Current through Register Vol. 46, No. 19, March 20, 2024
(1) Each
facility shall ensure that policies and procedures are written and implemented
which include, at a minimum, all of the following provisions (subrules 58.39(2)
to 58.39(6)) and which govern all areas of service provided by the facility.
These policies and procedures shall be available to staff, residents, their
families or legal representatives and the public and shall be reviewed
annually. (II)
(2) Policies and
procedures shall address the admission and retention of persons with histories
of dangerous or disturbing behavior. For the purposes of the subrule, persons
with histories of dangerous or disturbing behavior are those persons who have
been found to be seriously mentally impaired pursuant to Iowa Code section
229.13 within six months of the
request for admission to the facility. In addition to establishing the criteria
for admission and retention of persons so defined, the policies and procedures
shall provide for:
a. Reasonable precautions
to prevent the resident from harming self, other residents, or employees of the
facility.
b. Treatment of persons
with mental illness as defined in Iowa Code section 229.1(1) and which is
provided in accordance with the individualized health care plan.
c. Ongoing and documented staff training on
individualized health care planning for persons with mental
illness.
(3) Policies and
procedures regarding the admission, transfer, and discharge of residents shall
ensure that:
a. Only those persons are
accepted whose needs can be met by the facility directly or in cooperation with
community resources or other providers of care with which it is affiliated or
has contracts. (II)
b. As changes
occur in residents' physical or mental condition, necessitating services or
care which cannot be adequately provided by the facility, they are transferred
promptly to other appropriate facilities. (II)
(4) Policies and procedures regarding the use
of chemical and physical restraints shall define the use of said restraints and
identify the individual who may authorize the application of physical
restraints in emergencies, and describe the mechanism for monitoring and
controlling their use. (II)
(5)
Policies and procedures shall include a method for submitting complaints and
recommendations by residents or their responsible party and for ensuring a
response and disposition by the facility. (II)
(6) Policies and procedures shall include
provisions governing access to, duplication of, and dissemination of
information from the residents' records. (II)
(7) Policies and procedures shall include a
provision that each resident shall be fully informed of the resident's rights
and responsibilities as a resident and of all rules governing resident conduct
and responsibilities. This information must be provided upon admission, or in
the case of residents already in the facility, upon the facility's adoption or
amendment of residents' rights policies. (II)
a. The facility shall make known to residents
what they may expect from the facility and its staff, and what is expected from
them. The facility shall communicate these expectations during the period of
not more than two weeks before or five days after admission. The communication
shall be in writing, e.g., in a separate handout or brochure describing the
facility, and interpreted verbally, e.g., as part of a preadmission interview,
resident counseling, or in individual or group orientation sessions following
admission. (II)
b. Residents'
rights and responsibilities shall be presented in language understandable to
the resident. If the facility serves residents who are non-English speaking or
deaf or hard of hearing, steps shall be taken to translate the information into
a foreign or sign language. In the case of blind residents, either Braille or a
recording shall be provided. Residents shall be encouraged to ask questions
about their rights and responsibilities and these questions shall be answered.
(II)
c. A statement shall be signed
by the resident, or the resident's responsible party, indicating an
understanding of these rights and responsibilities, and shall be maintained in
the record. The statement shall be signed no later than five days after
admission, and a copy of the signed statement shall be given to the resident or
responsible party, if applicable. In the case of an intellectually disabled
resident, the signature shall be witnessed by a person not associated with or
employed by the facility. The witness may be a parent, guardian, Medicaid
agency representative, etc. (II)
d.
In order to ensure that residents continue to be aware of these rights and
responsibilities during their stay, a written copy shall be prominently posted
in a location that is available to all residents. (II)
e. All residents shall be advised within 30
days following changes made in the statement of residents' rights and
responsibilities. Appropriate means shall be utilized to inform non-English
speaking, deaf or hard-of-hearing, or blind residents of such changes.
(II)
(8) Each resident or
responsible party shall be fully informed in a contract as required in rule
481-58.13 (135C), prior to or at
the time of admission and during the resident's stay, of services available in
the facility, and of related charges including any charges for services not
covered under the Title XIX program or not covered by the facility's basic per
diem rate. (II)
(9) Each resident
or responsible party shall be fully informed by a physician of the resident's
health and medical condition unless medically contraindicated (as documented by
a physician in the resident's record). Each resident shall be afforded the
opportunity to participate in the planning of the resident's total care and
medical treatment, which may include, but is not limited to, nursing care,
nutritional care, rehabilitation, restorative therapies, activities, and social
work services. Each resident only participates in experimental research
conducted under the U.S. Department of Health and Human Services' protection
from research risks policy and then only upon the resident's informed written
consent. Each resident has the right to refuse treatment except as provided by
Iowa Code chapter 229. In the case of a confused or intellectually disabled
individual, the responsible party shall be informed by the physician of the
resident's medical condition and be afforded the opportunity to participate in
the planning of the resident's total care and medical treatment, to be informed
of the medical condition, and to refuse to participate in experimental
research. (II)
a. The requirement that
residents shall be informed of their conditions, involved in the planning of
their care, and advised of any significant changes in either shall be
communicated to every physician responsible for the medical care of residents
in the facility. (II)
b. The
administrator or designee shall be responsible for working with attending
physicians in the implementation of this requirement. (II)
c. If the physician determines or in the case
of a confused or intellectually disabled resident the responsible party
determines that informing the resident of the resident's condition is
contraindicated, this decision and reasons for it shall be documented in the
resident's record by the physician. (II)
d. The resident's plan of care shall be
based, in part, on the physician's orders. It shall be developed upon admission
by appropriate facility staff and shall include participation by the resident
if capable. Residents shall be advised of alternative courses of care and
treatment and their consequences when such alternatives are available. The
resident's preference about alternatives shall be elicited and honored if
feasible.
e. Any clinical
investigation involving residents must be under the sponsorship of an
institution with a human subjects review board functioning in accordance with
the requirements of 45 CFR
46. A resident being considered for
participation in experimental research must be fully informed of the nature of
the experiment, e.g., medication, treatment, and understand the possible
consequences of participating or not participating. The resident's (or
responsible party's) written informed consent must be received prior to
participation. (II)
This rule is intended to implement Iowa Code section
135C.23(2).
