Admissions, Discharges, And Transfers

(1) Every person admitted for care or treatment shall be under the supervision of a physician who holds a license in good standing to practice in Tennessee. The name of the resident’s attending physician shall be recorded in the resident’s medical record. The nursing home shall not admit the following types of residents: (a) Persons who pose a clearly documented danger to themselves or to other residents in the nursing home. (b) Children under fourteen (14) years of age, except when the department has approved the admission of a specific child. (c) Persons for whom the nursing home is not capable of providing the care ordered by the attending physician. Documentation of the reason(s) for refusal of the admission shall be maintained. (2) A diagnosis must be entered in the admission records of the nursing home for every person admitted for care or treatment. (3) Prior to the admission of a resident to a nursing home or prior to the execution of a contract for the care of a resident in a nursing home (whichever occurs first), each nursing home shall disclose in writing to the resident or to the resident’s guardian, conservator or representative, if any, whether the facility has liability insurance and the identity of the primary insurance carrier. If the facility is self-insured, their statement shall reflect that fact and indicate the corporate entity responsible for payment of any claims. (4) Any residential facility licensed by the board of licensing health care facilities shall upon admission provide to each resident the division of adult protective services’ statewide toll-free number: 888-277-8366. (5) Facilities utilizing secured units must be able to provide survey staff with twelve (12) months of the following performance information specific to the secured unit and its residents: (a) Documentation that each secured resident has been evaluated by an interdisciplinary team consisting of at least a physician, a social worker, a registered nurse, and a family member (or patient care advocate) prior to admittance to the unit; (b) Ongoing and up-to-date documentation of quarterly review by each resident’s interdisciplinary team as to the appropriateness of placement in the secured unit; (c) A current listing of the number of deaths and hospitalizations with diagnoses that have occurred on the unit; STANDARDS FOR NURSING HOMES CHAPTER 0720-18 (d) A current listing of all unusual incidents and/or complications on the unit; (e) An up-to-date staffing pattern and staff ratios for the unit is recorded on a daily basis. The staffing pattern must ensure that there is a minimum of one (1) attendant, awake, on duty, and physically located on the unit twenty-four (24) hours per day, seven (7) days per week at all times; (f) A formulated calendar of daily group activities scheduled including a resident attendance record for the previous three (3) months; (g) An up-to-date listing of any incidences of decubitus and/or nosocomial infections, including resident identifiers; and, (h) Documentation showing that 100% of the staff working on the unit receives and has received annual in-service training which shall include, but not be limited to the following subject areas: 1. Basic facts about the causes, progression and management of Alzheimer’s Disease and related disorders; 2. Dealing with dysfunctional behavior and catastrophic reactions in the residents; 3. Identifying and alleviating safety risks to the resident; 4. Providing assistance in the activities of daily living for the resident; and, 5. Communicating with families and other persons interested in the resident. (6) The facility shall ensure that no person on the grounds of race, color, national origin, or handicap, will be excluded from participation in, be denied benefits of, or otherwise subjected to discrimination in the provision of any care or service of the facility. The facility shall protect the civil rights of residents under the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. (7) Any admission in excess of the licensed bed capacity is prohibited except when an emergency admission is directed by the department. (8) No resident shall be discharged without a written order from the attending physician or through other legal processes and timely notification of next of kin and/or sponsor or authorized representative, if any. Each nursing home shall establish a policy for handling patients who wish to leave against medical advice. (9) When a resident is discharged, a brief description of the significant findings and events of the resident’s stay in the nursing home, the condition on discharge and the recommendation and arrangement for future care, if any, shall be provided. (10) No resident shall be transferred without a written order from the attending physician or through other legal processes and timely notification of next of kin and/or sponsor or authorized representative, if any. (11) When a resident is transferred, a summary of treatment given at the nursing home, condition of the resident at time of transfer and date and place to which he is transferred shall be entered in the record. If the transfer is due to an emergency, this information will be recorded within forty-eight (48) hours, otherwise, it will precede the transfer of the resident. STANDARDS FOR NURSING HOMES CHAPTER 0720-18 (12) When a resident is transferred, a copy of the clinical summary shall, with consent of the resident, be sent to the nursing home that will continue the care of the resident. (13) Where an involuntary transfer is proposed, in addition to any other relevant factors, the following factors shall be taken into account: (a) The traumatic effect on the resident. (b) The proximity of the proposed nursing home to the present nursing home and to the family and friends of the resident. (c) The availability of necessary medical and social services at the proposed nursing home. (d) Compliance by the proposed nursing home with all applicable federal and state regulations. (14) When the attending physician has ordered a resident transferred or discharged, but the resident or a representative of the resident opposes the action, the nursing home shall counsel with the resident, the next of kin, sponsor and representative, if any, in an attempt to resolve the dispute and shall not transfer the resident until such counseling has been provided. No involuntary transfer or discharge shall be made until the nursing home has first informed the department and the area long-term care ombudsman. Unless a disaster occurs on the premises or the attending physician orders the transfer as a medical emergency (due to the resident’s immediate need for a higher level of care) no involuntary transfer or discharge shall be made until five (5) business days after these agencies have been notified, unless they each earlier declare that they have no intention of intervening. (15) Except when the Board has revoked or suspended the license, a nursing home which intends to close, cease doing business, or reduce its licensed bed capacity by ten percent (10%) or more shall notify both the department and the area long-term care ombudsman at the earliest moment of the decision, but not later than thirty (30) days before the action is to be implemented. The facility shall establish a protocol, subject to the department’s approval, for the transfer or discharge of the residents. Should the nursing home violate the provisions of this paragraph, the department shall request the Attorney General of the State of Tennessee to intervene to protect the residents, as is provided by T.C.A. § 68-11-213(a).