2010 Tennessee Code
Title 68 - Health, Safety and Environmental Protection
Chapter 11 - Health Facilities and Resources
Part 2 - Regulation of Health and Related Facilities
68-11-270 - Assessment of prospective resident by adult care home provider prior to admission Development of residential plan of care Person centered approach Ability to meet needs of resident Meals and activities Staffing Resident’s rights Transfers or discharges Transitional plans. [Effective January 1, 2010.]

68-11-270. Assessment of prospective resident by adult care home provider prior to admission Development of residential plan of care Person centered approach Ability to meet needs of resident Meals and activities Staffing ResidentÂ’s rights Transfers or discharges Transitional plans. [Effective January 1, 2010.]

(a)  An adult care home provider shall conduct an assessment of a prospective resident before admitting the resident. The assessment shall include, but is not limited to, diagnoses, medications, personal care needs, nursing care needs, night care needs, nutritional needs, activities and lifestyle preferences. A copy of the assessment shall be given to the prospective resident and the prospective residentÂ’s family member or representative.

(b)  As a result of the assessment, the adult care home provider shall develop a residential plan of care for the day-to-day delivery of residential services, including personal and health care needs and night care needs. The adult care home provider shall use a person-centered approach that focuses on the needs and preferences of the resident and takes into consideration the supports necessary to sustain the person in the community and to maintain and whenever possible, to improve functional abilities. At a minimum, the resident and the residentÂ’s family members or representative shall be actively involved in the development of the plan of care. If adult care home services are or will be reimbursed through the TennCare CHOICES program, or any successor to the TennCare CHOICES program, the residential plan of care should be developed in collaboration with the member's care coordinator to ensure consistency regarding the member's comprehensive plan of care for the CHOICES program. Residential plans of care shall be reviewed at least quarterly and updated at a minimum on an annual basis and more frequently as resident's health status changes and circumstances warrant. The residential plan of care shall include, at a minimum, the following elements:

     (1)  Health and functional status, including cognitive/behavioral health status and any activities of daily living (ADL) deficiencies;

     (2)  Resident needs and preferences, including personal and health care needs and night care needs;

     (3)  Significant health conditions and required course of treatment for management of chronic conditions;

     (4)  Medication regimen;

     (5)  Any health care tasks that have been ordered by a health care professional that will be performed by the adult care home provider under the self-direction of the resident or the residentÂ’s family member;

     (6)  Identification of risks to health and safety; and

     (7)  Strategies to mitigate identified risks;

(c)  An adult care home provider shall be able to meet the needs, including personal and health care needs and night care needs, of a resident before admitting the resident.

(d)  An adult care home provider shall provide three (3) nutritionally balanced meals per day or shall make arrangements for meals on an as needed basis. Meal planning and preparation shall take into consideration any special dietary needs of the resident, as prescribed by the residentÂ’s physician.

(e)  An adult care home provider shall also provide to residents a daily regimen of activities commensurate with the resident's needs, as identified through the assessment developed pursuant to section (a) and specified in the residential plan of care.

(f)  An adult care home provider shall develop a written agreement for each resident specifying, at a minimum, resident rights, house rules and the rate schedule, including any patient liability for which the resident will be responsible. The written agreement shall specify the consequences for nonpayment of patient liability, as applicable, which may include involuntary discharge from the adult care home. The agreement shall be signed and dated by the adult care home provider and the resident or the residentÂ’s family member or representative and presented to the resident and the residentÂ’s family member or representative both verbally and in writing. The agreement shall be reviewed and updated as necessary as a part of the residential plan of care review process. The adult home care provider may not include any illegal or unenforceable provision in an agreement with a resident. The adult care home provider must give thirty (30) daysÂ’ written notice to the resident prior to making any change in the rates.

(g)  An adult care home provider shall provide twenty-four-hour staffing coverage that is adequate to meet the needs of residents. Staffing and clinical expertise should correspond to the license category of the adult care home. In addition, adult care home providers shall coordinate with the primary care physician, specialists and other health care professionals as appropriate.

(h)  Residents of adult care homes shall be granted specific rights that shall be specified by the board in rules. Adult care home providers shall guarantee these rights and help residents exercise them. The adult care home provider shall post a copy of the residentÂ’s rights in the entry or other equally prominent place in the adult care home. The adult care home provider cannot require a resident to waive any of the resident's rights.

(i)  An adult care home provider may not transfer or discharge a resident from an adult care home unless the transfer or discharge is necessary for medical reasons, for the welfare of the resident or for the welfare of other residents, due to nonpayment of patient liability, or closing or selling the facility.

(j)  For discharges or transfers related to medical reasons, for the welfare of the resident, for the welfare of other residents or due to nonpayment of patient liability, the adult care home provider shall give the resident written notice at least thirty (30) days prior to the proposed transfer or discharge, except in a medical emergency that requires immediate action. In such cases, the adult care home provider shall give the resident written notice as soon as possible under the circumstances.

(k)  In the event the transfer or discharge is due to medical reasons, the welfare of the resident or for the welfare of other residents, the adult care home provider shall work with the board, or for adult care home 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 adult care home provider shall assist the resident in locating an alternative appropriate setting, which shall be specified in the transition plan. The transition plan shall also include the most recent version of the resident's plan of care.

(l)  In the event the transfer or discharge is due to selling the facility to another adult care home provider, the current adult care home provider shall develop a transition plan for all residents to facilitate the transition to the new adult care home provider and shall maintain its license and operation of the facility until the point in time the new adult care home provider's license is approved.

(m)  In the event the transfer or discharge is due to closing of a facility, the adult care home provider shall provide ninety (90) daysÂ’ advance notice to residents and shall work with the board, or for adult care home services reimbursed through the TennCare CHOICES program, the managed care organization (MCO) as appropriate, to develop a transition plan to maintain continuity of care for the residents and to minimize the impact of transition. The adult care home provider shall assist each resident in locating an alternative placement, which shall be specified in the transition plan. The transition plan shall also include the most recent version of the resident's plan of care.

(n)  The board may promulgate regulations specifying additional components of the transition plan.

[Acts 2009, ch. 579, § 18.]