Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 07 - HOSPITALS
Chapter 10.07.14 - Assisted Living Programs
Section 10.07.14.02 - Definitions
Universal Citation: MD Code Reg 10.07.14.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) Abuse of a Resident.
(a) "Abuse of a resident" means physical,
sexual, mental, or verbal abuse, or the improper use of physical or chemical
restraints or involuntary seclusion as those terms are defined in this
regulation.
(b) "Abuse of a
resident" does not include:
(i) The
performance of an accepted medical procedure ordered by a physician or
administered by another health care practitioner practicing within the scope of
the physician or health care practitioner's license; or
(ii) Compliance with a valid advance
directive.
(2) Activities of Daily Living.
(a) "Activities of daily living" means normal
daily activities.
(b) "Activities
of daily living" includes:
(i) Eating or being
fed;
(ii) Grooming, bathing, oral
hygiene including brushing teeth, shaving, and combing hair;
(iii) Mobility, transfer, ambulation, and
access to the outdoors, when appropriate;
(iv) Toileting; and
(v) Dressing in clean, weather-appropriate
clothing.
(3)
Administration of Medication.
(a)
"Administration of medication" means the act of preparing and giving a
medication to a resident.
(b)
"Administration of medication" includes:
(i)
Identifying the time to administer the medication;
(ii) Opening the medication
container;
(iii) Removing the
medication from the container; or
(iv) Giving the medication to the
resident.
(c)
"Administration of medication" does not include residents who have the
cognitive ability to recognize their medications but only require assistance
such as:
(i) A reminder to take the
medication;
(ii) Physical
assistance with opening a medication container; or
(iii) Assistance with removing medication
from the container.
(4) "Adult medical day care" has the meaning
stated in Health-General Article, §§14-201 and 14-301, Annotated Code
of Maryland.
(5) "Advance
directive" means:
(a) A witnessed written
document, voluntarily executed by the declarant consistent with the
requirements of Health-General Article, Title 5, Subtitle 6, Annotated Code of
Maryland; or
(b) A witnessed oral
statement, made by the declarant consistent with the provisions of the
Health-General Article, Title 5, Subtitle 6, Annotated Code of
Maryland.
(6) "Agent"
means a person who manages, uses, or controls the funds or assets that legally
may be used to pay an applicant's or resident's share of the costs or other
charges for assisted living services.
(7) "Alzheimer's special care unit" means a
secured or segregated special unit or program specifically designed for
individuals with dementia, including a probable or confirmed diagnosis of
Alzheimer's disease or a related disorder.
(8) "Assessment" means a process of
evaluating an individual's health, functional and psychosocial history, and
condition using the Resident Assessment Tool.
(9) "Assist rail" means a hand rail or other
similar, substantially constructed device that is installed to enable residents
to move safely from one point or position to another.
(10) "Assisted living manager" means the
individual who is:
(a) Designated by the
licensee to oversee the day-to-day operation of the assisted living program;
and
(b) Responsible for the duties
set forth in Regulation .15 of this chapter.
(11) Assisted Living Program.
(a) "Assisted living program" means a
residential or facility-based program that provides housing and supportive
services, supervision, personalized assistance, health-related services, or a
combination of these services to meet the needs of individuals who are unable
to perform, or who need assistance in performing, the activities of daily
living or instrumental activities of daily living, in a way that promotes
optimum dignity and independence for the individuals.
(b) "Assisted living program" does not
include:
(i) A nursing home, as defined under
Health-General Article, §19-301, Annotated Code of Maryland;
(ii) A State facility, as defined under
Health-General Article, §10-101, Annotated Code of Maryland;
(iii) A program licensed or approved by the
Department under Health-General Article, Title 7 or Title 10, Annotated Code of
Maryland;
(iv) A hospice care
program licensed by the Department under Health-General Article, Title 19,
Annotated Code of Maryland;
(v)
Services provided by family members;
(vi) Services provided by a licensed
residential service agency or licensed home health agency in an individual's
own home; or
(vii) A Certified
Adult Residential Environment Program that is certified by the Department of
Human Resources under Article 88A, § 140, Annotated Code of
Maryland.
(12) "Authorized prescriber" means an
individual who is authorized to prescribe medications under Health Occupations
Article, Annotated Code of Maryland.
(13) "Background check" means a check of
court and other records by a private agency.
(14) "Bank" means a bank, trust company,
savings bank, savings and loan association, or financial institution that is:
(a) Authorized to do business in this State;
and
(b) Insured by the Federal
Deposit Insurance Corporation.
(15) "Certified medication technician" means
an individual who is certified as a medication technician by the Maryland Board
of Nursing under COMAR
10.39.04.02E.
(16) "Chemical restraint" means
the administration of drugs with the intent of significantly curtailing the
normal mobility or normal physical activity of a resident in order to protect
the resident from injuring the resident or others.
(17) Cognitive Impairment.
(a) "Cognitive impairment" means the loss of
those thought processes that orchestrate relatively simple ideas, movements, or
actions into goal-directed behavior.
(b) "Cognitive impairment" includes lack of
judgment, planning, organization, self-control, and the persistence needed to
manage normal demands of the individual's environment.
(18) "Common-use telephone" means a
telephone:
(a) That is within the
facility;
(b) That is accessible to
residents;
(c) That is located so
that residents can have private conversations; and
(d) With which residents can make local calls
free of charge.
(19)
"Contact isolation" means the creation of barriers and other protection such as
gloves, masks, or gowns to prevent the spread of an infection by close or
direct contact between an infected individual and others.
(20) "Criminal history records check" means a
check of criminal history information, as defined in Criminal Procedure
Article, §10-201, Annotated
Code of Maryland, by the Department of Public Safety and Correctional
Services.
(21) "Delegating nurse"
means a registered nurse who:
(a) Is licensed
to practice registered nursing in this State as defined in Health Occupations
Article, Title 10, Annotated Code of Maryland; and
(b) Has successfully completed the Board of
Nursing's approved training program for registered nurses, delegating nurses,
and case managers in assisted living.
(22) "Delegation of nursing tasks" means the
formal process approved by the Maryland Board of Nursing which permits
professional nurses to assign nursing tasks to other individuals if the
registered nurse:
(a) Provides proper
training, supervision, and monitoring; and
(b) Retains responsibility for the nursing
tasks.
(23) "Department"
means the Department of Health and Mental Hygiene.
(24) "Discharge" means releasing a resident
from an assisted living program, after which the releasing program no longer is
responsible for the resident's care.
(25) "Emergency admission" means the
temporary admittance of an individual in an assisted living program when the
individual's health and safety would be jeopardized by not permitting immediate
admittance.
(26) "Facility" means
the physical plant in which an assisted living program is operated.
(27) Facilitating Access.
(a) "Facilitating access" means:
(i) Making appropriate referrals for care and
treatment;
(ii) Arranging for the
appointment and involvement of appropriate health care decision makers, when
necessary; and
(iii) Facilitating
contact between the resident, the resident's representative, health care or
social service professional, and needed services.
(b) "Facilitating access" does not mean
guaranteeing payment for services that:
(i)
Are not covered by the resident agreement; or
(ii) Cannot be paid for by the resident or
the resident's agent.
(28) "Family council" means a group of
individuals who work together to protect the rights of and improve the quality
of life of residents of an assisted living program.
(29) "Financial exploitation" means the
misappropriation of a resident's assets or income, including spending the
resident's assets or income:
(a) Against the
will of or without the consent of the resident or the resident's agent;
or
(b) For the use and benefit of a
person other than the resident, if the resident or agent has not consented to
the expenditure.
(30)
"Frequent" means occurring or appearing quite often or at close intervals, but
not continuously.
(31) "Health care
practitioner" means an individual who provides health care services and is
licensed under Health Occupations Article, Annotated Code of
Maryland.
(32) "Health condition"
means the status of a resident's physical, mental, and psychosocial
well-being.
(33) "Home health
services" means those services provided under the provisions of Health-General
Article, §19-404, Annotated Code of Maryland, and COMAR
10.07.10.
(34) "Household member"
means an individual living in an assisted living facility who is not a resident
or staff member.
(35) "Incident"
means:
(a) The death of a resident from other
than natural causes;
(b) The
disappearance or elopement of a resident;
(c) An assault on a resident resulting in
injury;
(d) An injury to a resident
which may require treatment by a health care practitioner, or an event such as
a fall which could subsequently require treatment;
(e) Abuse of a resident;
(f) An error or omission in medication or
treatment which may result in harm to the resident; or
(g) An emergency situation or natural
disaster.
(36) "Informal
dispute resolution (IDR)" means an informal process that provides a licensee
the opportunity to question the Department about deficiencies cited on a recent
inspection.
(37) "Instrumental
activities of daily living" means home management skills, such as shopping for
food and personal items, preparing meals, or handling money.
(38) "Intensive" means highly
concentrated.
(39) "Intermittent
nursing care" means nursing care which is provided episodically, irregularly,
or for a limited time period.
(40)
Involuntary Seclusion.
(a) "Involuntary
seclusion" means the separation of a resident from others or from the
resident's room against the resident's will or the will of the resident's
representative.
(b) "Involuntary
seclusion" does not mean separating a resident from other residents on a
temporary and monitored basis.
(41) "Lavatory" means a basin used to
maintain personal cleanliness that has hot and cold running water and sanitary
drainage.
(42) "Law enforcement
agency" means the Maryland State Police or a police agency of a county or
municipal corporation.
(43)
"License" means a document issued by the Secretary to operate an assisted
living program in Maryland.
(44)
"Licensed pharmacist" means an individual who is authorized to practice
pharmacy under Health Occupations Article, Title 12, Annotated Code of
Maryland.
(45) "Licensee" means the
person, association, partnership, or corporation to whom a license is
issued.
(46) "Management firm"
means an organization, under contract with an applicant for a license or a
current licensee, that is intended to have or has full responsibility and
control over the day-to-day operations of the assisted living
program.
(47) "Medical record" has
the meaning stated in Health-General Article, §4-301, Annotated Code of
Maryland.
(48) "Mental abuse" means
an intentional course of conduct resulting in emotional harm.
(49) "Minimal" means the least amount
required to produce the desired result.
(50) "Neglect" means depriving a resident of
adequate food, clothing, shelter, supervision, essential medical treatment, or
essential rehabilitative therapy.
(51) Nursing Overview.
(a) "Nursing overview" means a process by
which a registered nurse assures that the health and psychosocial needs of the
resident are met.
(b) "Nursing
overview" includes:
(i) Observation;
(ii) Assessment;
(iii) Staff education; and
(iv) The development, implementation, and
evaluation of a resident's service plan.
(52) "Occasional" means occurring from time
to time, on an infrequent or irregular basis, with no particular
pattern.
(53) "Office of Health
Care Quality (OHCQ)" means the Office of Health Care Quality of the Department
of Health and Mental Hygiene.
(54)
"Ongoing" means continuing over an extended period of time.
(55) "Person" means an individual, receiver,
trustee, guardian, personal representative, fiduciary, or representative of any
kind and any partnership, firm, association, corporation, or other
entity.
(56) "Personal
representative" means an individual appointed by the court with the duties and
authority to settle and distribute the estate of the decedent.
(57) "Physical abuse" means the sustaining of
any physical injury or pain to a resident as a result of cruel or inhumane
treatment, or as a result of a malicious act by any individual.
(58) Physical Restraint.
(a) "Physical restraint" means the use of a
device or physical action to prevent, suppress, or control head, body, or limb
movement, that cannot be readily and easily removed by the resident.
(b) "Physical restraint" does not mean a
protective device as defined in this regulation.
(59) "Plan of correction" means a written
response from the assisted living program that addresses each deficiency cited
as a result of an inspection by the Department.
(60) "Protective device" means any device or
equipment, except bed side rails:
(a) That:
(i) Shields a resident from
self-injury;
(ii) Prevents a
resident from aggravating an existing physical problem; or
(iii) Prevents a resident from precipitating
a potential physical problem;
(b) That may limit, but does not eliminate,
the movement of the resident's head, body, or limbs; and
(c) That is prescribed by a
physician.
(61) "Quality
assurance" means a system for maintaining professionally acceptable standards
of care by:
(a) Identifying opportunities to
improve;
(b) Studying problems if
any, and their root causes; and
(c)
Implementing and monitoring interventions to ensure the intended improvement is
achieved and sustained.
(62) "Relief personnel" means qualified
individuals who have been hired to substitute for staff members:
(a) In emergency situations; or
(b) When the assisted living manager or other
staff is absent from the program for extended hours.
(63) "Representative" means a person
referenced in Regulation .34 of this chapter.
(64) "Resident" means an individual 18 years
old or older who requires assisted living services.
(65) "Resident agreement" means a document
signed by both the resident or the resident's agent and the assisted living
manager, or designee, stating the terms that the parties agree to, including,
at a minimum, the provisions set forth in Regulations .24 and .25 of this
chapter.
(66) "Resident Assessment
Tool" means Maryland's Assisted Living Resident Assessment and Level of Care
Scoring Tool (DHMH Form 4506) that is:
(a)
Incorporated by reference in Regulation .03 of this chapter; and
(b) Used by assisted living facilities to
assess the current health, physical, and psychosocial status of prospective and
current residents.
(67)
Restraint.
(a) "Restraint" means any chemical
restraint or physical restraint as defined in §B(16) and (58) of this
regulation.
(b) "Restraint" does
not include a protective device.
(68) "Sanction" means a disciplinary penalty
imposed for a violation of statutes or regulations relating to the operation of
an assisted living program, including but not limited to, those penalties
referenced in Regulations .56, .57, .60, .62, and .63 of this
chapter.
(69) "Secretary" means the
Secretary of Health and Mental Hygiene, or the Secretary's designee.
(70) "Self-administration of medication"
means a resident having the cognitive and physical ability to take medication
as prescribed by an authorized prescriber:
(a)
At the correct time;
(b) By the
correct route; and
(c) In the
correct dosage.
(71)
"Service plan" means a written plan developed by the licensee, in conjunction
with the resident and the resident's representative, if appropriate, which
identifies, among other things, services that the licensee will provide to the
resident based upon the resident's needs as determined by the Resident
Assessment Tool.
(72) "Sexual
abuse" means a crime listed in Criminal Law Article, Title 3, Subtitle 3,
Annotated Code of Maryland.
(73)
"Short-term residential care" means a stay, either continuous or intermittent,
in an assisted living program of not more than 30 days from the date of initial
admission, which cannot exceed 30 days per year.
(74) Significant Change of Condition.
(a) "Significant change of condition" means a
shift in a resident's health, functional, or psychosocial conditions that
either causes an improvement or deterioration in a resident's condition as
described in Appendix A of the Resident Assessment Tool.
(b) "Significant change of condition" does
not include any ordinary, day-to-day fluctuations in health status, function,
or behavior, or an acute short-term illness, such as a cold, unless these
fluctuations continue to recur.
(75) "Staff" means supervisors, assistants,
aides, or other employees, including independent contractors retained by an
assisted living program, to provide the care and services required by this
chapter.
(76) "Substantial" means
considerable in importance, degree, amount, frequency, or extent.
(77) "Treatment" means medical or
psychological management to cure or improve a disease or condition.
(78) "Unclaimed deceased resident" means a
resident of an assisted living program:
(a)
Who has not prearranged and prepaid for the disposal of the resident's body;
or
(b) For whom no individual has
claimed the body and assumed funeral or burial responsibility.
(79) "Verbal abuse" means the use
of any oral or gestured language that includes disparaging or derogatory terms,
which is directed to a resident, or within a resident's hearing distance,
regardless of the resident's age, ability to comprehend, or
disability.
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