New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter V - Medical Facilities
Subchapter A - Medical Facilities-minimum Standards
Article 3 - Residential Care Facilities
Part 415 - Nursing Homes-minimum Standards
Optional Services
Section 415.36 - Long-term inpatient rehabilitation program for head-injured residents
Universal Citation: 10 NY Comp Codes Rules and Regs ยง 415.36
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Definition. A head injury program shall mean a planned combination of services provided in a nursing home unit approved by the commissioner pursuant to Part 710 of this Title as a provider of specialized services for head-injured residents on a designated resident care unit of at least 20 beds. The head-injury program shall be designed specifically to serve medically stable, traumatically brain-injured individuals with an expected length of stay from 3 to 12 months. The program shall provide goal-oriented, comprehensive, interdisciplinary and coordinated services directed at restoring the individual to the optimal level of physical, cognitive and behavioral functioning. The population served shall consist primarily of individuals with traumatically acquired, nondegenerative, structural brain damage resulting in residual deficits and disability. The program shall not admit or retain individuals who are determined to be a danger to self or others.
(b) General requirements. The nursing home shall ensure:
(1) the development and implementation of a
planned and systematic program for monitoring and assessing the quality and
appropriateness of resident care to assure care is provided in accordance with
current standards of professional practice. The quality assurance process shall
define methods for the identification and selection of clinical and
administrative problems to be reviewed with written documentation of such
reviews. The process shall include but not be limited to reviews of clinical
records, resident and family complaints and suggestions, incident reports and
the resident's response to discharge plans. There shall be documentation that
recommendations are followed up, action is taken to resolve identified problems
and results of such action are assessed periodically;
(2) sufficient space, equipment and
facilities are available to support the clinical, educational and
administrative functions of the program in accordance with standards set forth
in Parts 711 and 713 of this Title;
(3) transfer agreements are in effect with
other facilities, in accordance with section
400.9 of this Title for the
acceptance of referrals or the transfer of head-injured residents in need of
services not available at the facility;
(4) the development and consistent
application of written admission and continued stay criteria for this service
which include but are not limited to the use of a generally recognized
classification system for measuring each individual's physical, affective,
behavioral and cognitive level of functioning and the family's capabilities and
functioning, and are consistent with the following requirements:
(i) a resident admitted for long-term
rehabilitation shall be a person who has suffered a traumatic brain injury with
structural nondegenerative brain damage, is medically stable, is not in a
persistent vegetative state, demonstrates potential for physical, behavioral
and cognitive rehabilitation and may evidence moderate to severe behavior
abnormalities. The resident must be capable of exhibiting at least localized
responses by reacting specifically but inconsistently to stimuli;
(ii) a resident admitted for coma management
shall be a person who has suffered a traumatic brain injury with structural
nondegenerative brain damage and is in a coma. The resident may be completely
unresponsive to any stimuli or may exhibit a generalized response by reacting
inconsistently and nonpurposefully to stimuli in a nonspecific manner;
and
(iii) a resident who has
diffuse brain damage caused by anoxia, toxic poisoning, cerebral vascular
accident, or encephalitis may be admitted to this program if considered
appropriate for coma management and long-term rehabilitation;
(5) records are maintained for at
least two years identifying persons who were determined by the facility to be
ineligible for admission under the head injury program. The records should
indicate the reason for ineligibility and any referral action taken;
(6) inservice and continuing education
programs which address the medical, physical, cognitive, psychosocial and
behavioral needs of head injured residents are conducted on a regular basis for
all personnel caring for such residents;
(7) educational programs are conducted for
personnel not providing direct care but who come in contact on a regular basis
with head-injured residents. The programs should familiarize personnel with the
specific needs of these residents; and
(8) education and counseling services are
available and offered to the residents and families as needed.
(c) Program management and staffing. There shall be distinct staffing for the direct care services in the head injury program unit.
(1) The program
shall be administered by a program director who has at least two years of
clinical or administrative experience in head injury rehabilitation programs.
The program director has specific responsibilities which include but are not
limited to:
(i) administrative direction and
oversight of the program;
(ii)
ongoing review of the program and implementation of program changes as
identified; and
(iii) development
and implementation of educational programs on an ongoing basis for staff
working with head injured residents.
(2) A physician who has advanced training and
experience in the care of the head injured shall be responsible for the medical
direction and medical oversight of the head injury program.
(3) A qualified specialist in physical
medicine and rehabilitation or a physician who has training and experience in
the care and rehabilitation of head injured patients or residents shall be
responsible for the medical management of each resident.
(4) Head injury programs admitting and
retaining residents who also require treatment for psychiatric disorders shall
have on staff qualified specialists in psychiatry sufficient in number to meet
the needs of these residents. A qualified specialist in psychiatry shall be
designated to assist in the development and implementation of policies and
procedures governing the provision of services for residents with psychiatric
disorders, including criteria for transfer of such residents to an appropriate
program which is licensed under the Mental Hygiene Law.
(5) A primary interdisciplinary team of
health care professional with special interest, training, experience and
expertise in head injury rehabilitation shall be responsible for the
assessment, coordinated program and care planning, and direct services for each
head injured resident. The interdisciplinary team members shall be specifically
assigned to serve head injured resident and the team shall include as a minimum
the following types of health care professionals:
(i) physician;
(ii) registered professional nurse;
(iii) physical therapist;
(iv) occupational therapist;
(v) speech-language pathologist;
(vi) social worker;
(vii) dietitian;
(viii) therapeutic recreation specialist;
and
(ix) clinical psychologist with
at least one year of training in neuropsychology.
(6) Nursing services for the head injury unit
shall be under the direction of a registered professional nurse with experience
in the provision of rehabilitation nursing for head injured patients or
residents.
(7) There shall be at
least one registered professional nurse with experience in rehabilitation
nursing assigned to each shift on the head injury unit.
(8) Consultative services of qualified
specialists shall be available as needed to the head injury program in
accordance with resident needs.
(9)
Depending upon types of residents being served and individual resident's needs,
the program shall provide or make formal arrangements for vocational
rehabilitation services and special education services.
(d) Interdisciplinary care planning.
(1) A member of the interdisciplinary team
managing the resident shall be designated to:
(i) coordinate the overall plan of care and
services and identify unmet needs for each resident including discharge and
follow-up plans;
(ii) serve as a
liaison among resident, family and staff to ensure that resident and family
concerns are addressed; and
(iii)
serve as a liaison with educational, social and vocational resources in the
community which are serving the resident.
(2) A written, comprehensive care plan shall
be developed and implemented which establishes rehabilitation goals for each
resident. The plan shall be developed on admission by the interdisciplinary
team and the attending physician in consultation with the resident, the
resident's family and outside agencies, as necessary. The care plan shall be
reviewed at least every 14 days and modified according to the resident's needs
by the interdisciplinary team. The comprehensive care plan is based upon total
and ongoing integrated, interdisciplinary assessments which shall address as a
minimum, medical and neurological status, emotional and psychiatric status,
nutritional status, the developmental needs of children and adolescents,
sensorimotor capacity, cognitive, perceptual and communicative capacity, affect
and mood, activities of daily living skills, educational or vocational
capacities, sexuality issues and concerns, family counseling and community
reintegration needs and recreation and leisure time interests.
(3) A written discharge plan shall be
developed within 30 days of admission for each resident as part of the overall
care plan and shall include input from all professionals caring for the
resident, the resident's family, and as appropriate, any outside agency or
resource that will be involved with the resident following discharge.
(4) The family and resident shall receive
preparation for discharge through the facility's educational and counseling
services.
(5) Provision shall be
made by the facility for the follow-up of each resident after discharge to
assess the resident's response to the discharge plan.
(e) Utilization review monitoring. The facility shall participate with the commissioner or his designee in a program of resident care and services monitoring which shall include but not be limited to review of admissions, care and services provided, continued stays, and discharge planning. The facility shall furnish such records and reports at such frequency as the commissioner or his designee may require and shall make available members of the interdisciplinary resident care team for case conferences as the commissioner or his designee deems necessary.
Disclaimer: These regulations may not be the most recent version. New York 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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