Current through Register Vol. 48, No. 9, September 27, 2024
A. Individuals
seeking admission shall be identified as appropriate for the level of care,
services, or assistance offered. The facility shall establish admission
criteria that are consistently applied and comply with local, State, and
Federal laws and regulations.
B.
The facility shall admit and retain only those persons appropriate for
placement in a CRCF in compliance with the standards of this
regulation.
C. The facility shall
not admit or retain any of the following persons in compliance with the
standards of this regulation:
1. Any person
who is likely to endanger him/herself or others as determined by a physician or
other authorized healthcare provider;
2. Any person other than an adult;
(II)
3. Any person needing
hospitalization or nursing home care;
4. Any person needing daily skilled
monitoring/observation due to an unstable or complex medical condition,
e.g., brittle diabetes, dialysis patients with complications
such as infections in the blood;
5.
Any person needing medications that require frequent dosage adjustment,
regulation and/or monitoring, e.g.diabetics receiving sliding
scale insulin;
6. Any person
needing intravenous medications or fluids, regular intra-muscular and
subcutaneous injections by staff or by responsible party. This does not include
injections administered on a part-time or intermittent basis by non-staff
licensed nurses. Routine injection(s) of insulin scheduled daily or less
frequently are permitted;
7. Any
person needing care of urinary catheter that cannot be managed independently by
the resident;
8. Any person needing
treatment of stage 2, 3 or 4 decubitus ulcers, or multiple pressure sores or
other widespread skin disorder (important considerations include: signs of
infection, full thickness tissue loss, or requirement of sterile
technique);
9. Any person needing
nasogatric tube feeding or having to be fed by a syringe or straw due to
difficulties in swallowing. Gastronomy tube feedings that cannot be managed
independently by the resident;
10.
Any person needing suctioning of the nose and/or mouth;
11. Any person needing tracheostomy or
sterile care of the tracheostomy that cannot be managed independently by the
resident; or
12. Any person
receiving oxygen for the first time, which requires adjustment and evaluation
of oxygen concentration.
D. The facility shall not retain any of the
following persons in compliance with the standards of this regulation:
1. Any person who has a serious aggressive,
violent or socially inappropriate behavioral symptoms which cannot be
controlled or improved in the facility.
2. Any person who has a dependency in all
activities of daily living for more than fourteen (14) consecutive days,
e.g., bedridden; incapable of locomotion; unable to transfer;
totally incontinent of urinary and/or bowel function; must be totally bathed
and dressed and toileted and needs extensive assistance to eat. The facility
shall develop a plan for transfer on the fifteenth
(15th) day of total dependency if the resident is
not improving.
3. Any person
needing the continuous daily attention of a licensed nurse, e.g.
care of a urinary catheter that cannot be managed independently,
treatment of stage 2, 3, or 4 decubitus ulcers. Nursing care may be furnished
to residents in need of short-term intermittent nursing care (no more than
fourteen (14) consecutive days) while convalescing from illness or injury,
provided the nursing services, e.g., the utilization of a home
health nurse for sterile dressing changes or for observation related to a
surgical site, are furnished by a licensed nurse facility staff member or a
home health nurse.
E.
Residents whose condition changes to a degree that nursing home care, the daily
attention of a nurse, or hospitalization may be required, or have a contagious
disease, shall be examined by a physician or other authorized healthcare
provider regarding the possible necessity for transfer to a facility where the
resident's eligibility for admission is appropriate.
F. When the provision of care/services in the
facility, combined with other appropriately licensed services, in accordance
with facility policy, e.g., hospice, home health, as may be ordered by a
physician or other authorized healthcare provider, does not meet the needs of
the resident, or if any resident becomes in need of continuous medical or
nursing supervision, or if the facility does not have the capability to provide
necessary care/services, the resident shall be transferred within 30 days to a
location which shall meet those needs. The administrator shall coordinate this
transfer with the resident, next-of-kin/responsible party, and
sponsor.
