Admissions, Discharges, And Transfers

(1) Admissions. (a) An ACH may only admit and continue to care for residents requiring specialized services. (b) A Level 2 ACH may provide care to both ventilator dependent patients and patient with traumatic brain injury. In the event a resident with traumatic brain injury is also ventilator dependent, the resident may only be served by a Level 2 ACH meeting the requirements for ventilator dependent patients. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 (c) ACHs may serve up to five (5) elderly or disabled adults who are unrelated to the adult care home provider by blood or marriage. (d) An ACH provider may choose to serve one (1) or more elderly or disabled adult members of their own family as long as the adult care home provider serves at least two (2) additional elderly or disabled adults unrelated to the adult care home provider by blood or marriage. In no event shall an adult care home provider serve more than five (5) elderly or disabled residents in the licensed ACH. (e) An ACH provider may permit members of the adult care home provider’s or resident manager’s family, who are not elderly or disabled, to reside in the ACH as long as it does not interfere with the care of the residents. For purposes of this rule, family member means spouse and children. (f) An ACH may not admit or retain a resident who cannot be evacuated within five (5) minutes. (g) An ACH shall upon admission of a resident: 1. Be able to identify at the time those residents whose needs for services are consistent with these rules and regulations, and those residents who should be transferred to a more appropriate level of care. 2. Document plans and procedures to show evacuation of the resident within five (5) minutes. 3. Provide to each resident a written admission agreement signed and dated by the ACH provider and the resident or the resident’s family member or representative and presented both verbally and in writing. The admission agreement shall be reviewed and updated as necessary as a part of the residential plan of care review process and contain the following: (i) A copy of the resident rights for the resident’s review and signature; (ii) A copy of house rules and the rate schedules, including any resident liability for which the resident will be responsible; (iii) An accurate written statement providing that the adult care home provider shall give thirty (30) days written notice to the resident prior to making any changes in the rates; (iv) The consequences for non-payment of resident liability which includes involuntary discharge from the ACH; (v) An accurate written statement regarding services which will be provided residents upon admission; (vi) Procedures for handling the transfer or discharge of residents that does not violate the residents’ rights under the law or these rules; (vii) A copy of the medication disposal policy, which shall be written in accordance with current FDA or current DEA medication disposal guidelines, for resident’s review and signature. STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 4. Disclose in writing to the resident or to the resident’s legal representative, the identity of the ACH’s primary liability insurance carrier. If the ACH is self-insured, its statement shall reflect that fact and indicate the corporate entity responsible for payment of any claims. 5. Document evidence of annual vaccination against influenza for each resident, in accordance with the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control most recent to the time of vaccine, unless such vaccination is medically contraindicated or the resident has refused the vaccine. Influenza vaccination for all residents accepting the vaccine shall be completed by November 30 of each year or within ten (10) days of the vaccine becoming available. Residents admitted after this date during the flu season and up to February 1, shall as medically appropriate, receive influenza vaccination prior to or on admission unless refused by the resident. 6. Document evidence of vaccination against pneumococcal disease for all residents who are sixty-five (65) years of age or older, in accordance with the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control at the time of vaccination, unless such vaccination is medically contraindicated or the resident has refused the offer of vaccine. The facility shall provide or arrange for the pneumococcal vaccination of residents who have not received this immunization prior to or on admission unless the resident refuses offer of the vaccine. (2) Discharges and Transfers. (a) Residents may only be moved, transferred or discharged from an ACH for the following reasons: 1. Medical reasons. The resident has a medical or nursing condition that exceeds the level of health services the facility provides; 2. Welfare of the resident or of other residents. This includes, but is not limited to the following: The ACH is unable to accomplish timely evacuation of the resident in the event of an emergency; the resident exhibits behavior that poses an imminent danger to self or others; the resident engages in behavior or actions that repeatedly and substantially interfere with the rights, health or safety of residents or others; or the resident engages in illegal drug use, or commits a criminal act that causes potential harm to the resident or others; 3. Nonpayment of patient liability; or 4. Closing or selling the facility. (b) An ACH resident shall be discharged and transferred to another appropriate setting such as home, a hospital, or a nursing home when the resident, the resident’s legal representative, or the resident’s treating physician determines that the ACH cannot safely and effectively meet the resident’s needs, including medical services. (c) The Board may require that an ACH resident be discharged or transferred to another level of care if it determines that the resident’s needs, including medical services, cannot be safely and effectively met in the ACH. (d) In the event of a discharge or transfer due to medical reasons, for the welfare of the resident or for the welfare of other residents or due to nonpayment of patient liability, STANDARDS FOR ADULT CARE HOMES – LEVEL 2 CHAPTER 0720-37 the adult care home provider shall give the resident written notice at least thirty (30) days prior to the proposed transfer or discharge. (e) In the event of a discharge or transfer due to medical reasons, the welfare of the resident, or for the welfare of other residents, the ACH provider shall work with the Board, or for ACH services reimbursed through the TennCare CHOICES program, the member’s care coordinator to develop a transition plan in order to maintain continuity of care for the resident and to minimize the impact of the transition. The ACH provider shall assist the resident in locating an alternate appropriate setting. (f) In the case of a medical emergency that requires immediate action, the ACH provider shall give the resident written notice as soon as possible under the circumstances. (g) In the event of discharge or transfer due to selling the facility to another ACH provider, the current ACH provider shall develop a transition plan for all residents to facilitate the transition to a new ACH and shall maintain its license and operation of the facility until the point in time the new ACH’s license is approved. (h) In the event of discharge or transfer due to the closing of the facility, the ACH provider shall provide ninety (90) day advance notice to residents and shall work with the board, or for ACH services reimbursed through the TennCare CHOICES program, the MCO as appropriate, to develop a transition plan to maintain continuity of care for the residents and to minimize the impact of transition. The ACH shall assist each resident in locating an alternative placement.