New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-P - Former Division of Public Health Services
Chapter He-P 800 - RESIDENTIAL CARE AND HEALTH FACILITY RULES
Part He-P 803 - NEW HAMPSHIRE NURSING HOME RULES
Section He-P 803.03 - Definitions

Universal Citation: NH Admin Rules He-P 803.03

Current through Register No. 40, October 3, 2024

(a) "Abuse" means any one of the following:

(1) "Emotional abuse" means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of residents;

(2) "Physical abuse" means the misuse of physical force which results or could result in physical injury to residents; or

(3) "Sexual abuse" means contact or interaction of a sexual nature involving residents without his or her informed consent.

(b) "Activities of daily living (ADL)" means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

(c) "Addition" means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) "Administer" means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

(e) "Administrator" means the person responsible for the management of the licensed premises, who is licensed by the state of New Hampshire pursuant to RSA 151, and who reports to and is accountable to the governing body.

(f) "Admission" means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

(g) "Advance directive" means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term "advance directive" includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

(h) "Affiliated or related parties" means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies, or other companies as the commissioner shall decide.

(i) "Agent" means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA-J:34-37.

(j) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a nursing home pursuant to RSA 151.

(k) "Area of non-compliance" means any action or failure to act that cause(s) a licensee to be out of compliance with RSA 151, He-P 803, or other applicable federal and state requirements.

(l) "Assessment" means a systematic data collection which enables facility personnel to plan care that allows the resident to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

(m) "Care plan or treatment plan" means a documented guide developed by the licensee, in consultation with personnel, the resident, and the resident's guardian, agent, or personal representative, if any, as a result of the assessment process, for the provision of care and services to a resident.

(n) "Certified nursing home" means a nursing home that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 803.

(o) "Change of ownership" means change in the controlling interest of an established nursing home to an individual or successor business entity.

(p) "Chemical restraint" means any medication that is used for discipline or staff convenience, in order to alter a resident's behavior such that the resident requires a lesser amount of effort or care, and is not in the resident's best interest, and not required to treat medical symptoms.

(q) "Commissioner" means the commissioner of the department of health and human services or his or her designee.

(r) "Core services" means those minimal services to be provided to any resident that must be included in the basic rate.

(s) "Critical incident stress management (CISM)" means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(t) "Days" means calendar days, unless otherwise specified.

(u) "Department" means the New Hampshire department of health and human services.

(v) "Direct care" means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(w) "Direct care personnel" means any person providing direct care to a resident.

(x) "Directed plan of correction" means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

(y) "Do not resuscitate order (DNR order)" means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes "do not attempt resuscitation order (DNAR order).

(z) "Elopement" means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee's personnel.

(aa) "Emergency" means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(ab) "Emergency plan" means a document outlining the responsibilities of personnel in an emergency.

(ac) "Equipment" means "any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services", not to include portable refrigerators. This term includes fixtures.

(ad) "Exploitation" means the illegal use of a resident's person or property for another person's profit or advantage, or the breach of a fiduciary relationship through the use of a person or person's property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

(ae) "Facility" means "facility" as defined in RSA 151:19, II.

(af) "Governing body" means a group of designated person(s) that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(ag) "Guardian" means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the resident's person and/or estate.

(ah) "Health care occupancy" means an occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical, or mental disability, or because of security measures not under the occupant's control.

(ai) "Incident command system (ICS)" means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(aj) "Infectious waste" means those items specified by Env-Sw 904.

(ak) "Informed consent" means the decision by a resident, his or her guardian or agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

(al) "In-service" means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

(am) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 803 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 803.

(an) "License" means the document issued by the department to an applicant at the start of operation as a nursing home which authorizes operation as a nursing home in accordance with RSA 151 and He-P 803, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date and the license number.

(ao) "License certificate" means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the nursing home is licensed for.

(ap) "Licensed practitioner" means:
(1) Medical doctor;

(2) Physician's assistant;

(3) Advanced practice registered nurse (APRN);

(4) Doctor of osteopathy;

(5) Doctor of naturopathic medicine; or

(6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.

(aq) "Licensed premises" means the building or buildings that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(ar) "Licensee" means any person or legal entity to which a license has been issued pursuant to RSA 151.

(as) "Life safety code" means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(at) "Mechanical restraint" means a device designed to prohibit a resident's free movement, including full bed rails, gates that prohibit a resident's free movement throughout the living areas of a unit, half doors that prohibit a residents free movement throughout the living areas of a unit, geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will, wrist or ankle restraints, vests or pelvic restraints, or other similar devices that prevent a resident's free movement.

(au) "Medical director" means a physician licensed in New Hampshire pursuant to RSA 329 or 326-B, who is responsible for the implementation of resident care policies and the coordination of medical care in the facility.

(av) "Medication" means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(aw) "Modification" means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

(ax) "Neglect" means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health and safety of any resident.

(ay) "Nursing care" means the provision or oversight of a resident's physical, mental, or emotional condition or diagnosis as confirmed by a licensed practitioner.

(az) "Nursing home(s)" means a place which provides for 2 or more persons basic domiciliary services, including board, room, and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.

(ba) "Nutritional requirements" means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

(bb) "Orders" means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner..

(bc) "Over-the-counter medications" means non-prescription medications.

(bd) "Owner" means a person or organization who has controlling interest in the nursing home.

(be) "Patient or resident rights" means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

(bf) "Personal representative" means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

(bg) "Personnel" means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a resident(s).

(bh) "Physical restraint" means the use of any hands-on or other physically applied techniques to physically limit the resident's freedom of movement.

(bi) "Physician" means a medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329, or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

(bj) "Plan of correction (POC)" means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bk) "Pro re nata (PRN) medication" means medication administered as circumstances may require in accordance with licensed practitioner's orders.

(bl) "Procedure" means a licensee's written, standardized method of performing duties and providing services.

(bm) "Protective care" means the provision of resident monitoring services, including but not limited to:

(1) Knowledge of resident whereabouts; and

(2) Minimizing the likelihood of accident or injury.

(bn) "Qualifications" means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

(bo) "Qualified personnel" means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(bp) "Reconstruction" means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(bq) "Renovation" means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(br) "Repair" means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(bs) "Resident" means any individual residing in and receiving care from a nursing home licensed in accordance with RSA 151 and all other federal and state requirements.

(bt) "Resident record" means documents maintained for each resident receiving care and services, which includes all documentation required by RSA 151, He-P 803, and all documentation compiled relative to the resident as required by other federal and state requirements.

(bu) "Service" means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

(bv) "Significant change" means a decline or improvement in a resident's status that:

(1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident's health status; and

(3) Requires interdisciplinary review and/or revision of the care plan.

(bw) "State monitoring" means the placement of individuals by the department at a nursing home to monitor the operation and conditions of the facility.

(bx) "Therapeutic diet" means a diet ordered by a licensed practitioner as part of the treatment for disease or clinical conditions.

(by) "Unusual incident" means an occurrence of any of the following while the resident is either in the nursing home or in the care of nursing home personnel:

(1) The unanticipated death of a resident that is not related to their diagnosis or underlying condition;

(2) An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and that has resulted in an injury that requires treatment in an emergency room or by a licensed practitioner; or

(3) An elopement from the nursing home or other circumstances that resulted in the notification and/or involvement of law enforcement or safety officials.

(bz) "Underwriters Laboratories (UL) listed" means that a product has been confirmed safe for use by a the global safety certification company UL.

(ca) "Volunteer" means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

#9856-A, eff 1-26-11

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