Current through Register Vol. 51, No. 19, September 20, 2024
A. Rehabilitative
Services - Admission Policies. In a nursing home which does not accept
residents in need of specialized rehabilitative services, the minimal
acceptable restorative service shall be the restorative nursing care plan
designed to maintain function or improve the resident's ability to carry out
activities of daily living as set forth in Regulation .18G, of this
chapter.
B. Arrangements for
Services.
(1) If a nursing home's admission
policies include the admission of residents requiring rehabilitative services,
the nursing home shall provide, or arrange for under written agreement,
specialized rehabilitative services by qualified personnel, such as a physical
therapist, speech-language pathologist and audiologist, and occupational
therapist.
(2) Initiation of
services to meet the rehabilitative needs of the resident shall occur within 48
hours, excluding Saturday, Sunday, and State and federal holidays, of the
physician's order for the specialized service.
(3) The resident may not be accepted for
admission if at least one service to meet the rehabilitative needs of the
resident cannot be initiated within the 48-hour period, excluding Saturday,
Sunday, and State and federal holidays.
C. Policies and Procedures.
(1) Written administrative and resident care
policies and procedures shall be developed for rehabilitative services by
appropriate rehabilitation team members and representatives of the medical,
administrative, and nursing staff.
(2) Policies shall provide for the
coordination of rehabilitative services and the rehabilitative aspects of
nursing.
(3) The nursing home shall
make its administrative and resident care policies available for review by
residents and the resident's representative.
D. Written Plan of Care. Rehabilitative
services shall be provided under a written plan of care, initiated by the
attending physician, and developed in consultation with appropriate
rehabilitation team members and the nursing service.
E. Physician's Orders.
(1) Specialized rehabilitative services shall
be provided only on written orders of the attending physician.
(2) Orders shall include modalities to be
used, frequency, and anticipated goals and shall be made a part of the resident
care plan.
(3) The physician shall
review with the resident or the family or resident's representative the goals
and the treatment program. The frequency of communications between the
physician and the rehabilitation team members shall depend on changes in the
resident and the resident's medical status.
F. Progress Notes.
(1) Within 2 weeks of referral to specialized
rehabilitative services, the rehabilitation team members shall provide the
attending physician with a written report of the evaluation, including goals
and progress of the resident.
(2)
Progress notes related to rehabilitative services shall be written at least
every 2 weeks.
G.
Reevaluation of Resident's Progress.
(1) The
physician and the rehabilitation team members shall reevaluate the resident's
progress as necessary, but at least every 30 days.
(2) The physician may document on the record
that the reevaluation may be less frequent but in no case may the reevaluation
exceed 60 days.
H.
Resident's Record.
(1) The physician's orders,
the initial evaluations, the plan of rehabilitative care, goals, services
rendered, evaluations of progress, and other pertinent information shall be:
(a) Recorded in the resident's medical
record; and
(b) Dated and signed by
the:
(i) Physician ordering the service;
and
(ii) Those disciplines who
provided the service.
(2) The record and progress notes concerning
the resident shall reflect at all times the most recent and current status of
the resident, including current short-term and long-term goals.
I. Proof of Licensure. The
facility shall maintain a file which includes proof of current licensure of all
the rehabilitative services' personnel.
J. Job Descriptions. Current job descriptions
for all rehabilitative services personnel shall be readily available in the
facility.
