13-005 Code Vt. R. 13-110-005-X - LICENSING AND OPERATING RULES FOR NURSING HOMES
It is the purpose of these rules to implement state and federal law governing the licensing, operation, and standard of care in nursing homes, also referred to in these rules as "nursing facilities" or "facilities", located in the State of Vermont. Compliance with these rules will help each resident attain or maintain the highest practicable physical, mental and psychosocial well-being in accordance with a comprehensive assessment and plan of care and prevailing standards of care and will promote a standard of care that assures that the ability of each resident to perform activities of daily living does not diminish unless the resident's ability is diminished solely as a result of a change in the resident's clinical condition.
These rules are promulgated pursuant to 33 V.S.A. § 7117 to implement the provisions of 33 V.S.A. Chapters 71 and 73, 18 V.S.A. Chapter 221, 18 V.S.A. Chapter 231, 42 U.S.C. §§ 13951-3 and 1396r, and 42 C.F.R. Part 483, Subpart B.
A determination that any provision or application of any provision of these rules is invalid shall not affect the validity of any other provision of these rules or its applicability.
These rules are effective June 1, 2018.
The words and phrases listed below, as used in these regulations, have the following meanings, unless otherwise specifically provided:
Application for a license shall be made to the licensing agency upon the prescribed forms and shall include the following information:
Before licensing a nursing home, the licensing agency shall inspect the facility.
The following reports must be filed with the licensing agency:
It is the duty of all members of the nursing home staff to ensure that every resident under their care is accorded all rights set out in Sections 3 and 4.
The resident shall have the right to choose his or her own personal physicians, and the right to request and receive a second opinion from a physician of the resident's choice where significant alternatives for care or treatment exist, or when the resident requests information concerning care or treatment alternatives, the resident shall receive such information from his or her doctor or the administrator, as appropriate.
Residents are not required to perform services for the facility that are not included for therapeutic purposes in his or her plan of care.
An individual resident may self-administer drugs if the interdisciplinary team has determined that this practice is safe.
A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life.
Each resident shall be treated with consideration, respect, and full recognition of his or her dignity and individuality, including privacy in treatment and in care of his or her personal needs. The resident shall have the exclusive right to use and enjoy his or her property, and such property shall not be used by other residents or staff without the express permission of the resident.
The resident has the right to:
Each resident shall be encouraged and assisted, throughout his or her period of stay, to exercise his or her rights as a resident and as a citizen and to this end may voice grievances and recommend changes in policies and services to facility staff or to outside representatives of his or her choice, free from restraint, interference, coercion, discrimination or reprisal.
A resident has the right, at his or her discretion, to participate in social, religious and community activities that do not interfere with the rights of other residents in the facility.
A nursing home must provide:
The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity.
At the time each resident is admitted, the facility must have physician orders for the resident's immediate care.
The services provided or arranged by the facility must:
When a discharge is anticipated, a facility must prepare for the resident a discharge summary that includes:
Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
Based on the comprehensive assessment of a resident, the facility must ensure that:
To ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the resident:
Based on the comprehensive assessment of a resident, the facility must ensure that:
Based on the resident's comprehensive assessment, the facility must ensure that:
Based on the comprehensive assessment of a resident, the facility must ensure that:
Based on the comprehensive assessment of a resident, the facility must ensure that:
Based on the comprehensive assessment of a resident, the facility must ensure that:
The facility must ensure that:
Based on a resident's comprehensive assessment, the facility must ensure that a resident:
The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.
The facility must ensure that residents receive proper treatment and care for the following special services:
The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care or as specified by the licensing agency.
The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.
A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician.
The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in section 11.2. All drugs must be administered in conformance with the requirements of 18 V.S.A. Chapter 84.
The facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel, and the public.
The facility must:
Each resident room must be equipped with or located near toilet facilities.
The nurses' station must be equipped to receive resident calls through a communication system from:
The facility must provide one or more rooms designated for resident dining and activities. These rooms must:
The facility must provide a safe, functional, sanitary and comfortable environment for residents, staff and the public. The facility must:
The facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well being of each resident.
General Rule. A facility must not use an individual working in the facility as a nurse aide for more than four (4) months, on a full-time basis, unless that individual:
A facility must not use on a temporary, per diem, leased or any basis other than a permanent employee any individual who does not meet the requirements in Section 10. 1.
A facility must not use any individual who has worked less than four (4) months as a nurse aide in that facility unless the individual:
If, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of twenty-four (24) consecutive months during none of which the individual provided nursing or nursing-related services for monetary compensation, the individual must complete a new training and competency evaluation program or a new competency evaluation program.
The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments and described in the plan of care.
Individuals providing specialized services to residents with developmental disabilities do not meet the definition of a nurse aide.
The facility must employ on a full-time, part-time or consultant basis those professionals necessary to carry out the provisions of these rules.
Professional staff must be licensed, certified, or registered in accordance with applicable laws.
The facility must keep confidential all information contained in the resident's records, regardless of the form or storage method of the records, except when release is required by:
The clinical record must contain:
The facility must have detailed written plans and procedures, approved by the Department of Public Safety, to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents.
The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures. Procedures shall include:
The facility must have in effect a written transfer agreement with one or more hospitals approved for participation under the Medicare and Medicaid programs that reasonably assures that:
The State may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this section.
Good faith attempts by the committee to identify and correct quality deficiencies cannot be used as a basis for sanctions.
The facility must comply with the disclosure requirements in subsection 2.5b.
The facility must provide written notice to the state agency responsible for licensing the facility, at the time of any change, if a change occurs in:
Failure to operate a nursing facility in accordance with these rules may subject a facility to the penalties set out in 33 V.S.A.§§ 7111 and 7304, including but not limited to suspension of admissions, receivership, modification, suspension, non-renewal or revocation of license, and civil money penalties.
A person who knowingly violates the licensure or confidentiality requirements of these rules shall be subject to criminal penalties pursuant to 33 V.S.A. § 7116.
Unless otherwise required by the context, as used in these rules, the following definitions apply:
"Advance Directive" means a written instruction of an individual, such as a terminal care document (living will) executed in accordance with 18 V.S.A. Chapter 111; durable power of attorney for health care, executed in accordance with 14 V.S.A. Chapter 121; or general durable power of attorney, executed in accordance with 14 V.S.A. § 3051; recognized under state law and relating to the provision of health care when the individual is unable to direct his or her own health care.
"Commissioner" means the commissioner of the Department of Aging and Disabilities.
"Department" means the Vermont Department of Aging and Disability.
"Discharge" means movement of a resident out of the licensed facility, without expectation that the resident will return.
"Do Not Resuscitate (DNR) Order" or "No Code Order" means a written physician's order supported by appropriate consent of the resident and medical documentation, to suspend the otherwise automatic initiation of cardiopulmonary resuscitation in the event of cardiac or respiratory arrest.
"HCFA" mean the United States Health Care Financing Administration.
"Legal representative" means a person appointed by an individual or by a duly authorized agency or court, or otherwise authorized by law to act on behalf of the individual, and includes the terms "representative payee" and "guardian".
"Licensee" means the person or persons who hold a license to operate a facility.
"Medicaid" means the medical assistance program established pursuant to Title XIX of the Social Security Act.
"Medicare" means the medical insurance program established pursuant to Title XVIII of the Social Security Act.
"Next of Kin" means, in descending order of priority:
"Nursing facility" or "facility" means an institution or a distinct part of an institution (excluding intermediate care facilities for the mentally retarded) which is primarily engaged in providing to its residents (a) skilled nursing care and related services for residents who require medical or nursing care; (b) rehabilitation services for the rehabilitation of injured, disabled or sick persons; or (c) on a 24 hour basis, health related care and services to individuals who because of their mental or physical condition require care and services which can be made available to them only through institutional care.
"Ombudsman" means any person or organization designated by the State Ombudsman, in accordance with 33 V.S.A. § 7501(3), as part of the Office of the State Long-Term Care Ombudsman.
"Options counseling" means providing consumers with complete information on all available long term care services and benefits for which the consumer might be eligible and giving the consumer the opportunity to make a fully informed choice from among the available options and services.
"Psychosocial needs" means any combination of mental health, emotional, spiritual or behavioral needs, concerns or aspects of the resident's life which are identified as important to the resident.
"Reciprocal beneficiary" means a person who has established a reciprocal beneficiaries' relationship pursuant to law.
"Representative Payee" means an individual or organization certified by the Commissioner of Social Security to receive benefits for or on behalf of a resident pursuant to 42 U.S.C. § 405(j).
"Resident" means an individual admitted for care in a facility. For the purposes of these rules whenever "resident" is used it includes (except when limited by the context) any legal representative or next of kin acting on the resident's behalf according to law.
"Skilled Nursing Facility" means a facility or distinct part of a facility that is certified for participation in the Medicare program as a skilled nursing facility.
"Special Care Unit" means a unit located in an identified distinct part of a nursing facility and provides an intensity of specialized services that is not routinely available in the rest of the facility.
"Transfer" means movement of a resident to another bed within the same facility or transfer to another health care setting with return anticipated.
"Vermont State Nurse Assistants Registry" means the registry established and maintained by the department containing the names of and other information about all persons who have successfully completed a competency evaluation or who have been otherwise deemed competent as a nurse assistant by the Department.
Notes
1966
AMENDED:
June 23, 198 Secretary of State Rule Log #80-59; January 1, 1997 Secretary of State Rule Log #96-84; December 15, 2001 Secretary of State Rule Log #01-66; June 1, 2018 Secretary of State Rule Log #18-015
STATUTORY AUTHORITY:
33 V.S.A. § 7117
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