N.H. Admin. Code § He-P 824.16

Current through Register No. 45, November 7, 2024

Section He-P 824.16 - Patient Admission Criteria, Temporary Absence, Transfer and Discharge

(a) At the time of admission, personnel of the HH shall:

(1) Provide, both orally and in writing, to the patient, their guardian or agent, if applicable, the HH's:

a. Policy on patient rights and responsibilities;

b. Complaint procedure;

c. List of care and services that are provided directly by the HH; and

d. List of the care and services that are provided by contract;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, their guardian or agent, if applicable;

(3) Collect and record the following information:

a. Patient's name, home address, home telephone number, and date of birth;

b. Name, address, and telephone number of an emergency contact and guardian and/or agent, if applicable;

c. Name of patient's primary care provider and their address and telephone number;

d. Copies of all legal directives such as durable power of attorney, legal guardian or living will; and

e. Written and signed consent for the provision of care and services; and

(4) Obtain documentation of informed consent and consent for release of information.

(b) In addition to (a) above, at the time of admission, the licensee shall provide a written copy to the patient and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) A patient's agreement including the following information:

a. The basic daily, weekly, and monthly fee;

b. A list of the core services required by He-P 824.15(a) and (b) that are covered by the basic fee;

c. Information regarding the timing and frequency of cost of care increases;

d. The time period covered by the admissions contract;

e. The HH's house rules;

f. The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

g. The HH's responsibility for patient discharge planning;

h. Information regarding nursing, other health care services or supplies not provided in the core services, to include:

1. The availability of services;

2. The HH's responsibility for arranging services; and

3. The fee and payment for services, if known;

i. The licensee's policies and procedures regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the patient and provided on the HH premises;

5. Handling of patient funds pursuant to RSA 151:24 and He-P 824.14(af);

6. Bed hold, in compliance with RSA 151:25;

7. Storage and loss of the patient's personal property; and

8. Smoking;

j. The licensee's medication management services; and

k. The list of grooming and personal hygiene supplies provided by the HH as part of the basic daily, weekly, or monthly rate;

(2) A copy of the most current version of the patients' bill of rights under RSA 151: 21 and the HH's policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the patient's right to appeal an involuntary transfer or discharge under RSA 151:26, II(5); and

(4) The HH's policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169-C:29.

(c) The hospice care provider shall ensure that medical direction is provided either from the patient's attending licensed practitioner or the hospice medical director.

(d) Patients who are admitted or accepted for services shall:

(1) Have a nursing assessment at the following intervals to determine the level of care and services required by the patient:

a. Within 48 hours of admission; and

b. Thereafter as required by the CMS conditions of participation; and

(2) Have a signed and dated order for any service for which such order is required by the practice acts of the person providing care, renewed at least every 90 days.

(e) The assessment required by (d)(1) above shall contain, at a minimum, the following:

(1) Pertinent diagnoses including mental status;

(2) A pain assessment, including symptom control and vital signs;

(3) A physical assessment;

(4) A cognition and mental status assessment;

(5) A behavioral assessment;

(6) A psychosocial assessment;

(7) Medication and treatments;

(8) Functional limitations;

(9) Nutritional requirements;

(10) Any equipment required; and

(11) Any safety precautions.

(f) In addition to the information required in (e) above, the nursing assessment shall include:

(1) Reactions of the patient and family members to terminal illness;

(2) History of the patient's and family coping strengths and weaknesses;

(3) Social and financial concerns; and

(4) Spiritual beliefs and desires of the patient.

(g) If the assessment required by (d) above is completed by an LPN, the assessment shall be reviewed and co-signed by the registered nurse or physician that is supervising the LPN prior to the development of the patient's care plan.

(h) The licensee shall establish an interdisciplinary hospice care team composed of at least:

(1) A licensed practitioner;

(2) A registered nurse;

(3) A social worker; and

(4) A clergy person or counselor.

(i) The interdisciplinary hospice care team shall:

(1) Establish the care plan;

(2) Be the primary care delivery team for a patient and his or her family through the total duration of hospice care; and

(3) Be responsible for supervising any patient care and services provided by others.

(j) The interdisciplinary team shall, in conjunction with the patient, the patient's personal representative, and their family, develop an individualized care plan, which reflects the changing care needs of the patient and family.

(k) The care plan required by (j) above shall include:

(1) The date the problem or need was identified;

(2) A description of the problem or need;

(3) The goal for the patient;

(4) The action or approach to be taken by HH personnel;

(5) The responsible person(s) or position; and

(6) The interventions used to address problems identified in the assessment including:

a. Medications ordered;

b. Pain control interventions, both pharmacological and non-pharmacological;

c. Symptom management treatment; and

d. Services required including frequency of visits.

(l) The care plan required by (j) above shall be:

(1) Developed in conjunction with the patient and their guardian or agent, if applicable;

(2) Completed within 3 days after completion of the nursing assessment;

(3) Reviewed and revised at least every 30 days by the interdisciplinary team following the completion of each assessment; and

(4) Made available to all personnel that assist the patients.

(m) The patient and their family shall be encouraged to participate in all components of care, including:

(1) Assessment and problem identification;

(2) Implementation of the plan of care; and

(3) Evaluation and revision of the plan, as needed.

(n) At the time of a patient's admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions and diet.

(o) A patient may refuse all care and services.

(p) When a patient refuses care or services that could result in a threat to their safety or that of others, the licensee or their designee shall:

(1) Inform the patient of the potential results of their refusal;

(2) Notify the licensed practitioner and guardian or agent if any, of the patient's refusal of care; and

(3) Document in the patient's record the refusal of care and the patient's reason for the refusal.

(q) Progress notes shall be written by any member of the interdisciplinary team to document:

(1) Changes in the patient's physical, functional and mental abilities;

(2) Changes in the patient's behaviors such as eating or sleeping patterns; and

(3) Newly identified needs of the patient and or their family.

(r) All staff of the HH shall follow the approaches stated in the care plan.

(s) The licensee shall provide an emergency data sheet to emergency medical personnel in the event of an emergency transfer to another medical facility.

(t) The data sheet referenced in (s) above shall include:

(1) The patient's full name and the name the patient prefers, if different;

(2) Name, address and telephone number of the patient's next of kin, guardian or agent, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directive; and

(10) Any other pertinent information not specified in (1)-(9) above.

(u) Written notes shall be documented in the patient's record for any unusual incident, occurrence, or explained absence involving the patient which shall include the information required by He-P 824.14(t) and the signature and title of the person reporting the incident or occurrence.

(v) For each patient accepted for care and services at the HH, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by He-P 824.16(b)(1);

(2) The identification data required by He-P 824.16(b)(2);

(3) The admission agreement required by He-P 824.16(c)(1);

(4) Consent and medical release forms, as applicable;

(5) Pertinent medical information;

(6) The emergency data sheet required by He-P 824.16(t);

(7) All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by He-P 824.16(e)(2);

(8) All assessments required by He-P 824.16(e)(1);

(9) All laboratory and x-ray reports if the tests were taken at the HH;

(10) All consults;

(11) All care plans required by He-P 824.16(k) including documentation that the patient or patient's guardian or agent, if applicable, participated in the development of the care plan;

(12) All progress notes required by He-P 824.16(r) including the signature of the person providing the care;

(13) All written notes required by He-P 824.16(v) including the signature of the person providing the care;

(14) All daily medication records required by He-P 824.17(aa);

(15) Discharge or transfer documentation, which shall include:

a. In the case of patient death:

1. Date and place of death; and

2. Bereavement follow-up plan; and

b. In the case of discharge other than patient death or transfer:

1. Date and time of patient discharge;

2. The physical, mental, and medical condition of patient at discharge;

3. Discharge instruction and referral; and

4. Signed licensed practitioner's order for discharge, if applicable; and

(16) Documentation of any unusual incidents involving the patient including the information required by (v) above.

N.H. Admin. Code § He-P 824.16

#9317, eff 11-8-08

Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12169, Effective 4/29/2017, Expires 10/26/2017.

Amended by Number 15, Filed April 13, 2023, Proposed by #13572, Effective 3/1/2023, Expires 3/1/2033.