2017 Tennessee Code
Title 68 - Health, Safety and Environmental Protection
Health
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 or traumatic brain injury (TBI) residential 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.

Universal Citation: TN Code § 68-11-270 (2017)

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(a) An adult care home provider or traumatic brain injury residential home provider shall conduct an assessment of a prospective resident before admitting the resident. The assessment shall include, but it 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 resident's family member or representative.

(b) As a result of the assessment, the adult care home provider or traumatic brain injury residential home provider shall develop a residential plan of care for the day-to-day delivery of residential services, including personal and healthcare needs and night care needs. The adult care home provider or traumatic brain injury residential 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 resident's family members or representatives 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 thereto, 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; provided, however, that no such care coordinator requirement shall apply to a traumatic brain injury residential home services. 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 ADL deficiencies;
- (2) Resident needs and preferences, including personal and healthcare needs, and night care needs;
- (3) Significant health conditions and required course of treatment for management of chronic conditions;
- (4) Medication regimen;
- (5) Any healthcare tasks that have been ordered by a healthcare professional that will be performed by the adult care home provider or traumatic brain injury residential home provider under the self-direction of the resident or of the resident's family member;
- (6) Identification of risks to health and safety;
- (7) Strategies to mitigate identified risks; and
- (8) For traumatic brain injury residential homes, activities in the community for which the resident, the resident's family, or legal representative has an interest, including, but not limited to, church attendance, visits to local parks, and other recreational activities.

(c) An adult care home provider or traumatic brain injury residential home provider shall be able to meet the needs, including personal and healthcare needs and night care needs, of a resident before admitting the resident.

(d) An adult care home provider or traumatic brain injury residential 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 resident's physician. For traumatic brain injury residential homes, there shall be no requirement that all three (3) meals be provided at the same residence, since the residents will consume some of these meals while at the separately licensed day care facility.

(e) An adult care home provider or traumatic brain injury residential 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 subsection (a) and specified in the residential plan of care.

(f) An adult care home provider or traumatic brain injury residential 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 non-payment of patient liability, as applicable, which may include involuntary discharge from the adult care home or traumatic brain injury residential home provider. The agreement shall be signed and dated by the adult care home provider or traumatic brain injury residential home provider and resident or the resident's family member or legal representative and presented to the resident and the resident's family member or legal 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 care home provider or traumatic brain injury residential home provider may not include any illegal or unenforceable provision in an agreement with a resident. The adult care home provider or traumatic brain injury residential home provider must give thirty (30) days' written notice to the resident prior to making any change in the rates.

(g) An adult care home provider or traumatic brain injury residential home provider shall provide twenty-four (24) hour staffing coverage that is adequate to meet the needs of residents. For traumatic brain injury residential home providers, this will include both the residences and the day services facility under separate license. Staffing and clinical expertise should correspond to the license category of the adult care home or traumatic brain injury residential home in accordance with this part. In addition, adult care home providers or traumatic brain injury residential home providers shall coordinate with primary care physicians, specialists and other healthcare professionals, as appropriate.

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

(i) An adult care home provider or traumatic brain injury residential home provider may not transfer or discharge a resident from an adult care home or traumatic brain injury residential 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 or for the welfare of other residents or due to nonpayment of patient liability, the adult care home provider or traumatic brain injury residential 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 or traumatic brain injury residential 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 or traumatic brain injury residential home provider shall 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 or traumatic brain injury residential 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 the transition plan; provided, however, that no care coordinator requirement shall apply to a traumatic brain injury residential home. The adult care home provider or traumatic brain injury residential 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 or traumatic brain injury residential home provider, the current adult care home provider or traumatic brain injury residential home provider shall develop a transition plan for all residents to facilitate the transition to the new adult care home provider or traumatic brain injury residential home provider and shall maintain its license and operation of the facility until the point in time the new adult care home provider's or traumatic brain injury residential 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 or traumatic brain injury residential home provider shall provide ninety (90) days' advance notice to residents, and shall develop a transition plan to maintain continuity of care for the residents and to minimize the impact of transition. The plan shall be developed in conjunction with the board, or, for adult care home services reimbursed through the TennCare CHOICES program, the MCO as appropriate; provided, however, that no requirement for working with an MCO shall apply to traumatic brain injury residential home services. The adult care home provider or traumatic brain injury residential 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 in accordance with this part.

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