Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 175 - HEALTH CARE FACILITIES AND SERVICES LICENSURE
Chapter 16 - HOSPICE SERVICES
Section 175-16-007 - PHYSICAL PLANT CONSTRUCTION STANDARDS

Universal Citation: 175 NE Admin Rules and Regs ch 16 ยง 007

Current through March 20, 2024

All facilities must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The physical plant standards for facilities, which include support services, care and treatment areas, construction standards, building systems and waivers, are set forth below.

007.01 Support Areas

The inpatient hospice may share the following support service areas among the detached structures, care and treatment suites, and with other licensed facilities.

16-007.01A Dietary: If food preparation is provided on site, the inpatient hospice must dedicate space and equipment for the preparation of meals. Inpatient hospice food services and facilities must comply with the Food Code. Food service locations providing food services for 16 or fewer patients, used only for training or activity purposes, must comply with the Food Code, except that:
1. Instead of a three compartment food preparation and handwashing sink, a two-compartment sink may be used for clean up, dishwashing, and hand washing;

2. Instead of a final rinse cycle temperature of not less than 160 degrees Fahrenheit, an automatic dishwasher may have a final rinse cycle temperature not less than 150 degrees Fahrenheit;

3. Instead of storage space for food items and cooking and serving utensils no less than 6 inches above the floor, the space may be no less than 4 inches above the floor; and

4. Service sink and indirect waste plumbing connections are optional.

16-007.01B Laundry: The inpatient hospice must provide laundry services. The service may be provided by contract or on-site by the inpatient hospice.
16-007.01B1 Contract: If contractual services are used, the inpatient hospice must have areas for soiled linen awaiting pickup and separate areas for storage and distribution of clean linen.

16-007.01B2 On-site: If on-site services are provided, the inpatient hospice must have areas dedicated to laundry.
16-007.01B2a Personal laundry areas are provided and equipped with a washer and dryer for use by patients. In new construction, the inpatient hospice must provide a conveniently located sink for soaking and handwashing of laundry.

16-007.01B2b The inpatient hospice laundry area for facility processed bulk laundry must be divided into separate soiled (sort and washer areas) and clean (drying, folding, and mending areas) rooms. In new facilities a separate soaking and hand washing sinks, and housekeeping room must be provided in the laundry area.

16-007.01B2c Separate clean linen supply storage facilities must be conveniently located in each care and treatment location.

16-007.01C Waste Processing: The inpatient hospice must provide areas to collect, contain, process, and dispose of medical and general waste produced within the inpatient hospice in a manner that prevents the attraction of rodents, flies, and all other insects and vermin, and to minimize the transmission of infectious diseases.

16-007.01D Cosmetology and Barber: Cosmetology and barber services as defined in the Cosmetology, Electrology, Esthetics, Nail Technology; and Body Art Practice, Neb. Rev. Stat. §§ 38-1001 to 38-10,171 and the Practice of Barbering, Neb. Rev. Stat. §§ 71-201 to 71-248 must be provided in conformance with those laws.

16-007.01E Pharmaceutical: Pharmacy services as defined in the Practice of Pharmacy, Neb. Rev. Stat. §§ 38-2801 to 38-28,103 must be provided in conformance with such law.

16-007.01F Housekeeping Room: The inpatient hospice must have a room with a service sink and space for storage of supplies and housekeeping equipment.

007.02 Care and Treatment Areas

The inpatient hospice must not share the following care and treatment areas among detached structures or with other licensed facilities operated by another licensee. Care and treatment areas must comply with the following standards.

16-007.02A Staff Areas: An inpatient hospice that provides nursing services must provide the following support areas for each distinct care and treatment suite of bedrooms:
16-007.02A1 Control Point: The inpatient hospice must have an area(s) for charting and patient records and call and alarm annunciation systems.

16-007.02A2 Medication Station: The inpatient hospice must have a medication station for storage and distribution of drugs and routine medications. Distribution may be done from a medicine preparation room or unit, from a self-contained medicine-dispensing unit, or by another system. If used, a medicine preparation room or unit must be under visual control of nursing staff and must contain a work counter, sink, refrigerator, and double-locked storage for controlled substances.

16-007.02A3 Patient Facilities: An inpatient hospice must have space for patient care, treatment, and consultation, and visiting area.

16-007.02A4 Utility Areas: An inpatient hospice must have a work area where clean materials are assembled. The work area must contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the area is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and handwashing fixtures may be omitted. An inpatient hospice must have separate work areas or holding rooms for soiled materials. A workroom for soiled materials must contain a fixture for disposing wastes and a handwashing sink.

16-007.02B Equipment and Supply: The inpatient hospice must have services and space to distribute, maintain, clean, and sanitize durable medical instruments, equipment, and supplies required for the care and treatment performed in the inpatient hospice.
16-007.02B1 Durable Medical: The inpatient hospice must ensure that the durable medical equipment is tested and calibrated in accordance with the manufacturer's recommendations.

16-007.02B2 Sterile Processing: The inpatient hospice must have areas for decontamination and sterilizing of durable medical instruments and equipment.
16-007.02B2a The inpatient hospice must provide separate central sterile processing and waste processing facilities.

16-007.02B2b Central processing facilities must have separate soiled (sorting and decontamination) and clean (sterilizing and processing) rooms. The inpatient hospice must have handwashing sinks in both clean and soiled rooms.

16-007.02B3 Equipment Storage: An inpatient hospice must have space to store equipment, stretchers, wheel chairs, supplies, and linen out of the path of normal traffic.

16-007.02B4 Required Equipment: The inpatient hospice must provide equipment adequate for meeting the patients needs as specified in the contracts, patient service agreements, and patient care plans.

16-007.02C In-patient Hospice Care: A facility providing in-patient hospice services must have at least one private patient bedroom, over-night and dining accommodations for family members, private family visiting areas, areas that allow for toileting, bathing, dressing and handwashing, storage for equipment and supplies, call system, medication storage and distribution.

007.03 Construction Standards

All facilities must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The standards for such facilities are set forth below.

16-007.03A Codes and Guidelines
16-007.03A1 New Construction: New construction must comply with the following codes and guidelines to provide a safe and accessible environment that is conductive to the care and treatment to be provided:
1. Building: Building Construction Act, Neb. Rev. Stat. §§ 71-6401 to 716407;

2. Plumbing: Plumbing Ordinance or Code, Neb. Rev. Stat. § 18-1915;

3. Electrical: State Electrical Act, Neb. Rev. Stat. §§ 81-2101 to 81-2143;

4. Elevators: Nebraska Elevator Code, Neb. Rev. Stat. § 48-418.12 and Department of Labor Regulations, 230 NAC 1;

5. Boiler: Boiler Inspection Act, Neb. Rev. Stat. §§ 48-719 to 48-743;

6. Accessibility: Nebraska Accessibility Requirements, State Fire Marshal Regulations, 156 NAC 1 to 12; and

7. Energy: Nebraska Energy Code, Neb. Rev. Stat. §§ 81-1608 to 81-1626, for construction initiated on or after July 1, 2005.

16-007.03A2 All Facilities: All facilities must comply with the following applicable codes and standards to provide a safe environment:
1. Fire Codes: Nebraska State Fire Code Regulations, State Fire Marshal, 153 NAC 1; and

2. The Food Code, Neb. Rev. Stat. § 81-2,244.01, as published by the Nebraska Department of Agriculture, except for compliance and enforcement provisions.

16-007.03A3 Existing and New Facilities: Existing and new facilities must comply with the physical plant standards contained in 175 NAC 16-007. The inpatient hospice must maintain all building materials and structural components so that total loads imposed do not stress materials and components more than one and one-half times the working stresses allowed in the buildings of similar structure, purpose, or location.

16-007.03B Conflicts in Standards: In situations where the referenced codes and guidelines conflict with these regulations, the adopted rules and regulations of the Department and the Nebraska State Fire Marshal must prevail.

16-007.03C Interpretations: All dimension, sizes, and quantities; noted herein must be determined by rounding fractions to the nearest whole number.

16-007.03D : Floor area is the space with ceilings at least seven feet in height and excludes enclosed storage, toilets and bathing rooms, corridors and halls. The space beyond the first two feet of vestibules and alcoves less than five feet in width must not be included in the required floor area. In rooms with sloped ceilings, at least half of the ceiling must be at least seven feet in height. Areas less than five feet in height must not be included in the required floor area.

16-007.03E Dining Areas: Dining areas must have an outside wall with windows for natural light and ventilation.
16-007.03E1 Dining areas must be furnished with tables and chairs that accommodate or conform to patient needs.

16-007.03E2 Dining areas must have a floor area of 15 square feet per patient in existing facilities and 20 square feet per patient in new construction.

16-007.03E3 Dining areas must allow for group dining at the same time in either separate dining areas or a single dining area, or dining in two shifts, or dining during open dining hours.

16-007.03E4 Dining areas must not be used for sleeping, offices or corridors.

16-007.03F Bathing Rooms: Existing or new facilities must provide a bathing room consisting of a tub and/or shower adjacent to each bedroom or provide a central bathing room on each floor. Tubs and showers regardless of location must be equipped with hand grips or other assistive devices as needed or desired by the patient.
16-007.03F1 In new construction a central bathing room must open off the corridor and contain a toilet and sink or have an adjoining toilet room.

16-007.03F2 Fixture Numbers: The inpatient hospice must have the following minimum number of bathing fixtures of one fixture per eight licensed beds in new facilities and new construction.

16-007.03G Toilet Rooms: The inpatient hospice must provide at least one room with a toilet and sink for patient use.
16-007.03G1 Existing facilities must have a toilet and sink adjoining each bedroom or shared toilet facilities minimum number of one fixture per four licensed beds in new facilities and new construction.

16-007.03G2 New construction must have a toilet and sink fixture provided adjoining each patient bedroom or in each apartment or dwelling.

16-007.03H Sleeping Rooms: The inpatient hospice must provide bedrooms which allow for sleeping, afford privacy, provide access to furniture and belongings, and accommodate the care and treatment provided to the patient of the following room types.
16-007.03H1 Bedrooms: The inpatient hospice must not locate bedrooms in a garage, storage area, shed, or similar detached buildings. Bedrooms must be:
1. A single room located within an apartment, dwelling, or dormitory-like structure;

2. Not be accessed through a bathroom, food preparation area, laundry or another bedroom;

3. Be located on an outside wall or an atrium with an operable window opening to allow natural ventilation with a minimum glass size of 10% of the required bedroom floor area for the number of room patients. The window must provide an unobstructed view of at least 10 feet;

4. Contain at least 25 cubic feet of enclosed storage volume per patient in dressers, closets, or wardrobes;

5. For multiple bed bedrooms, allow for an accessible arrangement of furniture; which provides a minimum of three feet between beds; and

6. For apartments and dwellings, also have a separate room containing a water closet, lavatory, and bathtub or shower; and a kitchen area with a sink, cooking appliance, and refrigeration facilities.

16-007.03H2 Existing or New Facility: Sleeping areas in existing and new facilities must have at least the following floor areas.
16-007.03H2a Floor areas for single bed sleeping rooms must be 100 square feet.

16-007.03H2b Floor areas for multiple bed sleeping rooms must be 80 square feet per patient with a maximum of 2 beds.

16-007.03H3 New Construction: Sleeping areas in new construction must have at least the following floor areas.
16-007.03H3a Floor areas for single bed sleeping rooms must be 120 square feet.

16-007.03H3b Floor area for apartments or dwellings must have 150 square feet for one patient plus 110 square feet for each additional patient with a maximum of 1 patient in any single bedroom.

16-007.03J Isolation Rooms: The inpatient hospice must have the capability to provide isolation rooms based on infection control risk assessment of the patients.
16-007.03J1 The inpatient hospice must make provisions for isolating patients with infectious diseases

16-007.03J2 In new construction, the inpatient hospice must equip isolation rooms with hand washing and gown changing facilities at the entrance of the room.

16-007.03K Corridors: The inpatient hospice corridors must be wide enough to allow passage and be equipped as needed by the patient with safety and assistive devices to minimize injury. All stairways and ramps must have handrails.

16-007.03L Doors: The inpatient hospice doors must be wide enough to allow passage and be equipped for privacy, safety, and with assistive devices to minimize patient injury
16-007.03L1 All bedroom, toilet, and bathing room doors must provide privacy yet not create seclusion or prohibit staff access for routine or emergency care.

16-007.03L2 In new construction, all patient-used toilet and bathing rooms with less than 50 square feet of clear floor area must not have doors that swing inward.

16-007.03M Outdoor Areas: The inpatient hospice must provide an outdoor area for patient usage. It must be equipped and situated to allow for patient safety and abilities.

16-007.03N Hand Washing Sinks: The inpatient hospice must provide a hand washing facility equipped with sink, disposable towels, and soap dispenser in all examination, treatment, isolation, and procedure rooms.

16-007.03O Privacy: Visual privacy and window curtains must be provided for each patient. In new facilities the curtain layout must totally surround each care and treatment location which will not restrict access to the entrance to the room, lavatory, toilet, or enclosed storage facilities.

16-007.03P Finishes: An inpatient hospice must provide the following special room finishes:
1. Washable room finishes provided in existing isolation rooms, clean workrooms, and food-preparation areas must have smooth, non-absorptive surfaces which are not physically affected by routine housekeeping cleaning solutions and methods. Acoustic lay-in ceilings, if used, must not interfere with infection control. Perforated, tegular, serrated cure, or highly textured tiles are not acceptable; and

2. Scrubbable room finishes provided in new isolation rooms must have smooth, non-absorptive, non-perforated surfaces that are not physically affected by harsh germicidal cleaning solutions and methods.

007.04 Building Systems

The inpatient hospice must have building systems that are designed, installed and operated in such a manner as to provide for the safety, comfort, and well being of the patient.

16-007.04A Water and Sewer Systems: The inpatient hospice must have and maintain an accessible, adequate, safe and potable supply of water. Where an authorized public water supply of satisfactory quantity, quality, and pressure is available, the inpatient hospice must be connected to it and its supply used exclusively.
16-007.04A1 The collection, treatment, storage, and distribution potable water system of an inpatient hospice that regularly services twenty-five or more individuals must be constructed, maintained, and operated in accordance with all provisions of the Nebraska Safe Drinking Water Act and Title 179, Regulations Governing Public Water Systems.

16-007.04A2 The collection, treatment, storage, and distribution potable water system of an inpatient hospice that serves less than twenty-five individuals on a regular basis must be maintained and operated as if it were a public water system in accordance with the Regulations Governing Public Water Systems, Title 179 2-002, 3 and 4. The inpatient hospice must report to the Department the result of all tests that indicate the water is in violation of the standards in 179 NAC 2-002 or 3. The inpatient hospice must construct all water wells in accordance with 178 NAC 12, Water Well Construction, Pump Installation, and Water Well Decommissioning Standards.

16-007.04A3 The water distribution system must be protected with anti-siphon devices, and air-gaps to prevent potable water system and equipment contamination.

16-007.04A4 Continuously circulated filtered and treated water systems must be provided as required for the care and treatment equipment used in the inpatient hospice.

16-007.04A5 Facilities must maintain a sanitary and functioning sewage system.

16-007.04B Hot Water System: The inpatient hospice must maintain hot and cold water to all hand washing and bathing locations. The hot water system must have the capacity to provide continuous hot water at a temperature in a range between 100 and 160 degrees Fahrenheit.

16-007.04C Heating and Cooling Systems: The inpatient hospice must provide a heating and air conditioning system for the comfort of the individual that is capable of maintaining the temperature in patient care and treatment areas as follows:
16-007.04C1 In existing and new facilities, the systems must be capable of producing a temperature of at least 70 degrees Fahrenheit during heating conditions and that does not exceed 85 degrees Fahrenheit during cooling conditions.

16-007.04C2 In new construction, the systems must be capable of producing a temperature of at least 75 degrees Fahrenheit during heating conditions and that does not exceed 80 degrees Fahrenheit during cooling conditions.

16-007.04C3 In new construction, central air distribution and return systems must have the following percent dust spot rated filters:
1. General areas................................................30+%; and

2. Care, treatment, clean processing areas..............80+% filters.

16-007.04C4 Airflow must move from clean to soiled locations. In new construction, air movement must be designed to reduce the potential of contamination of clean areas.

16-007.04C5 Floors in locations subject to wet cleaning methods or body fluids must not have openings to the heating and cooling system.

16-007.04D Ventilation System: The inpatient hospice must provide exhaust and clean air to prevent the concentrations of contaminants which impair health or cause discomfort to patient and employees.
16-007.04D1 Existing and new facilities must have adequate ventilation.

16-007.04D2 New construction must provide a mechanical exhaust ventilation system for windowless toilets, baths, laundry rooms, housekeeping rooms, kitchens, and similar rooms at ten air changes per hour (ACH).

16-007.04D3 New construction must provide mechanical ventilation system(s) capable of providing ACH as follows:
1. Care and treatment..............................5 ACH; and

2. Respiratory isolation............................15 ACH.

16-007.04E Electrical System: The inpatient hospice must have an electrical system that has sufficient capacity maintain the care and treatment services that are provided and that properly grounds care and treatment areas.
16-007.04E1 New construction and new facilities must have ground fault circuit interrupters protected outlets in wet areas and within six feet of sinks.

16-007.04E2 All facilities must provide minimum illumination levels as follows:
1. General purposes areas......................5 foot candles;

2. General corridors.............................10 foot candles;

3. Personal care and dining areas...........20 foot candles;

4. Reading and activity areas................30 foot candles;

5. Food preparation areas.....................40 foot candles;

6. Hazardous work surfaces...................50 foot candles;

7. Treatment and care locations..............70 foot candles;

8. Examination task lighting..................100 foot candles;

9. Reduced night lighting in bedrooms where nursing services are provided, corridors, and patient-used toilet and bathing rooms.

Light levels are measures at 30 inches above the floor in multiple areas in the room being evaluated and the readings are averaged.

16-007.04F Essential Power System: The inpatient hospice must have an emergency power generator for all care and treatment locations that involve electrical life support equipment.
16-007.04F1 Existing and new facilities must maintain emergency power for essential care and treatment equipment and lighting, medical gas systems, and nurse call systems.

16-007.04F2 New construction must maintain emergency power for essential care and treatment equipment and lighting, medical gas systems, ventilation and heating systems, and nurse call systems.

16-007.04F3 Facilities with electrical life support equipment must maintain essential power systems that must be equipped with an on-site fuel source. The minimum fuel source capacity must allow for non-interrupted system operation.

16-007.04G Call Systems: Call systems must be operable from patient beds and patient-used toilet and bathing areas. The system must transmit a receivable (visual, audible, tactile or other) signal to on-duty staff which readily notifies and directs the staff to the location where the call was activated.
16-007.04G1 In new construction, the call system must have dedicated emergency call devices which allows activation by a patient from each treatment room and cubicle and toilet and bathing fixtures.

16-007.04G2 In locations where patients are unable to activate the call, a dedicated staff assist or code call device must promptly summon other staff for assistance. Wireless call systems must have dedicated devices in all patient occupied central toilet and bathing locations to promptly summon staff to the call location.

007.05 Waivers

The Department may waive any provision of these regulations relating to construction or physical plant requirements of a licensed health care facility or health care service upon proof by the licensee satisfactory to the department (a) that such waiver would not unduly jeopardize the health, safety, or welfare of the persons residing in or served by the hospice, (b) that such provision would create an unreasonable hardship for the hospice and (c) that such waiver would not cause the State of Nebraska to fail to comply with any applicable requirements of Medicare or Medicaid so as to make the state ineligible for the receipt of all funds to which it might otherwise be entitled.

16-007.05A Unreasonable Hardship: In evaluating the issue of unreasonable hardship, the Department will consider the following:
1. The estimated cost of the modification or installation;

2. The extent and duration of the disruption of the normal use of areas used by persons residing in or served by the hospice resulting from construction work;

3. The estimated period over which the cost would be recovered through reduced insurance premiums and increase reimbursement related to costs;

4. The availability of financing; and

5. The remaining useful life of the building.

16-007.05B Waiver Terms and Conditions: Any such waiver may be granted under such terms and conditions and for such period of time as are applicable and appropriate to the waiver. Terms and conditions and period of waiver include but are not limited to:
1. Waivers that are granted to meet the special needs of a patients remain in effect as long as required by the patient.

2. Waivers may be granted for a period of time that ends at the time the conditions of approval no longer exist.

3. Waivers may be granted to permit a inpatient hospice time to come into compliance with the physical plant standards for a period of one year. Upon submission of proof of ongoing progress, the waiver may be continued for an additional year.

4. An applicant or licensee must submit any request for waiver of any construction or physical plant requirements specified in 175 NAC 16-007.

16-007.05C Denial of Waiver: If the Department denies a inpatient hospice's request for waiver, the inpatient hospice may request an administrative hearing as provided in the Administrative Procedure Act (APA) and the Department's rules and regulations adopted and promulgated under the APA.

Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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