Current through Reg. 49, No. 38; September 20, 2024
Based on the comprehensive assessment of a resident, the
facility must ensure that a resident receives treatment and care in accordance
with professional standards of practice, the comprehensive person-centered care
plan, and the resident's choices, including the following:
(1) Vision and hearing. To ensure that a
resident receives proper treatment and assistive devices to maintain vision and
hearing abilities, the facility must, if necessary, assist the resident:
(A) in making appointments; and
(B) by arranging for transportation to and
from the office of a practitioner specializing in the treatment of vision or
hearing impairment or the office of a professional specializing in the
provision of vision or hearing assistive devices.
(2) Skin Integrity.
(A) Pressure ulcers. Based on the
comprehensive assessment of the resident, the facility must ensure that:
(i) a resident receives care, consistent with
professional standards of practice, to prevent pressure ulcers and does not
develop pressure ulcers unless the resident's clinical condition demonstrates
that they are unavoidable; and
(ii)
a resident with pressure ulcers receives necessary treatment and services,
consistent with professional standards of practice, to promote healing, prevent
infection, and prevent new ulcers from developing.
(B) Foot Care. To ensure that a resident
receives proper treatment and care to maintain mobility and good foot health,
the facility must:
(i) provide foot care and
treatment, in accordance with professional standards of practice, including to
prevent complications from the resident's medical condition; and
(ii) if necessary, assist the resident in
making appointments with a qualified person, and arranging for transportation
to and from such appointments.
(3) Incontinence.
(A) The facility must ensure that a resident
who is continent of bladder and bowel on admission receives services and
assistance to maintain continence unless the resident's clinical condition is
or becomes such that continence is not possible to maintain.
(B) For a resident with urinary incontinence,
based on the comprehensive assessment of the resident, the facility must ensure
that:
(i) a resident who enters the facility
without an indwelling catheter is not catheterized unless the resident's
clinical condition demonstrates that catheterization is necessary;
(ii) a resident who enters the facility with
an indwelling catheter or subsequently receives one is assessed for removal of
the catheter as soon as possible unless the resident's clinical condition
demonstrates that catheterization is necessary; and
(iii) a resident who is incontinent of
bladder receives appropriate treatment and services to prevent urinary tract
infections and to restore continence to the extent possible.
(C) For a resident with fecal
incontinence, based on the resident's comprehensive assessment, the facility
must ensure that a resident who is incontinent of bowel receives appropriate
treatment and services to restore as much normal bowel function as
possible.
(4) Colostomy,
urostomy, or ileostomy care. The facility must ensure that a resident who
requires colostomy, urostomy, or ileostomy services, receives such care
consistent with professional standards of practice, the comprehensive care
plan, and the resident's goals and preferences.
(5) Mobility. The facility must ensure that:
(A) a resident who enters the facility
without a limited range of motion does not experience reduction in range of
motion unless the resident's clinical condition demonstrates that a reduction
in range of motion is unavoidable;
(B) a resident with a limited range of motion
receives appropriate treatment and services to increase range of motion and to
prevent further decrease in range of motion; and
(C) a resident with limited mobility receives
appropriate services, equipment, and assistance to maintain or improve mobility
with the maximum practicable independence unless a reduction in mobility is
unavoidable.
(6)
Assisted nutrition and hydration. (Includes naso-gastric and gastrostomy tubes,
both percutaneous endoscopic gastrostomy and percutaneous endoscopic
jejunostomy, and enteral fluids). Based on a resident's comprehensive
assessment, the facility must ensure that a resident:
(A) maintains acceptable parameters of
nutritional status, such as usual body weight or desirable body weight range
and electrolyte balance, unless the resident's clinical condition demonstrates
that this is not possible or the resident preferences indicate
otherwise;
(B) is offered
sufficient fluid intake to maintain proper hydration and health;
(C) is offered a therapeutic diet when there
is a nutritional problem and the health care provider orders a therapeutic
diet;
(D) who has been able to eat
enough alone or with assistance is not fed by enteral methods unless the
resident's clinical condition demonstrates that enteral feeding was clinically
indicated and consented to by the resident; and
(E) who is fed by enteral means receives the
appropriate treatment and services to restore, if possible, oral eating skills
and to prevent complications of enteral feeding including aspiration pneumonia,
diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal
ulcers.
(7) Parenteral
fluids. Parenteral fluids must be administered consistent with professional
standards of practice and in accordance with physician orders, the
comprehensive care plan, and the resident's goals and preferences.
(8) Respiratory care, including tracheostomy
care and tracheal suctioning. The facility must ensure that a resident who
needs respiratory care, including tracheostomy care and tracheal suctioning, is
provided such care, consistent with professional standards of practice, the
comprehensive care plan, the resident's goals and preferences, and §
554.802 of this chapter, (relating to Comprehensive Person-Centered Care
Planning).
(9) Prostheses. The
facility must ensure that a resident who has a prosthesis is provided care and
assistance, consistent with professional standards of practice, the
comprehensive care plan, and the resident's goals and preferences, to wear and
be able to use the prosthetic device.
(10) Pain management. The facility must
ensure that pain management is provided to a resident who requires such
services, consistent with professional standards of practice, the comprehensive
care plan, and the resident's goals and preferences.
(11) Dialysis. The facility must ensure that
a resident who requires dialysis receives such services, consistent with
professional standards of practice, the comprehensive care plan, and the
resident's goals and preferences.
(12) Trauma-informed care. Effective November
28, 2019, the facility must ensure that a resident who is a trauma survivor
receives culturally-competent, trauma-informed care in accordance with
professional standards of practice and accounting for resident's experiences
and preferences in order to eliminate or mitigate triggers that may cause
re-traumatization of the resident.
(13) Bed rails. The facility must attempt to
use appropriate alternatives before installing a side or bed rail. If a bed or
side rail is used, the facility must ensure correct installation, use, and
maintenance of bed rails, including the following elements:
(A) assess the resident for risk of
entrapment from bed rails before installation;
(B) review the risks and benefits of bed
rails with the resident or resident representative and obtain informed consent
before installation;
(C) ensure the
bed's dimensions are appropriate for the resident's size and weight;
and
(D) follow the manufacturers'
recommendations and specifications for installing and maintaining bed
rails.
(14) Accidents.
The facility must ensure that:
(A) the
resident environment remains as free of accident hazards as possible;
and
(B) each resident receives
adequate supervision and assistive devices to prevent accidents.
(15) Pediatric care.
(A) Licensed nursing care of children. A
facility caring for children must have 24 hour a day on-site licensed nursing
staff in numbers sufficient to provide safe care. For any facility with five or
more children under 26 pounds, at least one nurse must be assigned solely to
the care of those children.
(B)
Fewer than five pediatric residents. Facilities with fewer than five pediatric
residents must assure that the children's rooms are in close proximity to the
nurses' station.
(C) Respiratory
care of children.
(i) To facilitate the care
of ventilator-dependent children or children with tracheostomies, a facility
must group those children in rooms contiguous or in close proximity to each
other. An exception to this rule is children who are able to be schooled
off-site.
(ii) Facilities must
assure that alarms on ventilators, apnea monitors, and any other such equipment
uniquely identify the child or the child's room.
(iii) A facility caring for children with
tracheostomies requiring daily care (including ventilator-dependent children
with tracheostomies) must have 24 hour a day on-site respiratory therapy staff
in numbers sufficient to provide a safe ratio of respiratory therapist per
these residents. For the purposes of this rule, respiratory therapy staff is
defined as a registered respiratory therapist (RRT), a certified respiratory
therapy technician (CRT), or a licensed nurse whose primary function is
respiratory care.
(I) If the facility cares
for nine or more children with tracheostomies requiring daily care (including
ventilator-dependent children with tracheostomies), the facility must maintain
a ratio of no less than one respiratory therapy staff per nine tracheostomy
residents 24 hours a day.
(II) If
the facility cares for six or more ventilator dependent children, the facility
must:
(-a-) designate a respiratory therapy
supervisor, either on staff or contracted who must be credentialed by the
National Board for Respiratory Care (either CRT or RRT).
(-b-) provide and document that all
respiratory therapy staff is trained in the care of children who are ventilator
dependent. This training must be reviewed annually.
(-c-) assure that appropriate care,
maintenance, and disinfection of all ventilator equipment and accessories
occurs.
