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 824 - HOSPICE HOUSE
Section He-P 824.03 - Definitions

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

(b) "Activities of daily living (ADL)" means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and self-management, monitoring, or supervision 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) "Administrative remedy" means a corrective action imposed upon a licensee in response to non-compliance with RSA 151 or He-P 824.

(f) "Administrator" means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

(g) "Admission" means acceptance by a licensee for the provision of care and services to a patient and when the patient physically moves into the HH.

(h) "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.

(i) "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.

(j) "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 137-J:34-37.

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

(l) "Area of non-compliance" means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.

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

(n) "Care plan" means a written guide developed by the licensee or their personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

(o) "Change of ownership" means the transfer of the controlling interest of an established HH to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(p) "Chemical restraints" means a drug or medication that is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.

(q) "Clinical laboratory improvement amendments (CLIA)" means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

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

(s) "Contracted employee" means a temporary employee working under the direct supervision of the HH but employed by an outside agency.

(t) "Coordinator" means a person from the HH who coordinates the care and services necessary to provide optimum health care management for the patient.

(u) "Core services" means those services provided by the licensee that are included in the facility's basic rate.

(v) "Critical incident stress management (CISM)" means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

(w) "Days" means calendar days unless otherwise specified in the rule.

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

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

(z) "Direct care personnel" means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

(aa) "Directed plan of correction" means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified deficiencies.

(ab) "Discharge" means moving a patient from a licensed facility or entity to a non-licensed facility or entity.

(ac) "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 patient 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)".

(ad) "Elopement" means when a patient 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.

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

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

(ag) "Employee" means anyone employed by the HH and for whom the HH has direct supervisory authority.

(ah) "Enforcement action" means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 824.

(ai) "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".

(aj) "Exploitation" means the illegal use of a patient'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 patient through the use of undue influence, harassment, duress, deception, or fraud.

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

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

(am) "Guardian" means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient's health care and other personal needs.

(an) "Health care occupancy" means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant's control.

(ao) "Hospice" means a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

(ap) "Hospice house (HH)" means a residential setting providing a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

(aq) "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.

(ar) "Infectious waste" means those items specified by Env-Sw 103.28.

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

(at) "Informed consent" means the decision by a patient, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the patient, guardian, 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.

(au) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 824 or to respond to allegations of non-compliance with RSA 151 and He-P 824.

(av) "Laboratory" means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

(aw) "License" means the document issued to an applicant or licensee of an HH which authorizes operation in accordance with RSA 151 and He-P 824, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

(ax) "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 HH is licensed for.

(ay) "Licensed practitioner" means a:

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

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

(bb) "Licensing classification" means the specific category of services authorized by a license.

(bc) "Life safety code" means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(bd) "Mechanical restraint" means locked, secured, or alarmed HH or units within an HH, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a patient from freely exiting the HH or unit within.

(be) "Medical director" means a physician licensed in New Hampshire in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the HH.

(bf) "Medication" means a substance available with or without a prescription, used as a curative or remedial substance.

(bg) "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.

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

(bi) "Notice to correct" means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

(bj) "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.

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

(bl) "Owner" means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

(bm) "Patient" means any person admitted to or in any way receiving care, services, or both from a HH licensed in accordance with RSA 151 and He-P 824.

(bn) "Patient record" means documents maintained for each patient receiving care and services, which includes all documentation required by RSA 151 and He-P 824 and all documentation compiled relative to the patient as required by other federal and state requirements.

(bo) "Patient rights" means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

(bp) "Personal assistance" means providing or assisting a patient in obtaining one or more services as determined by their patient assessment.

(bq) "Personal representative" means a person designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose, or for the general purpose of assisting the patient in the exercise of any rights.

(br) "Personnel" means an individual, who is employed by, a volunteer of, or an independent contractor of the HH who provides services to patient(s).

(bs) "Physical restraint" means the use of hands-on or other physically applied technique to physically limit the patient's freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.

(bt) "Physician" means 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.

(bu) "Plan of correction (POC)" means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of 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.

(bv) "Point of care devices" means a system of devices used to obtain medical, diagnostic results including but not limited to:

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

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

(by) "Professional management responsibility" means that the professional staff of the HH provider continues to provide guidance and services to the patient regardless of the location of the patient.

(bz) "Professional staff" means:

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

(cb) "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.

(cc) "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.

(cd) "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.

(ce) "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.

(cf) "Reportable incident" means an occurrence of any of the following while the patient is either in the HH or in the care of HH personnel:

(cg) "Self-administration of medication" means an act whereby the patient takes his or her own medication(s) without the assistance of another person.

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

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

(cj) "State Fire Code" means the edition of the Life Safety Code 101 and Fire Code NFPA 1 adopted and amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

(ck) "State Building Code" means the edition of the International Building Code, the International Existing Building Code, the International Plumbing Code, the International Mechanical Code, the International Energy Conservation Code, the International Swimming Pool and Spa Code, and the International Residential Code, as published by the International Code Council, and the National Electrical Code adopted and amended by the state building code review board and ratified by the legislature in accordance with RSA 155-A:10.

(cl) "State monitoring" means the placement of individuals by the department at an HH to monitor the operation and conditions of the facility.

(cm) "Temporary manager" means a person appointed by the department to assume responsibility for the day-to-day operation and administration of an HH.

(cn) "Transfer" means moving a patient from one licensed facility or entity to another licensed facility or entity.

(co) "Underwriters Laboratories (UL) Listed" means that the global safety certification company UL has confirmed that the product is safe for use.

(cp) "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.