Definitions

(1) “Abuse” means 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)” means those activities which indicate an individual’s independence in eating, dressing, personal hygiene, bathing, toileting, ambulating, and medication management. (3) “Administering Medication” means the direct application of a single dose of medication to the body of a resident by injection, inhalation, ingestion, topical application or by any other means and the placement of a single dose of medication into a container. (4) “Administrator” means a natural person designated by the licensee to have the authority and responsibility to manage the ACLF and who is appropriately certified as an assisted-care STANDARDS FOR ASSISTED-CARE LIVING FACILITIES CHAPTER 0720-26 living facility administrator or is currently licensed in Tennessee as a nursing home administrator as required by T.C.A. §§ 63-16-101, et seq. (5) “Adult” means a person 18 years of age or older. (6) “Ambulatory” means the resident’s ability to bear weight, pivot and safely walk with the use of a cane, walker, or other mechanical supportive device with or without the minimal assistance of another person. The resident must be physically and mentally capable of self-preservation by evacuating in response to an emergency. A resident who requires a wheelchair must be capable of transferring to and propelling the wheelchair independently. (7) “Assisted-care living facility (ACLF)” means a building, establishment, complex or distinct part thereof that accepts primarily aged persons for domiciliary care and services. (8) “Assistance with Self-Administration of Medication” means assistance in reading labels, opening medication containers or packaging, reminding residents of their medication, or observing the resident while taking medication in accordance with the plan of care. (9) “Assisted-care living facility resident” or “resident” means primarily an aged person who requires domiciliary care, and who upon admission to the facility, if not ambulatory, is capable of self-transfer from the bed to a wheelchair or similar device and is capable of propelling such wheelchair or similar device independently. Such a resident may require one or more of the following services: room and board, assistance with non-medical activities of daily living, administration of typically self-administered medications, and medical services subject to the limitations of these rules. (10) “Assessment” means a procedure for determining the nature and extent of the problem(s) and needs of a resident or potential resident to ascertain if the ACLF can adequately address those problems, meet those needs, and secure information for the use in the development of the individual care plan. (11) “Cardiopulmonary resuscitation (CPR)” means the administering of any means or device to restore or support cardiopulmonary functions in a resident, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilators or respirators, defibrillation, the administration of drugs and/or 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. (12) “Continuous nursing care” means round-the-clock observation, assessment, monitoring, supervision, or provision of nursing services that can only be performed by a licensed nurse. (13) “Distinct part” means a unit or part thereof that is organized and operated to give a distinct type of care within the larger organization which renders other types or levels of care. “Distinct” denotes both organizational and physical separateness. A distinct part of an ACLF must be physically identifiable and be operated distinguishably from the rest of the institution. It must consist of all the beds within that unit such as a separate building, floor, wing or ward. Several rooms at one end of a hall or one side of a corridor is acceptable as a distinct part of an ACLF. (14) “Do-Not-Resuscitate Order (DNR)” means a written order, other than a POST, not to resuscitate a patient in cardiac or respiratory arrest in accordance with accepted medical practices. (15) “Emergency” means any situation or condition which presents an imminent danger of death or serious physical or mental harm to residents. STANDARDS FOR ASSISTED-CARE LIVING FACILITIES CHAPTER 0720-26 (16) “Health care” means 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). (17) “Health care decision” means an individual’s consent, refusal of consent or withdrawal of consent to health care. (18) “Health care decision-maker” means that 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 health care decision-making authority, the resident’s surrogate as determined pursuant T.C.A. § 68-11-1806, or the individual’s designated physician pursuant to T.C.A. § 68-11- 1802(a)(4). (19) “Infectious waste” means solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure could result in an infectious disease. (20) “Licensed health care professional” means: (a) Any health care professional currently licensed by the State of Tennessee to practice within the scope of a regulated profession, such as a nurse practitioner, dietitian, dentist, occupational therapist, pharmacist, physical therapist, physician, physician assistant, psychologist, social worker, speech-language pathologist, and emergency service personnel; or (b) A medication aide (as defined in Tennessee Code Annotated § 63-7-127). (21) “Licensee” means the person, association, partnership, corporation, company or public agency to which the license is issued. (22) “Life threatening or serious injury” means an injury requiring the resident to undergo significant diagnostic or treatment measures. (23) “Medical record” means documentation of medical histories, nursing and treatment records, care needs summaries, physician orders, and records of treatment and medication ordered and given which must be maintained by the ACLF, regardless of whether such services are rendered by ACLF staff or by arrangement with an outside source. (24) “Medically inappropriate treatment” means resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the resident or other medical or surgical treatments that cannot be expected to achieve the expressed goals of the informed resident. (25) “Medication Aide” means an individual who administers medications, as set forth in Tennessee Code Annotated § 63-7-127, under the general supervision of a licensed nurse pursuant to this section. (26) “Misappropriation of patient/resident property” means the deliberate misplacement, exploitation or wrongful, temporary or permanent use of an individual’s belongings or money without the individual’s consent. (27) “Neglect” means 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. STANDARDS FOR ASSISTED-CARE LIVING FACILITIES CHAPTER 0720-26 (28) “NFPA” means the National Fire Protection Association. (29) “Person” means an individual, association, estate, trust, corporation, partnership, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (30) “Personal services” means those services rendered to residents who need supervision or assistance in activities of daily living. Personal services do not include nursing or medical care. (31) “Physician Assistant” means 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. (32) “Physician Orders for Scope of Treatment” or “POST” means 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. (33) “Power of Attorney for Health Care” means the legal designation of an agent to make health care decisions for the individual granting such power under T.C.A. Title 34, Chapter 6, Part 2. (34) “Primarily aged” means that a minimum of fifty-one percent (51%) of the population of the facility is at least sixty-two (62) years of age. (35) “Resident sleeping unit” means a single unit providing sleeping facilities for one or more persons. Resident sleeping units can also include permanent provisions for living, eating and sanitation. (36) “Responsible attendant” means the individual person designated by the licensee to provide personal services to the residents. (37) “Secured unit” means a distinct part of an ACLF where the residents are intentionally denied egress except as is necessary to comply with life safety requirements. (38) “Self-Administration of Medication” means the ability to administer medicine to oneself without assistance other than receiving help with reading labels or with physically opening the container or packaging, being reminded of one’s medication, or being observed while taking medication in accordance with the plan of care. (39) “Supervising health care provider” means the health care provider who has undertaken primary responsibility for an individual’s health care. STANDARDS FOR ASSISTED-CARE LIVING FACILITIES CHAPTER 0720-26 (40) “Surrogate” means an individual, other than a resident’s agent or guardian, authorized to make a health care decision for the resident pursuant to T.C.A. § 68-11-1806. (41) “Treating health care provider” means a health care provider directly or indirectly involved in providing health care to a resident at the time such care is needed by the resident.