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 (ADLs)” means those activities which indicate an individual’s independence in eating, dressing, personal hygiene, bathing, toileting, ambulating, and medication management. (3) “Adequate evacuation” means the ability of the adult care home provider, resident manager, or substitute caregiver, including such additional minimum staff as may be required by the Board in regulation, to evacuate all residents from the dwelling within five (5) minutes. (4) “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. (5) “Adult” means a person 18 years of age or older. (6) “Adult care home (ACH)” means a single family residence licensed pursuant to this act in which twenty-four (24) hour residential care, including assistance with activities of daily living, is provided in a homelike environment to no more than five (5) elderly or disabled adults. (7) “Adult care home provider” means a person who is twenty-one (21) years of age or older that owns and operates an adult care home. (8) “Adult care home resident” means an individual residing at the adult care home who is ventilator dependent or who suffers from a traumatic brain injury. (9) “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 ACH can adequately address those problems, meet those needs, and secure information for use in the development of the individual care plan. (10) “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. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (11) “Board” means the Board for Licensing Health Care Facilities. (12) “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. (13) “Disabled” means an individual who is ventilator dependent or who has a traumatic brain injury. (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) “Elderly” means an individual who is fifty-five (55) years of age or older. (16) “Emergency” means any situation or condition which presents an imminent danger of death or serious physical or mental harm to residents. (17) “Exploitation” shall have the same meaning as set forth in T.C.A. § 68-11-1004(a)(2). (18) “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). (19) “Health care decision” means an individual’s consent, refusal of consent or withdrawal of consent to health care. (20) “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 to T.C.A. § 68-11-1806, or the individual’s designated physician pursuant to T.C.A. § 68-11- 1802(a)(4). (21) “Home like” means an environment that promotes the dignity, security and comfort of residents through the provision of personalized care and services and encourages independence, choice and decision-making by the residents. (22) “Infectious waste” means solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure could result in an infectious disease. (23) “Level 2 home” means an adult care home that provides services to residents who are ventilator dependent or who have a traumatic brain injury. (24) “Licensed health care professional” means 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, registered nurse, licensed practical nurse, (nurses may be licensed or hold multistate licensure pursuant to Tennessee Code Annotated §§ 63-7-101 et seq.), dietitian, dentist, occupational therapist, pharmacist, physical therapist, physician, physician assistant, psychologist, clinical social worker, respiratory therapist, speech-language pathologist, and emergency service personnel. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (25) “Licensee” means the person, association, partnership, corporation, company or public agency to which the license is issued. For the purposes of these rules, the term “licensee” is synonymous to “adult care home provider.” (26) “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 ACH, regardless of whether such services are rendered by ACH staff or by arrangement with an outside source. (27) “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. (28) “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. (29) “NFPA” means the National Fire Protection Association. (30) “Occupant” means anyone residing in or using the facility of the adult care home including residents, the adult care home provider, resident manager, substitute caregiver, staff, and an adult care home provider’s family members or a resident manager’s family members. (31) “Person” means an individual, association, estate, trust, corporation, partnership, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (32) “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. (33) “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. (34) “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. (35) “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. §§ 34-6-201, et seq. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (36) “Resident manager” means a person twenty-one (21) years of age or older who lives in an adult care home and oversees the day-to-day operation of the adult care home on behalf of the adult care home provider. (37) “Retaliation” means increasing charges, decreasing services, rights or privileges; taking or threatening to take any action to coerce or compel the resident to leave the facility; or abusing or threatening to harass or abuse a resident in any manner. (38) “Self-administration of medication” means assistance in reading labels, opening dosage packaging, reminding residents of their medication, and observing the resident while taking medication in accordance with the plan of care. (39) “Specialized services” means services provided to ventilator dependent residents and residents with a traumatic brain injury. (40) “Substitute caregiver” means any person twenty-one (21) years of age or older who temporarily oversees care and services in an adult care home during the short-term absence of the adult care home provider or resident manager. . (41) “Supervising health care provider” means the health care provider who has undertaken primary responsibility for an individual’s health care. (42) “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. (43) “Traumatic brain injury” means an acquired injury to the brain caused by an external physical force resulting in total or partial disability or impairment. Traumatic brain injury includes open and closed head injuries and may result in seizures, and/or mild, moderate, or severe impairment in one (1) or more areas including cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory perceptual and motor abilities, psychosocial behavior, physical functions, information processing, and speech. Such term does not include brain injuries induced by birth trauma, but may include brain injuries caused by anoxia and other related causes, infectious disease not of a degenerative nature, brain tumor, toxic chemical or drug reaction. (44) “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. (45) “Ventilator dependent” means using an apparatus designed to control air that is breathed through it to either intermittently or continuously assist or control pulmonary ventilation, without which, the patient would not be able to breathe independently.