Tenn. Comp. R. & Regs. 0720-26-.08 - ADMISSIONS, DISCHARGES, AND TRANSFERS
(1) An ACLF shall
not admit or permit the continued stay of any ACLF resident who has any of the
following conditions:
(a) Requires treatment
for stage III or stage IV decubitus ulcers or with exfoliative
dermatitis;
(b) Requires continuous
nursing care;
(c) Has an active,
infectious and reportable disease in a communicable state that requires contact
isolation;
(d) Exhibits verbal or
physical aggressive behavior which poses an imminent physical threat to self or
others, based on behavior, not diagnosis;
(e) Requires physical or chemical restraints,
not including psychotropic medications for a manageable mental disorder or
condition; or
(f) Has needs that
cannot be safely and effectively met in the ACLF.
(2) An ACLF resident shall be discharged and
transferred to another appropriate setting such as home, a hospital, or a
nursing home when the resident, the resident's legal representative, ACLF
administrator, or the resident's treating physician determine that the ACLF
cannot safely and effectively meet the resident's needs, including medical
services.
(a) The Board may require that an
ACLF resident be discharged or transferred to another level of care if it
determines that the resident's needs, including medical services, cannot be
safely and effectively met in the ACLF.
(3) Except for the limitations set forth in
(4)(a) and (4)(b) of this rule, an ACLF may admit and permit the continued stay
of an individual meeting the level of care requirement for nursing facility
services, if:
(a) The resident's treating
physician certifies in writing that the resident's needs, including medical
services, can be safely and effectively met by care provided in the ACLF;
and
(b) The ACLF can provide
assurances that the resident can be timely evacuated in case of fire or
emergency.
(4) An ACLF
shall not admit, but may permit the continued stay of residents who require:
(a) The following treatments on an
intermittent basis of up to three (3) twenty-one (21) day periods. The
resident's treating physician must certify that treatment can be safely and
effectively provided by the ACLF for the last two (2) twenty-one (21) day
periods.
1. Nasopharyngeal or tracheotomy
aspiration;
2. Nasogastric
feedings;
3. Gastrostomy feedings;
or
4. Intravenous therapy or
intravenous feedings.
(b)
The treatments described in parts (1)-(4) above can be provided on an on-going
basis if:
1. The resident is receiving
hospice services;
2. The resident
does not qualify for nursing facility level care and the board grants a waiver;
or
3. The resident is able to care
for the specified conditions without assistance of facility personnel or other
appropriately licensed entity. Such a resident may be admitted or permitted to
continue as a resident of the ACLF.
(5) An ACLF resident qualifying for hospice
care shall be able to receive hospice care services and continue as a resident
if the resident's treating physician certifies that such care can be
appropriately provided in the ACLF.
(a) In the
event that the resident is able to receive hospice services in an ACLF, the
resident's hospice provider and the ACLF shall be jointly responsible for a
plan of care that is prepared pursuant to current hospice guidelines
promulgated by the Centers for Medicaid and Medicare and ensures both the
safety and well-being of the resident's living environment and provision of the
resident's health care needs.
(b)
The hospice provider shall be available to assess, plan, monitor, direct and
evaluate the resident's palliative care with the resident's treating physician
and in cooperation with the ACLF.
(6) An ACLF shall:
(a) Be able to identify at the time of
admission and during continued stay those residents whose needs for services
are consistent with these rules and regulations, and those residents who should
be transferred to a higher level of care;
(b) Have a written admission agreement that
includes a procedure for handling the transfer or discharge of residents and
that does not violate the residents' rights under the law or these
rules;
(c) Have an accurate written
statement regarding fees and services which will be provided residents upon
admission;
(d) Give a thirty (30)
day notice to all residents before making any changes in fee
schedules;
(e) Ensure that
residents see a physician for acute illness or injury and are transferred in
accordance with any physician's orders;
(f) Provide to each resident at the time of
admission a copy of the resident's rights for the resident's review and
signature;
(g) Have written
policies and procedures to assist residents in the proper development, filing,
modification and rescission of an advance directive, a living will, a
do-not-resuscitate order, and the appointment of a durable power of attorney
for health care;
(h) Prior to the
admission of a resident or prior to the execution of a contract for the care of
a resident (whichever occurs first), each ACLF shall disclose in writing to the
resident or to the resident's legal representative, whether the ACLF has
liability insurance and the identity of the primary insurance carrier. If the
ACLF is self-insured, its statement shall reflect that fact and indicate the
corporate entity responsible for payment of any claims;
(i) Document evidence of annual vaccination
against influenza for each resident, in accordance with the recommendation of
the Advisory Committee on Immunization Practices of the Centers for Disease
Control most recent to the time of vaccine, unless such vaccination is
medically contraindicated or the resident has refused the vaccine. Influenza
vaccination for all residents accepting the vaccine shall be completed by
November 30 of each year or within ten (10) days of the vaccine becoming
available. Residents admitted after this date during the flu season and up to
February 1, shall as medically appropriate, receive influenza vaccination prior
to or on admission unless refused by the resident; and
(j) Document evidence of vaccination against
pneumococcal disease for all residents who are sixty-five (65) years of age or
older, in accordance with the recommendations of the Advisory Committee on
Immunization Practices of the Centers for Disease Control at the time of
vaccination, unless such vaccination is medically contraindicated or the
resident has refused offer of the vaccine. The facility shall provide or
arrange the pneumococcal vaccination of residents who have not received this
immunization prior to or on admission unless the resident refuses offer of the
vaccine.
(k) Prior to the admission
of a resident or prior to the execution of a contract for the care of a
resident (whichever occurs first), each ACLF shall disclose in writing to the
resident or to the resident's legal representative a copy of the medication
disposal policy, which shall be written in accordance with current FDA or
current DEA medication disposal guidelines.
(7) An ACLF shall have documented plans and
procedures to show evacuation of all residents.
(8) An ACLF may not retain a resident who
cannot evacuate within thirteen (13) minutes unless the ACLF complies with
Chapter 19 of the 2006 edition of the NFPA Life Safety Code, and the
Institutional Unrestrained Occupancy of the 2006 edition of the International
Building Code.
(9) An ACLF
utilizing secured units shall provide survey staff with twelve (12) months of
the following performance information specific to the secured unit and its
residents at its annual survey:
(a)
Documentation that an interdisciplinary team consisting of at least a
physician, a registered nurse, and a family member (or patient care advocate)
has evaluated each secured resident prior to admittance to the unit;
(b) Ongoing and up-to-date documentation that
each resident's interdisciplinary team has performed a quarterly review as to
the appropriateness of placement in the secured unit;
(c) A current listing of the number of deaths
and hospitalizations, with diagnoses, that have occurred on the unit;
(d) A current listing of all unusual
incidents and/or complications on the unit;
(e) An up-to-date staffing pattern and staff
ratios for the unit that is recorded on a daily basis. The staffing pattern
must ensure that there is a minimum of one (1) attendant, awake, on duty, and
physically located on the unit twenty-four (24) hours per day, seven (7) days
per week, at all times;
(f) A
formulated calendar of daily group activities scheduled, including a resident
attendance record for the previous three (3) months;
(g) An up-to-date listing of any incidences
of decubitus and/or nosocomial infections, including resident identifiers;
and
(h) Documentation showing that
100% of the staff working on the unit receives annual inservice training which
shall include, but not be limited to, the following subject areas:
1. Basic facts about the causes, progression
and management of Alzheimer's disease and related disorders;
2. Dealing with dysfunctional behavior and
catastrophic reactions in the residents;
3. Identifying and alleviating safety risks
to the resident;
4. Providing
assistance in the activities of daily living for the resident; and
5. Communicating with families and other
persons interested in the resident.
Notes
Authority: T.C.A. ยงยง 4-5-202, 4-5-204, 68-11-201(5), 68-11-202, 68-11-204, 68-11-206, 68-11-209, 68-11-211, 68-11-263, and 68-11-266.
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