(a) This subchapter
shall not apply to cooperative sober living residences.
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
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.
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
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
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
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.
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.
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.
In the event the assessment determines
that a transfer to a facility providing a higher level of care is required, the
transferring facility shall
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