N.J. Admin. Code § 5:27-13.1 - Appropriate placement and care

(a) This subchapter shall not apply to cooperative sober living residences.

(b) A resident with a diagnosis of probable Alzheimer's disease, other dementia, or other cognitive impairments shall be transferred from a licensed Class C boarding home to a facility which offers a higher level of care, if the resident exhibits one or more of the following characteristics:

1. The resident is consistently and totally dependent in eating and toileting. "Consistently and totally dependent in eating" means being unable to swallow and/or requiring a feeding tube. "Consistently and totally dependent in toileting" means requiring a colostomy bag and/or catheter.

2. The resident is unable to self-administer medications (oral, topical, injectable) even when monitored; provided, however, that residents who are unable to self-administer medication shall be permitted to remain in the facility provided the facility owner or operator has a certified medication aide on-site, who is under the supervision of a registered nurse, full time.

3. The resident requires treatment of a stage two, three or four pressure sore.

4. The resident exhibits behaviors and/or has cognitive impairments of such severity as to be a danger to self or others.

5. The resident is in need of a therapeutic diet that cannot be accommodated at the facility and requires nursing monitoring. For example, monitoring of blood sugar, food and fluid intake, monitoring of skin integrity and possible dehydration.

6. The resident is in need of any type of feeding tube or other artificial feeding apparatus.

7. The resident is bed bound or requires repositioning due to his or her disease progression or due to a medically disabling condition.

(c) Each resident's weight shall be taken at least monthly at the facility and recorded appropriately. Weight information shall be provided to the assessing professional for quarterly review, in accordance with (g) below. If a resident loses more than five percent of his or her weight in a one-month period (and is not on a prescribed weight reduction plan), the facility must immediately notify the resident's attending physician.

(d) The provision of hospice services in a residence is permitted under the supervision of a home health agency (HHA) in accordance with 5:27-13.7 and with the development of a care plan by a registered nurse employed by the hospice service in conjunction with the residence Registered Nurse. The residence is responsible for the care plan implementation under the review of the Quality Assurance Nurse and with the assistance of the hospice service. (See 5:27-13.7(b).)

(e) Services such as those provided by a visiting nursing or home health aide agency are permitted for short term, intermittent nursing care only.

(f) Absent an emergency, physical or chemical restraints that are being used for the purpose of restricting a person's mobility within the facility are not permitted. Whenever a physical or chemical restraint is being considered for use in a facility, it must be approved in writing by the resident's attending physician with an accompanying rationale for use of same.

(g) Even if a resident has a "Do Not Resuscitate" (DNR) order, staff must call 911 for appropriate assistance in the event of an emergency, so that appropriate medical staff can assist the resident and act, if appropriate.

(h) Each resident shall be assessed prior to admission, by a physician, physician's assistant, registered professional nurse, or clinical nurse specialist/nurse practitioner licensed to practice in the State of New Jersey. The assessment shall be conducted in person, and a signed, original copy of the assessment report shall be kept on-site at the residence. The licensed professional who carries out this assessment shall be the person's personal health care professional and shall be financially independent of the residence.

(i) Prior to admission, and at least annually thereafter, the facility shall notify the resident and the resident's family, care giver, or responsible agency in writing of the transfer characteristics in (a) above.

(j) In the event the assessment determines that a transfer to a facility providing a higher level of care is required, the transferring facility shall:

1. Verbally notify the resident, the resident's family, care giver or responsible agency of the assessment results within 24 hours of completion, with written notification to follow within 72 hours of assessment completion;

2. In consultation with the resident and the resident's family, arrange for and/or assist in the orderly transfer of the resident within 15 days; this shall include facility assistance in seeking out and securing an appropriate placement for the resident; and

3. Arrange for the provision of all necessary services for the appropriate care of the resident until the resident is discharged.

Notes

N.J. Admin. Code § 5:27-13.1

Amended by 50 N.J.R. 310(a), effective 1/16/2018