Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Activities of Daily Living (ADL’s). Those personal functional activities which indicate an individual’s independence in eating, dressing, personal hygiene, bathing, toileting, and moving from one place to another. (3) Adult. An individual who has capacity and is at least 18 years of age. (4) Advance Directive. An individual instruction or a written statement relating to the subsequent provision of health care for the individual, including, but not limited to, a living will or a durable power of attorney for health care. (5) Aged. A person who is fifty-five (55) years of age or older. (6) Agent. An individual designated in an advance directive for health care to make a health care decision for the individual granting the power. (7) Ambulatory Resident. A resident who is physically and mentally capable under emergency conditions of finding a way to safety without physical assistance from another person. An ambulatory resident may use a cane, wheelchair or other supportive device and may require verbal prompting. (8) Board. The Tennessee Board for Licensing Health Care Facilities. (9) Capacity. An individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision. These regulations do not affect the right of a resident to make health care decisions while having the capacity to do so. A resident shall be presumed to have capacity to make a health care decision, to give or revoke an advance directive, and to designate or disqualify a surrogate. Any person who challenges the capacity of a resident shall have the burden of proving lack of capacity. (10) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to restore or support cardiopulmonary function in a resident, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilators or respirations, defibrillation, the administration of drugs and/or STANDARDS FOR HOMES FOR THE AGED CHAPTER 0720-21 chemical agents intended to restore cardiac and/or respiratory functions in a resident where cardiac or respiratory arrest has occurred or is believed to be imminent. (11) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (12) Department. The Tennessee Department of Health. (13) Designated Physician. A physician designated by an individual or the individual’s agent, guardian, or surrogate, to have primary responsibility for the individual’s health care or, in the absence of designation or if the designated physician is not reasonably available, a physician who undertakes such responsibility. (14) Do-Not-Resuscitate Order (DNR). A written order, other than a POST, not to resuscitate a patient in cardiac or respiratory arrest in accordance with accepted medical practices. (15) Emancipated Minor. Any minor who is or has been married or has by court order or otherwise been freed from the care, custody and control of the minor’s parents. (16) Emergency. Any situation or condition which presents an imminent danger of death or serious physical or mental harm to residents. (17) Emergency Responder. A paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer acting within the scope of his or her proper function under law or rendering emergency care at the scene of an emergency. (18) Evacuation Capability. The ability to either evacuate the building or move to a point of safety. (19) Guardian. A judicially appointed guardian of conservator having authority to make a health care decision. (20) Hazardous Waste. Materials whose handling, use, storage, and disposal are governed by local, state, or federal regulations. (21) Health Care. Any care, treatment, service or procedure to maintain, diagnose, treat, or otherwise affect an individual’s physical or mental condition, and includes medical care as defined in T.C.A. § 32-11-103(5). (22) Health Care Decision. Consent, refusal or consent or withdrawal of consent to health care. (23) Health Care Decision-Maker. In the case of a resident who lacks capacity, the resident’s health care decision-maker is one of the following: the resident’s health care agent as specified in an advance directive, the resident’s court-appointed guardian or conservator with healthcare decision-making authority, the resident’s surrogate as determined pursuant to Rule 0720-21-.12 or T.C.A. § 33-3-220, the designated physician pursuant to these rules or in the case of a minor child, the person having custody or legal guardianship. (24) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (25) Health Care Provider A person who si licensed, certified or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession. (26) Holding Out to the Public. Advertising or soliciting the public through the use of personal, telephone, mail or other forms of communication to provide information about services provided by the facility. STANDARDS FOR HOMES FOR THE AGED CHAPTER 0720-21 (27) Home for the Aged. A home represented and held out to the general public as a home which accepts primarily aged persons for relatively permanent, domiciliary care with primarily being defined as 51% or more of the population of the home for the aged. It provides room, board and personal services to four (4) or more nonrelated persons. The term home includes any building or part thereof which provides services as defined in these rules. (28) Home for the Aged Resident. A person who is ambulatory and who requires permanent, domiciliary care but who will be transferred to a licensed hospital, licensed nursing home or licensed assisted care living facility when health care services are needed which must be provided in such other facilities. (29) Incompetent. A resident who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity. (30) Individual Instruction. An individual’s direction concerning a health care decision for the individual. (31) Infectious Waste. Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host could result in an infectious disease. (32) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. (33) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (34) Medically Inappropriate Treatment Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the resident or other medical or surgical treatments to achieve the expressed goals of the informed resident. In the case of the incompetent resident, the resident’s representative expresses the goals of the resident. (35) N.F.P.A. The National Fire Protection Association. (36) Misappropriation of Patient/Resident Property. The deliberate misplacement, exploitation or wrongful, temporary or permanent use of an individual’s belongings or money without the individual’s consent. (37) Neglect. The failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness; however, the withholding of authorization for or provision of medical care to any terminally ill person who has executed an irrevocable living will in accordance with the Tennessee Right to Natural Death Law, or other applicable state law, if the provision of such medical care would conflict with the terms of the living will, shall not be deemed “neglect” for purposes of these rules. (38) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency or instrumentality, or any other legal or commercial entity. (39) Personal Services. Those services that are rendered to residents who need supervision or assistance in activities of daily living. Personal services must include protective care of the resident, responsibility for the safety of the resident when in the facility, daily awareness of the resident’s whereabouts and the ability and readiness to intervene if crises arise. Personal services do not include nursing or medical care. STANDARDS FOR HOMES FOR THE AGED CHAPTER 0720-21 (40) Personally Informing. A communication by any effective means from the resident directly to a health care provider. (41) Physician Assistant. A person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under Title 63, Chapter 19. (42) Physician Orders for Scope of Treatment or POST. Written orders that: (a) Are on a form approved by the Board for Licensing Health Care Facilities; (b) Apply regardless of the treatment setting and that are signed as required herein by the patient’s physician, physician assistant, nurse practitioner, or clinical nurse specialist; and (c) 1. Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted; 2. Specify other medical interventions that are to be provided or withheld; or 3. Specify both 1. and 2. (43) Power of Attorney for Health Care. The designation of an agent to make health care decisions for the individual granting the power under T.C.A. Title 34, Chapter 6, Part 2. (44) Qualified Emergency Medical Service Personnel. Includes, but shall not be limited to, emergency services personnel providers, or entities acting within the usual course of their professions, and other emergency responders. (45) Reasonably Available. Readily able to be contacted without undue effort and willing and able to act in a timely manner considering the urgency of the resident’s health care needs. Such availability shall include, but not limited to, availability by telephone. (46) Responsible Attendant. The person designated by the licensee who remains awake to provide personal services to the residents. In the absence of the licensee, the responsible attendant is responsible for ensuring the home complies with all rules and regulations. (47) Secured Unit. A facility or distinct part of a facility where the residents are intentionally denied egress by any means. (48) Shall or Must. Compliance is mandatory. (49) State. A state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States. (50) Supervising Heath Care Provider. The designated physician or, if there is no designated physician or the designated physician is not reasonably available, the health care provider who has undertaken primary responsibility for an individual’s health care. (51) Surrogate. An individual, other that a resident’s agent or guardian, authorized to make a health care decision for the resident. (52) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the resident. STANDARDS FOR HOMES FOR THE AGED CHAPTER 0720-21