Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Administrator. A person who: (a) Is a licensed physician with at least one (1) year supervisory or administrative experience in home health care, hospice care or related health programs; or (b) Is a registered nurse with at least one (1) year supervisory or administrative experience in home health care, hospice care or related health programs; or (c) Has training and experience in health service administration and at least one (1) year of supervisory or administrative experience in home health care, hospice care or related health programs. (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) Agency. A Home Care Organization providing hospice services. (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 to make health care decisions while having the capacity to do so. A patient shall be presumed to have capacity to make a health care STANDARDS FOR HOME CARE ORGANIZATIONS PROVIDING CHAPTER 0720-28 HOSPICE SERVICES decision, to give or revoke an advance directive, and to designate or disqualify a surrogate. Any person who challenges the capacity of a patient 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, 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 chemical agents intended to restore cardiac and/or respiratory functions in a patient 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 assessment, responses to medications, treatments, services, any changes in condition and signed by a health team member who made contact with the patient. (14) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (15) Competent. A patient 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) 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. (20) 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. (21) 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. (22) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (23) Hazardous Waste. Materials whose handling, use, storage and disposal are governed by local, state or federal regulations. STANDARDS FOR HOME CARE ORGANIZATIONS PROVIDING CHAPTER 0720-28 HOSPICE SERVICES (24) 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). (25) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. (26) Health Care Decision-Maker. In the case of a patient who lacks capacity, the patient’s health care decision-maker is one of the following: the patient’s health care agent as specified in an advance directive, the patient’s court-appointed guardian or conservator with health care decision-making authority, the patient’s surrogate as determined pursuant to Rule 0720-28- .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. (27) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (28) 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. (29) Home Care Organization. As defined by T.C.A. § 68-11-201, a “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. (30) 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, and household services essential to health care at home. (31) Homemaker Service. A non-skilled service in the home to maintain independent living which does not require a physician’s order. An agency does not have to be licensed as a home care organization to provide such services. (32) 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 services program may provide services to a non-hospice patient; provided, that services to a non-hospice patient shall be limited to palliative care only. (33) Incompetent. A patient who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity. (34) Individual Instruction. An individual’s direction concerning a health care decision for the individual. (35) 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. (36) Licensed Clinical Social Worker. A person currently licensed as such by the Tennessee Board of Social Workers. STANDARDS FOR HOME CARE ORGANIZATIONS PROVIDING CHAPTER 0720-28 HOSPICE SERVICES (37) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (38) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. (39) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (40) Medical Record. Medical histories, records, reports, clinical notes, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries and other written electronic or graphic data prepared, kept, made or maintained in an agency that pertains to confinement or services rendered to patients. (41) Medical Social Services. Medical social services must be provided by a qualified social worker under the direction of a physician, in accordance with the plan of care. (42) Medically Inappropriate Treatment. Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the patient or other medical or surgical treatments to achieve the expressed goals of the informed patient. In the case of the incompetent patient, the patient’s representative expresses the goals of the patient. (43) 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. (44) 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. (45) Occupational Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (46) Occupational Therapy Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (47) 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. (48) Patient. Hospice patient means only a person who has been diagnosed as terminally ill; been certified by a physician in writing to have an anticipated life expectancy of six (6) months or less; has voluntarily though self or a surrogate requested admission to a hospice; and been accepted by a licensed hospice. Patient will also include a non-hospice patient receiving only palliative care. (49) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (50) Personally Informing. A communication by any effective means from the patient directly to a health care provider. STANDARDS FOR HOME CARE ORGANIZATIONS PROVIDING CHAPTER 0720-28 HOSPICE SERVICES (51) Physical Therapist. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (52) Physical Therapy Assistant. A person currently licensed as such by the Tennessee Board of Occupational and Physical Therapy Examiners. (53) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. (54) 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. (55) 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. (56) 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. (57) 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. (58) 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 health care needs. Such availability shall include, but not be limited to, availability by telephone. (59) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (60) Respiratory Technician. A person currently licensed as such by the Tennessee Board of Respiratory Care. (61) Respiratory Therapist. A person currently licensed as such by the Tennessee Board of Respiratory Care. (62) Respite Care. A short-term period of inpatient care provided to the patient only when necessary to relieve the family members or other persons caring for the patient. (63) Shall or Must. Compliance is mandatory. STANDARDS FOR HOME CARE ORGANIZATIONS PROVIDING CHAPTER 0720-28 HOSPICE SERVICES (64) 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. (65) 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. (66) Spiritual Counselor. A person who has met the requirements of a religious organization to serve the constituency of that religious organization. (67) 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. (68) Student. A person currently enrolled in a course of study that is approved by the appropriate licensing board or equivalent body. (69) 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. (70) 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 rules. (71) Surrogate. An individual, other than a patient’s agent or guardian, authorized to make a health care decision for the patient. (72) 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. (73) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the patient. (74) Volunteer. An individual who agrees to provide services to a hospice care patient and/or family member(s), without monetary compensation, in either direct patient care or an administrative role and supervised by an appropriate hospice care employee.