(1) Abuse. The willful infliction of injury,
unreasonable confinement, intimidation or punishment with resulting physical
harm, pain or mental anguish.
Administrator. A person currently licensed as such by the Tennessee Board of
Examiners for Nursing Home Administrators.
(3) Adult. An individual who has capacity and
is at least 18 years of age.
Advance Directive. An individual instruction or a written statement relating to
the subsequent provision of health care for the individual, including, but not
limited to, a living will or a durable power of attorney for health
(5) Agent. An individual
designated in an advance directive for health care to make a health care
decision for the individual granting the power.
(6) Board. The Tennessee Board for Licensing
Health Care Facilities.
Capacity. An individual's ability to understand the significant benefits,
risks, and alternatives to proposed health care and to make and communicate a
health care decision. These regulations do not affect the right of a resident
to make health care decisions while having the capacity to do so. A resident
shall be presumed to have capacity to make a health care decision, to give or
revoke an advance directive, and to designate or disqualify a surrogate. Any
person who challenges the capacity of a resident shall have the burden of
proving lack of capacity.
Cardiopulmonary Resuscitation (CPR). The administering of any means or device
to restore or support cardiopulmonary functions in a resident, whether by
mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac
massage, tracheal intubation, manual or mechanical ventilations or
respirations, defibrillation, the administration of drugs and/or chemical
agents intended to restore cardiac and/or respiratory functions in a resident
where cardiac or respiratory arrest has occurred or is believed to be
(9) Certified Nurse Aide
or Certified Nursing Assistant. An individual who has successfully completed an
approved nursing assistant training program and is registered with the
(10) Clinical Fellow. A
Speech Language Pathologist who is in the process of obtaining his or her paid
professional experience, as defined by a Communications Disorders and Sciences
Board-approved accreditation agency, before being qualified for
(11) Commissioner. The
Commissioner of the Tennessee Department of Health or his or her authorized
(12) Competent. A
resident who has capacity.
Department. The Tennessee Department of Health.
(14) Designated Physician. A physician
designated by an individual or the individual's agent, guardian, or surrogate,
to have primary responsibility for the individual's health care or, in the
absence of a designation or if the designated physician is not reasonably
available, a physician who undertakes such responsibility.
(15) Dietitian. A person currently licensed
as such by the Tennessee Board of Dietitian/Nutritionist Examiners. Persons
exempt from licensure shall be registered with the American Dietetics
Association pursuant to T.C.A. §
(16) Director of Nursing (DON). A Registered
Nurse employed full time in a nursing home who satisfies the responsibilities
set forth in this chapter.
Do-Not-Resuscitate Order (DNR). A written order, other than a POST, not to
resuscitate a patient in cardiac or respiratory arrest in accordance with
accepted medical practices.
Emancipated Minor. Any minor who is or has been married or has by court order
or otherwise been freed from the care, custody and control of the minor's
(19) Emergency Responder.
A paid or volunteer firefighter, law enforcement officer, or other public
safety official or volunteer acting within the scope of his or her proper
function under law or rendering emergency care at the scene of an
(20) Guardian. A
judicially appointed guardian or conservator having authority to make a health
care decision for an individual.
(21) Hazardous Waste. Materials whose
handling, use, storage, and disposal are governed by local, state or federal
(22) Health Care. Any
care, treatment, service or procedure to maintain, diagnose, treat, or
otherwise affect an individual's physical or mental condition, and includes
medical care as defined in T.C.A. §
(23) Health Care Decision. Consent, refusal
of consent or withdrawal of consent to health care.
Health Care Decision-maker. In the case
of a resident who lacks capacity, the resident's health care decision-maker is
one of the following: the resident's health care agent as specified in an
advance directive, the resident's court-appointed guardian or conservator with
health care decision-making authority, the resident's surrogate as determined
pursuant to Rule
or T.C.A. §
the designated physician pursuant to these Rules or in the case of a minor
child, the person having custody or legal guardianship.
(25) Health Care Institution. A health care
institution as defined in T.C.A. §
(26) Health Care Provider. A person who is
licensed, certified or otherwise authorized or permitted by the laws of this
state to administer health care in the ordinary course of business or practice
of a profession.
(27) Hospital. Any
institution, place, building or agency represented and held out to the general
public as ready, willing and able to furnish care, accommodations, facilities
and equipment for the use, in connection with the services of a physician or
dentist, of one (1) or more nonrelated persons who may be suffering from
deformity, injury or disease or from any other condition for which nursing,
medical or surgical services would be appropriate for care, diagnosis or
The reception and care of any person for a continuous period longer than
twenty-four (24) hours, for the purpose of giving advice, diagnosis, nursing
service or treatment bearing on the physical health of such person, and
maternity care involving labor and delivery for any period of time.
(29) Incompetent. A resident who has been
adjudicated incompetent by a court of competent jurisdiction and has not been
restored to legal capacity.
Individual instruction. An individual's direction concerning a health care
decision for the individual.
Infectious Waste. Solid or liquid wastes which contain pathogens with
sufficient virulence and quantity such that exposure to the waste by a
susceptible host could result in an infectious disease.
(32) Involuntary Transfer. The movement of a
resident between nursing homes, without the consent of the resident, the
resident's legal guardian, next of kin or representative.
(33) Licensed Practical Nurse. A person
currently licensed as such by the Tennessee Board of Nursing.
(34) Licensee. The person or entity to whom
the license is issued. The licensee is held responsible for compliance with all
rules and regulations.
Threatening Or Serious Injury. Injury requiring the patient to undergo
significant additional diagnostic or treatment measures.
(36) Medical Director. A licensed physician
employed by the nursing home to be responsible for medical care in the
(37) Medical Emergency. A
medical condition manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical attention
could reasonably be expected to result in placing the resident's health in
serious jeopardy, serious impairment to bodily functions or serious dysfunction
of any bodily organ or part.
Medical Equipment. Equipment used for the diagnosis, treatment and monitoring
of patients, including, but not limited to, oxygen care equipment and oxygen
delivery systems, enteral and parenteral feeding pumps, and intravenous
(39) Medical Record. Medical
histories, records, reports, summaries, diagnoses, prognoses, records of
treatment and medication ordered and given, entries, x-rays, radiology
interpretations and other written, electronic, or graphic data prepared, kept,
made or maintained in a facility that pertains to confinement or services
rendered to residents.
Medically Inappropriate Treatment. Resuscitation efforts that cannot be
expected either to restore cardiac or respiratory function to the resident or
other medical or surgical treatments to achieve the expressed goals of the
informed resident. In the case of the incompetent resident, the resident's
representative expresses the goals of the resident.
(41) Misappropriation of Patient/Resident
Property. The deliberate misplacement, exploitation or wrongful, temporary or
permanent use of an individual's belongings or money without the individual's
(42) Neglect. The failure
to provide goods and services necessary to avoid physical harm, mental anguish
or mental illness; however, the withholding of authorization for or provision
of medical care to any terminally ill person who has executed an irrevocable
living will in accordance with the Tennessee Right to Natural Death Law, or
other applicable state law, if the provision of such medical care would
conflict with the terms of the living will, shall not be deemed "neglect" for
purposes of these rules.
The National Fire Protection Association.
(44) Nurse Aide or Nursing Assistant Training
Program. A specialized program approved by the Department to provide classroom
instruction and supervised clinical experience for individuals who wish to be
employed as Nurse Aides or Nursing Assistants.
(45) Nursing Personnel. Licensed nurses and
certified nurse aides who provide nursing care.
(46) Occupational Therapist. A person
currently licensed as such by the Tennessee Board of Occupational and Physical
(47) Person. An
individual, corporation, estate, trust, partnership, association, joint
venture, government, governmental subdivision, agency, or instrumentality, or
any other legal or commercial entity.
(48) Personally Informing. A communication by
any effective means from the resident directly to a health care
(49) Pharmacist. A person
currently licensed as such by the Tennessee Board of Pharmacy.
(50) Physical Therapist. A person currently
licensed as such by the Tennessee Board of Occupational and Physical Therapy
Assistant. A person who has graduated from a physician assistant educational
program accredited by the Accreditation Review Commission on Education for the
Physician Assistant, has passed the Physician Assistant National Certifying
Examination, and is currently licensed in Tennessee as a physician assistant
under title 63, chapter 19.
Physician Orders for Scope of Treatment or POST. Written orders that:
(a) Are on a form approved by the Board for
Licensing Health Care Facilities;
(b) Apply regardless of the treatment setting
and that are signed as required herein by the patient's physician, physician
assistant, nurse practitioner, or clinical nurse specialist; and
Specify whether, in the event the patient suffers cardiac or respiratory
arrest, cardiopulmonary resuscitation should or should not be
2. Specify other medical
interventions that are to be provided or withheld; or
3. Specify both 1 and 2.
(53) Physician. An individual
authorized to practice medicine or osteopathy under Tennessee Code Annotated,
Title 63, Chapters 6 or 9.
Podiatrist. A person currently licensed as such by the Tennessee Board of
Registration in Podiatry.
Power of Attorney for Health Care. The designation of an agent to make health
care decisions for the individual granting the power under T.C.A. Title 34,
Chapter 6, Part 2.
Coordinator. A registered nurse who possesses a minimum of two years nursing
experience with at least one year in long term care and is responsible for
ensuring that the requirements of the Nurse Aide Training Program are
(57) Qualified Emergency
Medical Service Personnel. Includes, but shall not be limited to, emergency
medical technicians, paramedics, or other emergency services personnel,
providers, or entities acting within the usual course of their professions, and
other emergency responders.
Reasonably Available. Readily able to be contacted without undue effort and
willing and able to act in a timely manner considering the urgency of the
resident's health care needs. Such availability shall include, but not be
limited to, availability by telephone.
(59) Registered Nurse. A person currently
licensed as such by the Tennessee Board of Nursing.
(60) Resident/Patient. Includes but is not
limited to any person who is suffering from an illness or injury and who is in
need of nursing care.
Unit. A facility or distinct part of a facility where residents are
intentionally denied egress by any means.
(62) Shall or Must. Compliance is
Social Worker. In a
facility with more than 120 beds a qualified social worker is an individual
(a) A bachelor's degree in social work
or a bachelor's degree in a human services field including but not limited to
sociology, special education, rehabilitation counseling, and psychology;
(b) One year of supervised
social work experience in a health care setting working directly with
Language Pathologist. As defined in T.C.A. §
person currently licensed as such by the Tennessee Board of Communications
Disorders and Sciences.
A state of the United States, the District of Columbia, the Commonwealth of
Puerto Rico, or a territory or insular possession subject to the jurisdiction
of the United States.
A person currently enrolled in a course of study that is approved by the
appropriate licensing board.
Supervising Health Care Provider. The designated physician or, if there is no
designated physician or the designated physician is not reasonably available,
the health care provider who has undertaken primary responsibility for an
individual's health care.
Surrogate. An individual, other than a resident's agent or guardian, authorized
to make a health care decision for the resident.
(69) Survey. An on-site examination by the
department to determine the quality of care and/or services provided.
(70) Transfer. The movement of a resident
between nursing homes at the direction of a physician or other qualified
medical personnel when a physician is not readily available. The term does not
include movement of a resident who leaves the facility against medical advice.
The term does not apply to the commitment and movement of mentally ill and
mentally retarded persons, the discharge or release of a resident no longer in
need of nursing home care, or a nursing home's refusal, after an appropriate
medical screening, to render any medical care on the grounds that the person
does not have a medical need for nursing home care.
(71) Treating Health Care Provider. A health
care provider who at the time is directly or indirectly involved in providing
health care to the resident.
Treating Physician. The physician selected by or assigned to the resident and
who has the primary responsibility for the treatment and care of the resident.
Where more than one physician shares such responsibility, any such physician
may be deemed to be the "treating physician."