19 CSR 30-83.010 - Definition of Terms
PURPOSE: This rule defines terms used in the rules for long-term care facilities as set forth in chapters 19 CSR 30-85, 19 CSR 30-86, 19 CSR 30-87, and 19 CSR 30-88.
(1) Activities of daily living (ADL) -Shall
mean one (1) or more of the following:
(A)
Eating;
(B) Dressing;
(C) Bathing;
(D) Toileting;
(E) Transferring; and
(F) Walking.
(2) Administrator -Shall mean an individual
person who is in general administrative charge of a facility .
(3) Assisted living facility (ALF) -Shall mean
any premises , other than a residential care facility , intermediate care
facility , or skilled nursing care facility , that is utilized by its owner,
operator , or manager to provide twenty-four (24) hour care and services and
protective oversight to three (3) or more residents who are provided with
shelter, board, and who may need and are provided with the following:
(A) Assistance with any activities of daily
living and any instrumental activities of daily living;
(B) Storage, distribution or administration
of medications; and
(C) Supervision
of health care under the direction of a licensed physician , provided that such
services are consistent with a social model of care.
(D) The term "assisted living facility " does
not include a facility where all of the residents are related within the fourth
degree of consanguinity or affinity to the owner, operator , or manager of the
facility .
(4) Automated
dispensing system -Shall mean a mechanical system that performs functions that
may include, but are not limited to, storing, packaging or dispensing
medications, and that collects, controls and maintains all transaction
information.
(5)
Certified-medication technician -Shall mean a nursing assistant who has
completed a course in medication administration approved by the Department of
Health and Senior Services.
(6)
Chemical restraint -Shall mean a psychopharmacologic medication that is used for
discipline or convenience and not required to treat medical symptoms.
(7) Communicable disease-Any illness, disease
or condition reportable to the Missouri Department of Health and Senior
Services as required by
19 CSR
20-20.010 and
19 CSR
20-20.020 is considered, for the context of these
rules, a communicable disease.
(8)
Community based assessment -Shall mean documented basic information and analysis
provided by appropriately trained and qualified individuals describing an
individual's abilities and needs in activities of daily living, instrumental
activities of daily living, vision/hearing, nutrition, social participation and
support, and cognitive functioning using an assessment tool approved by the
Department of Health and Senior Services (the department ), that is designed for
community based services and that is not the nursing home minimum data set. The
assessment tool may be one developed by the department or one used by a
facility which has been approved by the department .
(9) Control of medication -Shall mean assuming
responsibility by the facility for all facets of control of medication
including, but not limited to, acquisition, storage, security and
administration.
(10)
Convenience -Shall mean any action taken by the facility to control resident
behavior or maintain residents with a lesser amount of effort by the facility
and not in the resident's best interest.
(11) Dementia -Shall mean a general term for
the loss of thinking, remembering, and reasoning so severe that it interferes
with an individual's daily functioning, and may cause symptoms that include
changes in personality, mood, and behavior.
(12) Designee -Shall mean an individual who
has been designated in writing by a resident to handle matters and receive
reports related to his/her personal possessions and property.
(13) Discipline -Shall mean any action taken
by the facility for the purpose of punishing or penalizing residents.
(14) Emergency medical procedure -Shall mean
those written policies and procedures which describe the types and degrees of
accidents and injuries, how they will be treated, by whom, in which instances
the resident's physician will be notified and how quickly.
(15) Emergency medication supply -Shall mean
a limited number of dosage units of prescription medications that may be
administered to a resident in an emergency situation or for initial doses of a
necessary medication when a pharmacy cannot provide a prescription for a
resident within a reasonable time based on the resident's clinical needs at the
time.
(16) Existing or existing
licensed facility - Shall mean a long-term care facility which was licensed and
in operation or one whose plans were approved prior to June 10, 1981 for a
skilled or intermediate care facility or prior to November 13, 1980 for
residential care facilities and assisted living facilities except as otherwise
indicated in 19 CSR 30-86.012,
19 CSR
30-86.022 and
19 CSR
30-86.032.
(17) Exit -Shall mean a door leading to the
outside or through a horizontal exit in a fire wall to a fire-safe area in the
building.
(18) Facility -Shall mean
any residential care facility , assisted living facility , intermediate care
facility or skilled nursing facility licensed by the department .
(19) Fire-resistant construction-For
intermediate care facilities and skilled nursing facilities, fire-resistant
construction shall mean that a facility meets the specifications for Type II
(222) or Type II (111) construction as given in the
National Fire
Protection Association Code 220 . Fire-resistant construction for
residential care facilities and assisted living facilities is defined in
19 CSR
30-86.022.
(20) Hazardous area -Shall mean furnace rooms
other than electric forced air furnaces, laundries, kitchens, maintenance shops
and storage rooms of over one hundred (100) square feet and any areas which
contain combustible materials which will be either easily ignited, burn with an
intense flame or result in the production of dense smoke and fumes.
(21) Home-like-means a self-contained
long-term care setting that integrates the psychosocial, organizational and
environmental qualities that are associated with being at home. Home-like may
include, but is not limited, to the following:
(A) A living room and common use areas for
social interactions and activities;
(B) Kitchen and family style eating area for
use by the residents;
(C) Laundry
area for use by residents;
(D) A
toilet room that contains a toilet, lavatory and bathing unit in each
resident's room;
(E) Resident room
preferences for residents who wish to share a room, and for residents who wish
to have private bedrooms;
(F)
Outdoor area for outdoor activities and recreation; and
(G) A place where residents can give and
receive affection, explore their interests, exercise control over their
environment, engage in interactions with others and have privacy, security,
familiarity and a sense of belonging.
(22) Individualized service plan (ISP) -Shall
mean the planning document prepared by an assisted living facility which
outlines a resident's needs and preferences, services to be provided, and the
goals expected by the resident or the resident's legal representative in
partnership with the facility .
(23)
Instrumental activities of daily living (IADL) -Shall mean one (1) or more of
the following activities:
(A) Preparing
meals;
(B) Shopping for personal
items;
(C) Medication
management;
(D) Managing
money;
(E) Using the
telephone;
(F) Housework;
and
(G) Transportation
ability.
(24)
Intermediate care facility -Shall mean any premises , other than a residential
care facility , assisted living facility , or skilled nursing facility , which is
utilized by its owner, operator , or manager to provide twenty-four (24) hour
accommodation, board, personal care, and basic health and nursing care services
under the daily supervision of a licensed nurse and under the direction of a
licensed physician to three (3) or more residents dependent for care and
supervision and who are not related within the fourth degree of consanguinity
or affinity to the owner, operator or manager of the facility .
(25) Involuntary seclusion -Shall mean
separation of a resident from other residents or from her/his room or
confinement to her/his room (with or without roommates) against the resident's
will, or the will of the resident's legal representative. Emergency or short
term monitored separation from other residents will not be considered
involuntary seclusion and may be permitted if used for a limited period of time
as a therapeutic intervention to reduce agitation until professional staff can
develop a plan of care to meet the resident's needs.
(26) Keeping residents in place -Shall mean
maintaining residents in place during a fire in lieu of evacuation where a
building's occupants are not capable of evacuation, where evacuation has a low
likelihood of success, or where it is recommended in writing by local fire
officials as having a better likelihood of success and/or lower risk of
injury.
(27) Level I medication
aide -Shall mean an individual who has completed a course approved by the
department in medication administration in a residential care facility or
assisted living facility .
(28)
Long-term care facility -Shall mean a facility that is licensed either solely or
in combination as a skilled nursing facility , an intermediate care facility , a
residential care facility , or assisted living facility .
(29) Long-term care services -Shall mean the
assistance and support that a resident receives in a residential care facility ,
assisted living facility , intermediate care facility , and skilled nursing care
facility , to meet the resident's individual need for nursing care, protective
oversight , monitoring, medication management, social interactions, cooking,
housekeeping, laundry, and recreational activities.
(30) Major fraction thereof -Shall mean
anything over fifty percent (50%) of the number of occupied beds.
(31) Major remodeling -Shall mean any
remodeling of a long-term care facility which involves the addition of
resident-use rooms, which affects fire safety or the structure of the
building.
(32) Multistory
building -Shall mean any building with more than one (1) floor entirely above
the grade. A floor that is partially below grade will be counted as the first
story to determine sprinkler requirements only if it contains resident sleeping
rooms.
(33) New or newly licensed
facility -Shall mean a long-term care facility whose plans are approved or which
is licensed after June 10, 1981 for a skilled nursing or intermediate care
facility or after November 13, 1980 for residential care facility or assisted
living facility except as otherwise indicated in
19 CSR
30-86.012,
19 CSR
30-86.022, and
19 CSR
30-86.032.
(34) Nursing personnel-Shall include any
employee, including a nurse's aide or an orderly, who provides or assists in
the provision of direct resident health care services.
(35) Operator -Shall mean any person licensed
or required to be licensed under the provisions of sections 198.003-198.096,
RSMo, in order to establish, conduct, or maintain a facility . The term person
required to be licensed shall mean any person having the following, as
determined by the department :
(A) Ultimate
responsibility for making and implementing decisions regarding the operation of
the facility ;
(B) Ultimate
financial control of the operation of a facility ; and
(C) Legal right to possession of the premises
on which a facility is located.
(36) Person -Shall mean any individual, or any
entity, including, but not limited to, a corporation, limited liability
company, partnership, association, nonprofit organization, fraternal
organization, church, or political subdivision of the state of
Missouri.
(37) Physical
restraint -Shall mean any manual method or physical or mechanical device,
material or equipment attached to or adjacent to the resident's body that the
individual cannot remove easily which restricts freedom of movement or normal
access to one's body. Physical restraints include, but are not limited to, leg
restraints, arm restraints, hand mitts, soft ties or vests, lap cushions, and
lap trays the resident cannot remove easily. Physical restraints also include
facility practices that meet the definition of a restraint, such as the
following:
(A) Using side rails that keep a
resident from voluntarily getting out of bed;
(B) Tucking in or using Velcro to hold a
sheet, fabric, or clothing tightly so that a resident's movement is
restricted;
(C) Using devices in
conjunction with a chair, such as trays, tables, bars, or belts, that the
resident cannot remove easily, that prevent the resident from rising;
(D) Placing the resident in a chair that
prevents a resident from rising; and
(E) Placing a chair or bed so close to a wall
that the wall prevents the resident from rising out of the chair or voluntarily
getting out of bed.
(38)
Physician -Shall mean an individual licensed to practice medicine in the state
of Missouri under Chapter 334, RSMo.
(39) Premises -Shall mean any structures that
are in close proximity one to the other and which are located on a single piece
of property.
(40) Protective
oversight -Shall mean an awareness twenty-four (24) hours a day of the location
of a resident, the ability to intervene on behalf of the resident, supervision
of nutrition, medication, or actual provisions of care, and the responsibility
for the welfare of the resident, except where the resident is on voluntary
leave .
(41) Qualified
dietitian -Shall mean an individual who is registered by the American Dietetic
Association or who is eligible for registration.
(42) Qualified therapist -Shall mean an
individual who is either registered or is eligible for registration by the
national accrediting association for that therapy or, if applicable, is
licensed by the state of Missouri for the practice of the profession in which
s/he is engaged.
(43) Qualified
therapy assistant -Shall mean an individual who would be qualified as an
occupational therapy or physical therapist assistant as outlined in 42 CFR
484.4.
(44) Residential care
facility (RCF) -Shall mean any premises , other than an assisted living facility ,
intermediate care facility , or skilled nursing facility , which is utilized by
its owner, operator , or manager to provide twenty-four (24) hour care to three
(3) or more residents, who are not related within the fourth degree of
consanguinity or affinity to the owner, operator , or manager of the facility
and who need or are provided with shelter, board, and with protective
oversight , which may include storage and distribution or administration of
medications and care during short-term illness or recuperation, except that,
for purposes of eligible residents of facilities formerly licensed as
residential care facilities II receiving supplemental welfare assistance
payments, any residential care facility that was licensed as a residential care
facility II on or before August 27, 2006 that continues to meet the licensure
standards for a residential care facility II in effect on August 27, 2006 shall
be considered a residential care facility II for purposes of its eligible
residents receiving the cash grant payment amount allocated immediately prior
to August 28, 2006 for residents of a residential care facility II pursuant to
section 208.030, RSMo.
(45) Responsible party -Shall mean an
individual who has been designated in writing by the resident to handle matters
and receive reports related to his/her general condition.
(46) Self-administration of medication -Shall
mean the act of actually taking or applying medication to oneself.
(47) Self-control of medication -Shall mean
assuming immediate responsibility by a resident for the storage and
administration of medication for oneself while the facility retains ultimate
control of medication .
(48) Skilled
nursing care -Shall mean services furnished pursuant to physicians' orders which
require the skills of licensed nurses and which are provided directly by or
under the on-site supervision of these personnel. Examples of skilled nursing
care may include, but are not limited to: administration of levine tube or
gastrostomy tube feedings; nasopharyngeal and tracheotomy aspiration; insertion
of medicated or sterile irrigation solutions and replacement of catheters;
administration of parenteral fluids; inhalation therapy treatments;
administration of other treatments requiring aseptic technique; and
administration of injectable medication other than insulin.
(49) Skilled nursing facility -Shall mean any
premises , other than a residential care facility , assisted living facility , or
an intermediate care facility , which is utilized by its owner, operator , or
manager to provide for twenty-four (24) hour accommodation, board and skilled
nursing care and treatment services to at least three (3) residents who are not
related within the fourth degree of consanguinity or affinity to the owner,
operator , or manager of the facility . Skilled nursing care and treatment
services are those services commonly performed by or under the supervision of a
registered professional nurse for individuals requiring twenty-four (24) hours
a day care by licensed nursing personnel including acts of observation, care,
and counsel of the aged, ill, injured, or infirm, the administration of
medications and treatments as prescribed by a licensed physician or dentist,
and other nursing functions requiring substantial specialized judgment and
skill.
(50) Social model of
care-means long-term care services based on the abilities, desires, and
functional needs of the individual delivered in a setting that is more
home-like than institutional, that promote the dignity, individuality, privacy,
independence, and autonomy of the individual, that respects residents'
differences and promotes residents' choices.
(51) Voluntary leave -Shall mean an
off-premises leave initiated by:
a) a
resident that has not been declared mentally incompetent or incapacitated by a
court; or
b) a legal guardian of a
resident that has been declared mentally incompetent or incapacitated by a
court.
(52) Vulnerable
person -Shall mean any person in the custody, care, or control of the Department
of Mental Health that is receiving services from an operated, funded, licensed,
or certified program.
Notes
*Original authority: 198.009, RSMo 1979, amended 1993, 1995 and 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007.
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