Iowa Admin. Code r. 481-58.39 - Residents' rights in general
(1) Each
facility shall ensure that policies and procedures are written and implemented
which include, at a minimum, all of the following provisions (subrules 58.39(2)
to 58.39(6)) and which govern all areas of service provided by the facility.
These policies and procedures shall be available to staff, residents, their
families or legal representatives and the public and shall be reviewed
annually. (II)
(2) Policies and
procedures shall address the admission and retention of persons with histories
of dangerous or disturbing behavior. For the purposes of the subrule, persons
with histories of dangerous or disturbing behavior are those persons who have
been found to be seriously mentally impaired pursuant to Iowa Code section
229.13 within six months of the
request for admission to the facility. In addition to establishing the criteria
for admission and retention of persons so defined, the policies and procedures
shall provide for:
a. Reasonable precautions
to prevent the resident from harming self, other residents, or employees of the
facility.
b. Treatment of persons
with mental illness as defined in Iowa Code section
229.1(1) and
which is provided in accordance with the individualized health care
plan.
c. Ongoing and documented
staff training on individualized health care planning for persons with mental
illness.
(3) Policies and
procedures regarding the admission, transfer, and discharge of residents shall
ensure that:
a. Only those persons are
accepted whose needs can be met by the facility directly or in cooperation with
community resources or other providers of care with which it is affiliated or
has contracts. (II)
b. As changes
occur in residents' physical or mental condition, necessitating services or
care which cannot be adequately provided by the facility, they are transferred
promptly to other appropriate facilities. (II)
(4) Policies and procedures regarding the use of
chemical and physical restraints shall define the use of said restraints and
identify the individual who may authorize the application of physical
restraints in emergencies, and describe the mechanism for monitoring and
controlling their use. (II)
(5)
Policies and procedures shall include a method for submitting complaints and
recommendations by residents or their responsible party and for ensuring a
response and disposition by the facility. (II)
(6) Policies and procedures shall include provisions
governing access to, duplication of, and dissemination of information from the
residents' records. (II)
(7)
Policies and procedures shall include a provision that each resident shall be
fully informed of the resident's rights and responsibilities as a resident and
of all rules governing resident conduct and responsibilities. This information
must be provided upon admission, or in the case of residents already in the
facility, upon the facility's adoption or amendment of residents' rights
policies. (II)
a. The facility shall make
known to residents what they may expect from the facility and its staff, and
what is expected from them. The facility shall communicate these expectations
during the period of not more than two weeks before or five days after
admission. The communication shall be in writing, e.g., in a separate handout
or brochure describing the facility, and interpreted verbally, e.g., as part of
a preadmission interview, resident counseling, or in individual or group
orientation sessions following admission. (II)
b. Residents' rights and responsibilities shall be
presented in language understandable to the resident. If the facility serves
residents who are non-English speaking or deaf or hard of hearing, steps shall
be taken to translate the information into a foreign or sign language. In the
case of blind residents, either Braille or a recording shall be provided.
Residents shall be encouraged to ask questions about their rights and
responsibilities and these questions shall be answered. (II)
c. A statement shall be signed by the
resident, or the resident's responsible party , indicating an understanding of
these rights and responsibilities, and shall be maintained in the record. The
statement shall be signed no later than five days after admission, and a copy
of the signed statement shall be given to the resident or responsible party , if
applicable. In the case of an intellectually disabled resident, the signature
shall be witnessed by a person not associated with or employed by the facility.
The witness may be a parent, guardian, Medicaid agency representative, etc.
(II)
d. In order to ensure that
residents continue to be aware of these rights and responsibilities during
their stay, a written copy shall be prominently posted in a location that is
available to all residents. (II)
e.
All residents shall be advised within 30 days following changes made in the
statement of residents' rights and responsibilities. Appropriate means shall be
utilized to inform non-English speaking, deaf or hard-of-hearing, or blind
residents of such changes. (II)
(8) Each resident or responsible party shall be fully
informed in a contract as required in rule
481-58.13 (135C), prior to or at
the time of admission and during the resident's stay, of services available in
the facility, and of related charges including any charges for services not
covered under the Title XIX program or not covered by the facility's basic per
diem rate . (II)
(9) Each resident
or responsible party shall be fully informed by a physician of the resident's
health and medical condition unless medically contraindicated (as documented by
a physician in the resident's record). Each resident shall be afforded the
opportunity to participate in the planning of the resident's total care and
medical treatment, which may include, but is not limited to, nursing care,
nutritional care, rehabilitation, restorative therapies, activities, and social
work services. Each resident only participates in experimental research
conducted under the U.S. Department of Health and Human Services' protection
from research risks policy and then only upon the resident's informed written
consent. Each resident has the right to refuse treatment except as provided by
Iowa Code chapter 229. In the case of a confused or intellectually disabled
individual, the responsible party shall be informed by the physician of the
resident's medical condition and be afforded the opportunity to participate in
the planning of the resident's total care and medical treatment, to be informed
of the medical condition, and to refuse to participate in experimental
research. (II)
a. The requirement that
residents shall be informed of their conditions, involved in the planning of
their care, and advised of any significant changes in either shall be
communicated to every physician responsible for the medical care of residents
in the facility. (II)
b. The
administrator or designee shall be responsible for working with attending
physicians in the implementation of this requirement. (II)
c. If the physician determines or in the case of a
confused or intellectually disabled resident the responsible party determines
that informing the resident of the resident's condition is contraindicated,
this decision and reasons for it shall be documented in the resident's record
by the physician. (II)
d. The
resident's plan of care shall be based, in part, on the physician's orders. It
shall be developed upon admission by appropriate facility staff and shall
include participation by the resident if capable. Residents shall be advised of
alternative courses of care and treatment and their consequences when such
alternatives are available. The resident's preference about alternatives shall
be elicited and honored if feasible.
e. Any clinical investigation involving residents must
be under the sponsorship of an institution with a human subjects review board
functioning in accordance with the requirements of 45 CFR 46 . A resident being
considered for participation in experimental research must be fully informed of
the nature of the experiment, e.g., medication , treatment, and understand the
possible consequences of participating or not participating. The resident's (or
responsible party 's) written informed consent must be received prior to
participation. (II)
This rule is intended to implement Iowa Code section 135C.23(2).
Notes
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