Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Administrator. An individual appointed by a governing body who is responsible for the day to day management of the hospice program. (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) Agent. An individual designated in an advance directive for health care to make a health care decision for the individual granting the power. (6) Bereavement Counseling. Counseling services provided to the patient’s or resident’s family both prior to and after the patient’s or resident’s death. (7) Bereavement Counselor. An individual who has at least a bachelor’s degree in social work, counseling, psychology, pastoral care, or specialized training or experience in bereavement theory and counseling. (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 patient or resident to make health care decisions while having the capacity to do so. A patient or 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 patient or resident shall have the burden of proving lack of capacity. (10) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to support cardiopulmonary functions in a patient or resident, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilations or respirations, defibrillation, the administration of drugs and/or STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 chemical agents intended to restore cardiac and/or respiratory functions in a patient or resident where cardiac or respiratory arrest has occurred or is believed to be imminent. (11) Certified Master Social Worker. A person currently certified as such by the Tennessee Board of Social Worker Certification and Licensure. (12) Clinical Fellow. A Speech Language Pathologist who is in the process of obtaining his or her paid professional experience, as defined by a Communications Disorders and Sciences Board-approved accreditation agency, before being qualified for licensure. (13) Clinical Note. A written and dated notation containing a patient or resident assessment, responses to medications, treatments and services, and/or any changes in condition signed by a health team member who made contact with the patient or resident. (14) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (15) Competent. A patient or resident who has capacity. (16) Core Services. Services consisting of nursing, medical social services, physician services and counseling services. (17) Department. The Tennessee Department of Health. (18) 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 a designation or if the designated physician is not reasonably available, a physician who undertakes such responsibility. (19) Dietitian. A person currently licensed as such by the Tennessee Board of Dietitian/Nutritionist Examiners. Persons exempt from licensure shall be registered with the American Diabetics Association pursuant to T.C.A. § 63-25-204. (20) 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. (21) 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. (22) 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. (23) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (24) Hazardous Waste. Materials whose handling, use, storage, and disposal are governed by local, state, or federal regulations. (25) 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). (26) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (27) Health Care Decision-Maker. In the case of a patient or resident who lacks capacity, the patient’s or resident’s health care decision-maker is one of the following: the patient’s or resident’s health care agent as specified in an advance directive, the patient’s or resident’s court-appointed guardian or conservator with health care decision-making authority, the patient’s or resident’s surrogate as determined pursuant to Rule 0720-23-.13 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. (28) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (29) Health Care Provider. A person who is 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. (30) HIV Resident. An individual who is in need of domiciliary care and who has been diagnosed and certified in writing by a licensed physician as being HIV (human immunodeficiency virus) positive. (31) Home Care Organization. As defined by T.C.A. § 68-11-201 “home care organization” provides home health services, home medical equipment services or hospice services to patients on an outpatient basis in either their regular or temporary place of residence. (32) Home Health Aide/Hospice Aide. A person who has completed a total of seventy-five (75) hours of training which included sixteen (16) hours of clinical training prior to or during the first three (3) months of employment and who is qualified to provide basic services, including simple procedures as an extension of therapy services, personal care regarding nutritional needs, ambulation and exercise. (33) Hospice Care Clinical Coordinator. A person identified as being responsible for the clinical management of all aspects of a hospice program. The hospice clinical coordinator must have at least one (1) year of supervisory experience in hospice or home health care and be either a licensed physician or a registered nurse. (34) Hospice Patient. An individual who: (a) Has been diagnosed as terminally ill; (b) Has been certified in writing by a physician to have an anticipated life expectancy of six (6) months or less; and, (c) Has voluntarily requested admission to, and been accepted by a licensed hospice. (35) Hospice Services. As defined by T.C.A. § 68-11-201, “hospice services” means a coordinated program of care, under the direction of an identifiable hospice administrator, providing palliative and supportive medical and other services to hospice patients and their families in the patient’s regular or temporary place of residence. Hospice services shall be available twenty-four (24) hours a day, seven (7) days a week pursuant to the patient’s Hospice plan of care. A licensed hospice may provide services to a non-hospice patient; provided, that services to a non-hospice patient shall be limited to palliative care only. (36) Incompetent. A patient or resident who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity. (37) Individual Instruction. An individual’s direction concerning a health care decision for the individual. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (38) 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. (39) Involuntary Transfer. The movement of a patient or resident without the consent of the resident, the resident’s legal guardian, next of kin or representative, with required notification to the appropriate agencies. (40) Licensed Clinical Social Worker. A person currently licensed as such by the Tennessee Board of Social Workers. (41) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (42) Licensed Psychologist. A person currently licensed as such by the Tennessee Board of Examiners in Psychology. (43) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. (44) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (45) Medical Director. A licensed physician employed by the residential hospice to be responsible for medical care in the facility. (46) Medical Emergency. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s or resident’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part. (47) Medical Record. Medical histories, records, reports, clinical notes, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries, and other written electronics, or graphic data prepared, kept, made or maintained in an agency that pertains to confinement or services rendered to patients and residents. (48) Medically Inappropriate Treatment. Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the patient or resident or other medical or surgical treatments to achieve the expressed goals of the informed patient or resident. In the case of the incompetent patient or resident, the patient’s or resident’s representative expresses the goals of the patient or resident. (49) Medical Social Services. When provided, shall be given by a certified master social worker, a licensed clinical social worker, or by a social worker or social work assistant employed by the residential hospice and under the supervision of a certified master social worker or licensed clinical social worker, and in accordance with the plan of care. The medical social services provider shall assist the physician and other team members in understanding the significant social and emotional factors related to the health problems, participate in the development of the plan of care, prepare clinical and progress notes, work with the family, utilize appropriate community resources, participate in discharge planning and in-service programs, and act as a consultant to other organization personnel. (50) 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. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (51) 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. (52) N.F.P.A. The National Fire Protection Association. (53) Occupational Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (54) Occupational Therapy Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (55) Palliative. The reduction or abatement of pain or troubling symptoms by appropriate coordination of all elements of the hospice care team to achieve needed relief of distress. (56) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (57) Personally Informing. A communication by any effective means from the patient or resident directly to a health care provider. (58) Pharmacist. A person currently licensed as such by the Tennessee Board of Pharmacy. (59) Physical Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (60) Physical Therapist Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (61) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. (62) 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. (63) 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. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (64) 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. (65) Qualified Emergency Medical Service Personnel. Includes, but shall not be limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the usual course of their professions, and other emergency responders. (66) 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 patient’s or resident’s health care needs. Such availability shall include, but not be limited to, availability by telephone. (67) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (68) Residential Hospice. A licensed homelike residential facility designed, staffed and organized to provide hospice and/or HIV care services, except such services shall be provided at such residential facility rather than the patient’s or resident’s regular or temporary place of residence. A residential hospice shall not provide hospice and/or HIV care services to any person other than a hospice and/or HIV resident. (69) Respiratory Therapist. A person currently licensed as such by the Tennessee Board of Respiratory Care. (70) Respiratory Therapy Technician. A person currently licensed as such by the Tennessee Board of Respiratory Care. (71) Respite Care. A short-term period of inpatient care provided to a hospice patient only when necessary to relieve the family members or other persons caring for the patient. (72) Secured Unit. A facility or distinct part of a facility where the residents are intentionally denied egress by any means. (73) Shall or Must. Compliance is mandatory. (74) Social Worker. An individual who has at least a bachelor’s degree from a school accredited or approved by the Council on Social Work Education and has one (1) year of social work experience in a health care setting. (75) Social Work Assistant. A person who has a baccalaureate degree in social work, psychology, sociology, or other field related to social work, and has at least one (1) year of social work experience in a health care setting. Social work related fields include bachelor/masters degrees in psychology, sociology, human services (behavioral sciences, not human resources), masters degree in counseling fields (psychological guidance and guidance counseling) and degrees in gerontology. (76) Speech Language Pathologist. As defined in T.C.A. § 63-17-103, a person currently licensed as such by the Tennessee Board of Communications Disorders and Sciences. (77) Spiritual Counselor. A person who has met the requirements of a religious organization to serve the constituency of that organization. (78) 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. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (79) Student. A person currently enrolled in a course of study that is approved by the appropriate licensing board or equivalent body. (80) Supervising Health 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. (81) Supervision. Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity with initial direction and periodic inspection of the actual act of accomplishing the function or activity. Periodic supervision must be provided if the person is not a licensed or certified assistant, unless otherwise provided in accordance with these regulations. (82) Surrogate. An individual, other than a patient’s or resident’s agent or guardian, authorized to make a health care decision for the patient or resident. (83) Terminally Ill. An individual with a medical prognosis that his or her life expectancy is six (6) months or less if the illness runs its normal course. (84) Transfer. The movement of a patient or resident at the direction of a physician or other qualified medical personnel when a physician is not readily available, but does not include such movement of a patient or resident who leaves the facility against medical advice. (85) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the patient or resident. (86) Volunteer. An individual who agrees to provide services to a hospice care patient or HIV resident and/or family member(s), without monetary compensation, with appropriate supervision by the facility.