Admissions, Discharges, And Transfers

(1) The residential hospice shall have a policy to admit only patients who meet the following criteria, or HIV care residents: (a) Has been diagnosed as terminally ill; (b) Has been certified by a physician, in writing, to have an anticipated life expectancy of six (6) months or less; (c) Has personally, or through a representative, voluntarily requested admission to and been accepted by a licensed residential hospice; and (d) Has personally or through a representative, in writing, given informed consent to receive hospice care. (2) Patients shall be admitted to receive hospice services or residents admitted to receive HIV care on the basis of a reasonable expectation that the patient’s or resident’s medical, nursing and psychosocial needs can be met adequately by the residential hospice. STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 (3) Care shall follow a written plan of care established and reviewed by the attending physician, the medical director, or the physician’s designee and the interdisciplinary group. Care shall continue under the supervision of the attending physician. (4) The residential hospice staff shall determine that the patient’s or resident’s needs can be met by the facility’s services and capabilities. (5) Every person admitted for care or treatment to any residential hospice covered by these rules shall be under the supervision of a physician who holds a license in good standing to practice in Tennessee. The name of the patient’s attending physician shall be recorded in the patient’s medical record. (6) The residential hospice staff shall obtain the patient’s or resident’s written consent for hospice or HIV care services. (7) The signed consent form shall be included with the patient’s or resident’s individual clinical record. (8) A diagnosis must be entered in the admission records of the residential hospice for every person admitted for care or treatment. (9) Any admission in excess of the licensed bed capacity is prohibited except when an emergency admission is approved by the department. (10) A medical record shall be developed and maintained for each patient or resident admitted. (11) No patient or resident shall be discharged without a written order from the attending physician or the medical director stating the patient does not meet hospice criteria or the resident does not meet HIV care criteria, or through other legal processes, and timely notification of next of kin and/or the authorized representative. (12) When a patient or resident is discharged, a summary of the significant findings and events of the patient’s or resident’s care, the patient’s or resident’s condition on discharge and the recommendation and arrangement for future care, if any, is required. (13) When a patient or resident is transferred, a summary of treatment given at the residential hospice, condition of the patient or 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 patient or resident. (14) When a patient or resident is transferred, a copy of the clinical summary shall, with consent of the patient or resident, be sent to the facility that will continue the care of the patient or resident. (15) Except when the Board has revoked or suspended the license, a residential hospice which intends to close, cease doing business, or reduce its licensed bed capacity by ten percent (10%) or more, shall notify the Department 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 patients and/or residents. Should the residential hospice violate the provisions of this subsection, the department shall request the Attorney General of the State of Tennessee to intervene to protect the patients and/or residents, as is provided by T.C.A. § 68-11-213(a). (16) The residential hospice 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 STANDARDS FOR RESIDENTIAL HOSPICES CHAPTER 0720-23 subjected to discrimination in the provision of any care or service of the residential hospice. The residential hospice shall protect the civil rights of patients and residents under the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. (17) 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 patient or resident has been evaluated by an interdisciplinary team consisting of at least a physician, a social worker, a registered nurse, and a family member and/or significant other (or patient care advocate) prior to admittance to the unit; (b) Ongoing and up-to-date documentation of quarterly review by each patient or 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; (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 that 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. (18) 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.