietary habitsf) High blood pressure and cholesterol levels


Lifestyle Factors

Age - The greatest known risk factor forAlzheimer’s is increasing age. Mostindividuals with the disease are 65 orolder. The likelihood of developingAlzheimer’s doubles about every fiveyears after age 65. After age 85, the riskreaches nearly 50%!


Lifestyle Factors (cont’d)

Heredity - Research has shown that afamily history of AD increases the chanceof getting the disease.

Head trauma – Again, there seems to be astronger AD chance if you’ve had aserious head injury.



Educational level – Research isshowing that the more years offormal education one has, the lesslikely you are to get AD.

Dietary habits – the brain benefitsfrom a low-fat diet rich inantioxidants such as Vitamin E andC. Vitamin B is also beingresearched.



High blood pressure andcholesterol levels -studies are showing thatwhat's good for the heart- keeping cholesteroland blood pressure incheck - may also begood for the brain.


Keeping AD away!

EXERCISE! Eat a low-fat diet rich in

dark green vegetables and bright colored vegetables.

Keep your weight at a safe and appropriate level.

Keep your brain active.


TREATMENT


Treatments

Because there is no cure, managing the disease usuallyinvolves medications to control symptoms, incombination with various non-drug strategies designedto ease the suffering of the person afflicted as well as hisor her family and caregiver.


Treatments

The focus of drug treatment for Alzheimer’s Disease is to improve cognitive abilities – such as memory or thinking –and slow the progressionof these symptoms.


Treatments for Cognitive Symptoms

2 types of 5 individual drugs have beenapproved by the FDA for treatingcognitive symptoms:

1. Cholinesterases

2. Memantines


Cholinesterases

These prevent the breakdown ofacetylcholine, a chemical messengerimportant for learning and memory.

On average, these drugs delay worseningof the symptoms for 6 – 12 months


Cholinesterases Donepezil (Aricept) – treats all stages

Rivastigmine (Exelon) – treats mild-moderate

Galantamine (Razadyne or Reminyl) – treatsmild-moderate

Tacrine (Cognex) – this is rarely prescribeddue to serious side effects, including possibleliver disease


Cholinesterases

Aricept:

o Approved by the FDA in 1996 – 2nd AD drugo #1 drug prescribed for ADo It remains in the system longer than the other

drugs

o 5 mg = white pillo 10 mg = yellow pill


Aricept

Taken in the evening before bedTaken with or without foodDoctors start off with 5 mg for 4-6 weeks

and then increase it to 10 mg It takes 15 days for patients to achieve a

steady therapeutic level in their bodiesMust take the drug every day to continue

benefits


AriceptSide effects:

increases the production of stomach acids, leading to:

nauseavomitingloss of appetiteincreased frequency of bowel movementsliver toxicity


Exelon Approved by the FDA in 2000 Not as popular because of the gastrointestinal

side effects Requires 2 doses daily instead of 1 They do have a liquid form for patients with

difficulty swallowing pills Taken with food Starts with 1.5 mg twice a day – goal is 6-12

mgs 1.5 mg = yellow pill; 3 mg = orange pill; 4.5 mg =

red pill; 6.0 mg = orange and red pill


Reminyl

o Approved by the FDA in 2001o Actually from a flower called a snowdrop –

part of the daffodil family – relievedheadaches

o This drug appears to hold AD patients at ahigher level of cognitive functioning thanthe others – an average of 12 monthscompared to 6-9 for the other drugs.


Reminyl Delays troublesome behaviors such as agitation,

aggression, apathy, hallucinations, delusionsand a lack of inhibition.

4 mg = white tablet; 8 mg = pink tablet; 12 mg =orange-brown tablet

Also available in oral solution Pills taken twice a day with meals and plenty of

fluid Start at 4 mg – increase to 12 mg


Reminyl

Side effects:

gastrointestinal bleeding (liver disease patients cannot take this)

nausea


Memantine (Namenda)

This works by regulating the activity ofglutamate, a messenger chemical involvedin learning and memory.

Glutamate – excess levels of thisneurotransmitter contributes to the deathof brain cells in people with AD.


Memantine (Namenda)

Approved in 2003 for treatment ofmoderate-severe AD.

Currently the only drug of its typeapproved to treat AD.


Drug Options

o In general, Reminyl, Exelon and Aricept aremost effective when treatment is begun in theearly stages.

o Namenda is the only drug shown to be effectivefor the later stages of the disease.

o Aricept is taken once a day, the others twice aday.


Drug Options (cont’d)

Both have been shown to moderately slowthe progression of cognitive symptomsand reduce problematic behaviors in somepeople, but at least half of the people whotake these drugs do not respond to them.


Other Medications

Antidepressants Anti-anxieties Anti-psychotics Seizure

medications/mood stabilizers


Alternative Treatments

There are claims being made on the effectiveness of herbal remedies, vitamins and other dietary supplements such ginkgo biloba or coenzyme Q10.


Alternative Treatments (cont’d)

Ginkgo biloba: Subject of a number ofongoing studies regarding its potentialto help people with AD retain memory.

Vitamin B: The theory is that certain Bvitamins help lower the levels of theamino acid homocysteine in the body(high levels have been linked to anincrease in AD).


Alternative Treatments (cont’d)

Vitamin E: Strong evidence that 1,000I.U. of Vitamin E taken twice a day mayslow the progression of AD in somepeople.

Estrogen: Studies show that estrogenmay affect brain regions relevant tomemory, but it’s still being studied.

Dining with Dementia

Our goal is to create the most positive diningexperience for our residents with dementiaas we can.


Licensing Requirements

Regulations state that we must serve theresidents “an appropriate variety of foodsand shall be planned with consideration forcultural and religious background and thefood habits of the residents.”

• What is appropriate for our residents with AD?• How do we find out what they like?



Food Choices for Residents with AD

• Small, “finger foods”• Not too many items on the plate• Peas, small bits of food are hard to scoop up• Rough textured food, like toast, that stimulates

the person’s tongue and encourages chewing• Mashed or pureed fruits or vegetables• Scrambled eggs, puddings, chicken fingers• Sandwiches into quarters• Use bendable straws• Residents with AD love sweets!


Food Choices to AvoidHard candyTaffyHot dogsNutsCrunchy foods like chips or crackersPeanut butterGumGrapes or cherriesThin liquids if given too rapidly


Helping the Resident Eat

Things that might causeproblems with eating:

Not enough light, or glare Noise and distractions Too many choices Unpleasant smells Unappetizing food Anxiety over being rushed


Helping the Resident Eat (Cont’d)

Personal conditions that may disrupt eating:

Mouth discomfort Side effects of medication Inability to recognize hunger Constipation Agitation Forgetting how to eat or use utensils


Eating Tips & Techniques

1. Eating with one or two other people in a quietroom.

2. Restless residents should be encouraged toeat with other residents and have frequentnutritious snacks.

3. Sleepy residents should also be encouraged toeat with other, interactive residents.

1. Do not try to serve a resident that is too sleepy –they may choke.


Eating Tips & Techniques (cont’d)

4. Do not use plastic utensils but you can use aplastic tablecloth or placemats.

5. Use a placemat that is a different color thanthe plate.

6. Avoid glass if the resident has difficulty seeingit.

7. Make sure the resident’s dentures are in inplace and they fit properly.

8. Keep food simple!9. Offer one choice at a time.10. Play soft, relaxing music at mealtime.11. Encourage the serving of “finger foods.”



10. Pay attention to your residents; do notsocialize with other staff during mealtimes.

11. Allow residents to feed themselves as much asthey can.

12. Resident food likes/dislikes13. Pay attention to food temperature.14. NO alcohol!15. Remove condiments (salt, pepper, etc.) from

the table if the resident is confused by them.16. If the resident is confused by too many

silverware choices, only give them one.



Do not have on the table:

items that look like food, but are not(i.e., fake fruit)

salt, pepper, hot sauce, vinegar plants

Food Presentation

Serve meals on colorful dishes withcontrasting colors since Alzheimer'spatients can't always differentiatebetween a piece of white chicken on awhite plate.

Opt for red or green plates where foodbecomes easily visible.


Food Presentation

NO!


Eating Challenges

Someone with Alzheimer's can have moodand behavioral changes that impact on theirability to take a good balanced diet.

They may be highly distractible, talkative,apathetic, anxious, agitated or displaywandering behavior that will all inhibit theirability to eat.



ResistanceIssue: Refusing to eat

Possible causes:

o Unpleasant presentation of foodo Too many choiceso Noise and confusion in dining room, smellso Approach of caregivero Dry mouth from medicationso Pain from dentures or teeth issueso Inability to recognize sensation of hungero Fear of poisoning (distrust of caregiver)

What to try

Give them foods that they like! Try sweet foods, like fruit or applesauce Keep noise and activities to a minimum Check for chewing problems Keep a routine Find that favorite caregiver to assist Encourage physical activity Consult their physician



ResistanceIssue: Eating all the time

Possible causes:

o Short-term memory losso Lack of routineo Burning calories from pacing, agitationo Boredomo Former smoker

What to try

• Feed them more frequently (try 5-6 mealseach day), and smaller amounts at each meal

• Keep a routine• Give them something to drink• Have low calorie snacks available, such as

apples and carrots• Consider whether other activities such as

walks, or increased social contacts may help



ResistanceIssue: Unable to sit still

Possible causes:

o Short attention spano Foods presented in complicated wayo Agitation from confusing environmento Inactivity during non-meal times

What to try

• Give the resident “to-go” foods (small piecesof sandwiches, etc.)

• Make the dining room as inviting as possible• Play their favorite music• Have a caregiver sit with them



ResistanceIssue: Difficulty eating and swallowing

Possible causes:

o Brain damage from the diseaseo Need for cues or modelingo Mouth discomforto Dry mouth from medicationso Throat infectiono Inappropriate sizes/texture/form of food

What to try

• Check medications for side effects• Schedule a dental exam• Offer soft foods or small bites one at a time• Cut food into small pieces or chop/grind• Moisten foods with gravy or sauce• Provide hydration• Serve liquids with a straw• Have a caregiver sit with the resident and cue

themAssisted Living Education 90


ResistanceIssue: Eating inappropriate things

Possible causes:

o Inappropriate things on dining tableo Things that look edible, like wax fruito Smells goodo Poor lightingo Diminishing eyesight

What to try

• Never put inedible items, like pine cones, onthe dining table

• Supervise the residents while eating• Ensure there is adequate lighting• Serve familiar food

NO!



ResistanceIssue: Forgetting they just ate

Possible causes:

o Memory loss from brain damageo Lack of routineo Craving other foods/sweetso An activity cues the person to eato Time change (daylight savings)o Boredomo Confusion other symptoms, like dehydration,

with hunger

What to try

• Maintain a routine• Involve them in an activity• Provide high-calorie foods or large portions

(if they are still hungry)….or• Provide smaller meals more often• Keep them hydrated – offer a beverage



ResistanceIssue: Forgetting that they haven’t eaten

Possible causes:

o Time change (if it’s dark, they must have eaten)

o Change in routineo Constipationo Unable to recognize hungero Actually have been eating/snacking all day


ResistanceIssue: Weight loss, even with eating

Possible causes:

o Pacing/agitationo Inappropriate dieto Physical problem (unable to

absorb nutrients)o Acute illness/disease (cancer)

What to try

• This could indicate a serious illness ordisease – schedule a doctor’s appointment

• If the doctor prescribes a nutritionalsupplement, serve it to the resident asdirected. Do NOT do this without a doctor’sorder.

• Provide higher calorie meals or morefrequent meals



DSS Regulations for Dementia

Residents


DSS Regulations

• Section 87705 (Care of Persons withDementia) applies to licensees who acceptor retain residents diagnosed by aphysician to have dementia.

• Note: Mild cognitive impairment is notconsidered to be dementia.


DSS Regulations

In addition to the requirements in Section87705, Care of Persons with Dementia,licensees who advertise, promote, orotherwise hold themselves out as providingspecial care, programming, and/orenvironments for residents with dementia orrelated disorders shall meet the regulationsin Section 87706 and 87707.

Staff Training - 2016

Effective January 1, 2016, caregiversreceive 20 hours of training before workingindependently with residents.

Of these 20 hours, 6 hours must be indementia care training.


Staff Training - 2016Dementia care topics need to include, but are not limited to:

• The use and misuse of drugs such as antipsychotics• The non-pharmacologic, person-centered approach to dementia care• Hydration• Assisting with ADL’s• Skin care• Communication• Therapeutic activities• Environment• Recognizing symptoms that may cause or aggravate dementia

behaviors• Recognizing the effects of medications commonly used to treat the

symptoms of dementia; and• Security and supervision of the residents.


Staff Training – 2016

• Caregivers must also receive an additional20 hours of training within the first 4 weeksof employment.

• Of these additional 20 hours, at least 6more must be dementia care training.


Staff Training – 2016

Annual caregiver training:

20 hours =

o 6 hours must be in dementia care trainingo 4 hours must be in postural supports,

restricted health conditions and hospicecare


Section 87705

In addition to your facility’s Plan of Operation (seeSection 87208), you will need to address:

1. Procedures for notifying the resident's physician,family members and responsible persons whohave requested notification, and conservator, ifany, when a resident's behavior or conditionchanges.

2. Safety measures to address behaviors such aswandering, aggressive behavior and ingestion oftoxic materials.


Section 87705

1. Residents with dementia must reside in a non-ambulatory cleared room.

2. The Emergency Disaster Plan, as required inSection 87212, addresses the safety ofresidents with dementia.

3. Staff is trained (refer to preceding slides).4. There is an adequate number of direct care

staff to support each resident's physical, social,emotional, safety and health care needs asidentified in his/her current appraisal.


Section 87705

5. Each resident with dementia shall have anannual medical assessment and a reappraisaldone at least annually (see upcoming slide).

6. The activity program must be appropriate forresidents with dementia.

7. Ranges, heaters, wood stoves, inserts, andother heating devices cannot be accessible toresidents.

8. Swimming pools and other bodies of watershall be fenced.


Section 87705

9. The following must be stored inaccessible toresidents with dementia:

• Knives, matches, firearms, tools and other itemsthat could constitute a danger to the resident(s);and

• Over-the-counter medication, nutritionalsupplements or vitamins, alcohol, cigarettes,and toxic substances such as certain plants,gardening supplies, cleaning supplies anddisinfectants.


Section 87705

You must inform the families that theyCANNOT bring medications, such as coughdrops, Tylenol, vitamins, etc. into the facilityto give to the resident.

Any medication that is given to residentMUST have a written physician’s order for itand it CANNOT be in the resident’spossession.


Section 87705

10. Outdoor facility space used for residentrecreation and leisure must be completelyenclosed by a fence with self-closinglatches and gates, or walls, to protect thesafety of residents.

11. The licensee shall have an auditorydevice or other staff alert feature tomonitor exits, if exiting presents a hazardto any resident.



Care Plans and Physician Reports

Updated Annually

Updated upon change of condition

Physician Reports

CarePlans

Sections 87706-87707

Additional regulations:

• More detailed Plan of Operation• Additional requirements in the Admissions

Agreement• Keep copies of all advertising/marketing material

for a minimum of 3 years



Conclusion

As our aging population increases, and thebaby boomers start to reach their 70’s and80’s, more funding and time will beallocated to finding a cure for Alzheimer’sdisease. Until then, we will continue tocare for our residents, providing the dignityand safety that they need and deserve.

Proceed to Test

You have completed the class presentation andnow you must take the 20 question Final Test.

You must score at least 70%, which is 14 or morecorrect answers, to pass the test. If you do notpass the test, you will be redirected to take thetest again.

Proceed to the next slide to begin your Final Test.

Good Luck!


Completion

Congratulations on completing this online class for your RCFE Administrator Certification.

You are now are now readyto proceed to the nextsection, Part 2 of 10.


Documents

Initial RCFE Administrator Certification€¦ · and deserves to be punished preoccupation with health problems. Assisted Living Education 21 Poor Eating Habits o Vitamin B deficiencies