Agency Services

(1) Admission (a) The Board of Directors in cooperation with the executive director shall establish written admission policies clearly stating who is eligible for the services of the home. (b) Pre-placement procedures must be clearly set forth. These must include providing an explanation of all agency policies, regulations, and requirements prior to a resident’s entry into the home and the resident’s written acknowledgment of having received this information. (c) Clients are to be admitted for care only after an intake evaluation by social service staff indicates that this is the most suitable plan for her. (d) Commitment to a definite plan for the child must not be a condition for admission. There must be a clear understanding that the plan for the child rests with the client. (e) Admission of a child from another state shall be in accordance with the Interstate Compact on the Placement of Children. (f) The agency must not admit any residents in excess of its licensed capacity. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (2) Discharge Policy (a) The Board of Directors in cooperation with the executive director shall establish written discharge policies. (b) Discharge policies shall be interpreted to each client at the time of application or admission. These policies must include a description for procedures for prepared discharge. (c) Normally residents shall not be discharged without medical permission and a social service plan. (d) Residents who wish to surrender their children for adoption shall be referred to a licensed child-placing agency for this service. (e) A written discharge statement shall be signed by the resident’s legal custodian or resident which relieves the agency of further legal responsibility. (3) Provision of Social Services (a) Casework services shall be available daily to every resident admitted to a maternity home, either through qualified staff or by contract with a qualified agency or individual. (b) Social Services must include: 1. Pre-admission evaluation to determine whether group care is appropriate for a particular client. 2. Regular contact, individually and/or in groups to: (i) Help the resident resolve her conflicts and handle the immediate problems; (ii) Assist the resident in planning for her child including options of marriage, single parenting or adoption; (iii) Provide service to the resident’s parents and/or the father of the child, if this is possible and appropriate; and (iv) Prepare the resident for the return to community life. (c) Adequate records shall be maintained on each applicant. The following information must be recorded: 1. Resident’s full name, date of birth, address, occupation, social security number and educational level; 2. Parents’ name and address(es) (if available); 3. Person to contact in case of emergency; 4. Name and address of alleged father, when available; 5. Date of entering the home; STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 6. Social history; 7. Report of physical examination; 8. Psychological evaluation, if available and indicated; 9. Correspondence; 10. Agreement for services must be signed by the resident, and, if a minor, signed also by her parents Consent for medical services signed by the resident and, if a minor, signed by her parents or guardian; 11. Date of discharge and final plan for the resident and her baby; and 12. At discharge, combined medical, nursing, and social service records shall be stored in a locked fire-resistant file and must be handled confidentially. (4) Health Services (a) Each maternity home shall have a medical advisor who is a licensed physician. He shall be available for individual case consultation as needed. Medical consultants must also be available to establish and periodically review standards for the provision of health services within the agency. (b) Each maternity home shall have written health service policies covering such areas as storing and administering prescription medication, provisions of medical service during the absence of staff and for other emergencies, and other aspects of the total health program. (c) Medications 1. All medications including over the counter drugs, attitude manipulators, tranquilizers, legend pain killers, barbiturates, or amphetamines, must be safeguarded by a double entry medication system whereby each medication is recorded as it comes into the agency. Administration of all medications must be documented. Medications must be double-locked within the agency. 2. The agency must not have psychotrophic drugs as stock items. Such drugs must be individually prescribed and kept in the original containers with the name of the patient, drug, dosage, frequency of administration, and prescription number unless filled directly by the physician. 3. Other prescribed medication may not be administered without a specific order or standing order from a licensed physician. (d) Each maternity home shall have the services of a registered nurse or a licensed practical nurse. Their responsibilities will be to coordinate the total health services provided each resident, maintain contact with the residents, in order to recognize problems which may require medical follow-up, and implement medical recommendations, special diets, and other routine procedures. (e) Maternity homes using local hospitals and clinics for prenatal care and/or delivery shall use only those hospitals and clinics approved and licensed by the Tennessee Department of Health and Environment. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (f) Delivery and nursery services for newborn infants, if operated by a maternity home, shall be licensed by the Tennessee Department of Health and Environment. (g) Prenatal Care 1. A medical and obstetric history shall be obtained at the time of admission. 2. Within two weeks following admission a complete examination and pelvic measurement shall be made. The admission examination shall include blood pressure determination, weight urinalysis, laboratory tests for syphilis, gonorrhea, Hepatitis B Virus and Herpes 11, tuberculin skin test, determination of hemoglobin, red and white blood cell counts, and any other special studies that may be indicated. 3. The physician shall examine the patient at least once a month in the first six (6) months of pregnancy twice a month in the seventh and eight months, weekly during the ninth month, and more often if indicated. (h) Postpartum 1. Every patient shall be given close medical nursing supervision, and allowed an adequate period for recovery. 2. Adequate diet shall be provided in accordance with the needs of the patient and on the recommendation of the physician. 3. The length of the recovery period and the continued limitation of activity shall be determined by the attending physician. 4. A postpartum examination shall be made by the physician before discharge from the home. (i) Medical and nursing records shall be kept by the appropriate staff members. (j) At the time of the resident’s discharge from the home, the medical and nursing records shall be placed in the folder with the running case record, and the complete document placed in the closed files. (k) Psychiatric and Psychological Services Psychiatrists serving maternity homes shall be board certified, or have successfully completed the requirements of a residency in psychiatry, or be currently participating in a psychiatric residency program. 1. Psychologists serving maternity homes shall have at least a Master’s degree in psychology from an accredited university. 2. Psychiatric and psychological services, if needed, shall include consultation for social service staff and group or individual services for residents under care. (1) Clinic If prenatal supervision is given by a physician in the residence, there shall be a room for medical examination. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (5) Basic and Informal Education (a) Accredited academic instructions shall be available for the mandatory school-age residents whose education has been interrupted. Arrangements must be made through the local school board to be certain that a certified teacher is used and that credits are given for work completed. Safeguards are necessary to be certain that information about the resident is handled confidentially when credits are transferred. (b) Health education shall be available including: 1. Sound hygiene practices; 2. Preparation for childbirth; 3. Infant and child care; 4. Drug and-alcohol use and abuse; 5. Family planning; 6. Sex education; 7. Parenting education; and 8. Sexually transmitted diseases. (6) The atmosphere prevailing in the home must be such as to foster the spiritual growth of the resident in her daily living. Residents shall be provided the opportunity to participate in religious activities as they desire. (7) Recreational Activities (a) Appropriate recreational activities shall be provided. (b) The participation of individual residents in strenuous recreational activities shall be approved by the staff physician. (8) Food Services (a) All maternity home facilities located in counties or municipalities which have an adopted food service code, ordinance, or regulation, must comply with such code, ordinance or regulation. (b) Food of adequate quality and quantity shall be served. The most currently recommended nutritional requirements for the expectant mother as defined by the medical consultant shall be provided. (c) Three meals and snacks shall be provided daily. (d) All special diets and diets of infants shall be prepared as prescribed by the physician. For feeding suggestions for infants, copies of “Food for Infants” can be obtained from the Tennessee Department of Health and Environment. (e) Denial of nutritionally adequate diet shall not be used as a punishment. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (f) When a qualified nutritionist or a dietitian is not on the staff, the person responsible for meal planning shall request consultation, at least twice a year, from a qualified nutritionist or dietitian. These services may be requested from the Department of Health and Environment, local colleges, universities, or hospitals, etc. (g) Menus for the week shall be prepared and posted, in advance. These menus shall be followed, although reasonable substitutions are permissible if the substituted food contains approximately the same nutrients.