1,200 HOSPITALS FOR THE MENTALLY RETARDED 1,000 800 600 400 200 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80 + DEFINITION OF INSTITUTIONAL CARE AND SERVICES IN NURSING HOMES FOR A. DEFINITION OF LEVEL OF CARE 1. Skilled Nursing Home Care.-Characterized by the need for and availability of full-time nursing services as set forth in this guide plus required personal services in a facility licensed as a nursing home for mentally retarded under state law and which meets all criteria for a skilled nursing home as set forth in this guide. 2. Intermediate Care Facility.-Is an institution or a distinct part thereof, which is licensed under state law and meets the requirements for ICF set forth in this guide. Care provided in an Intermediate Care Facility could be characterized as follows: a. Semi-Skilled Nursing Home Care.-Characterized by required availability of professional nursing personnel on less than a full-time basis and full-time aides with a formal course in training for care of mentally retarded plus necessary personal services in nursing home beds licensed for care of mentally retarded. b. Personal Care.-Characterized by the provision of personal services in a facility licensed for care of mentally retarded. B. SERVICES REQUIRING PROFESSIONAL NURSING ADMINISTRATION OR SUPERVISION Note: This does not mean trained sub-professionals and aides cannot perform these duties in facilities or that these cannot be done by trained relatives in a home situation under proper supervision. 1. Oxygen or Inhalation therapy. 2. Urine testing for sugar, acetone, etc. 3. Surgical dressings (sterile technique). 4. Nursing treatments. 5. Medication administered hypodermically (intramuscularly or intravenously). 6. Enema. 7. Intravenous feeding. 8. Intake/output chart maintenance. 9. Care of indwelling catheter (including irrigations). 10. Colostomy or ileostomy care. 11. Care of total bed patients to provide preventive and therapeutic care relating to skin care and contractures as well as lifting to and from chair at intervals when possible, proper positioning, etc. 12. Care of incontinence when required for treatment of skin problems or other infections and reporting changes in continency or incontinency pattern which may alert physician to other medical problems. 13. Treatment of persistent conditions such as boils, acne, scabies, fungus, etc. 14. Skilled observation of side effects of medication to assist physician in determination if reaction is dose-related, due to individual patient sesitivity or due to patient's special medical problems. This would include neuromuscular reactions, motor restlessness, dystonias, pseudoparkinsonism, edemas, blood presbehavior, etc. The reporting of these observations to be referred to the physician sure, or heart rhythm irregularities, skin disorders, jaundice, recurrent psychotic behavior, etc. The reporting of these observations to be referred to the physician for treatment adjustments or change. 15. Planned training and teaching self-help such as performing bodily functions (bowel and bladder control), speaking, walking, dressing, self-feeding, socializing skills, personal hygiene, learning basic commands, use of prosthetic devices. 16. Regular checking of patients whose behavior results in self-abuse and injury such as inserting objects in body orifices, picking at self, head banging, etc. 17. Control and modification of the following kinds of on-going and recurrent behavior: 1. Assaultive or combative 2. Withdrawn 3. Destructive 4. Sexually aggressive 18. Planned service to prevent contractures and musculoskeletal deformities or to ease those conditions already existing. 19. Help in eating for those patients who have masticating and/or swallowing problems. Plans for these patients should be recorded and available for all nursing personnel. 20. Carry out plans for opportunity and continued activity of patients in maintaining level of function. C. PERSONAL SERVICES NOT REQUIRING AVAILABILITY OF PROFESSIONAL NURSING PERSONNEL FOR ADMINISTRATION OR SUPERVISION 1. Help in bathing. 2. Help with dressing and/or undressing. 3. Help with personal care, i.e., care of teeth, hair, nails, and skin. 4. Security (supervision to insure personal safety). 5. Help with ambulation. Mr. ANDREW F. JURAS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Administrator, State Public Welfare Commission, DEAR MR. JURAS: This letter will confirm the comments in your July 23, 1969, letter regarding payments in behalf of mentally retarded individuals in skilled nursing homes and intermediate care facilities. As a result of the PREP team discussion on August 4, 1969, you, no doubt, have the comfirmation needed, and, hopefully, your questions answered. We would like to use this letter as a means of bringing our files up to date as well as reconfirming our discussions. Those present at the discussion on August 4th were: Art Wilkinson, Fiscal Analyst, Executive Department, Public Welfare and Ken Gaver, M.D., Director, and J. D. Bray, M.D., Deputy Director, Mental Health Division; Robert Heilman, M.D., Director of Licensing and Standards, State Health Clarence Jenike, M.D., Deputy State Public Health Administrator; It was determined that all aspects of licensing are entirely determined by the State. If you wish to write regulations specifically for nursing homes for mentally retarded, this would be a State decision. If these nursing homes are to be included in Federal programs, however, they must meet all applicable Federal standards and requirements. It was also determined that payments could be made to an I.C.F. which is a distinct part of a public institution, as long as it is a medical institution. Finally, it was determined that no special provisions are required in the State Plan to include mentally retarded individuals. The fact that a person is or is not mentally retarded has no bearing in and of itself on the eligibility under either program. It will be necessary to include the new licensing standards, however. We hope this letter is in sufficient detail to adequately confirm our discussions. Should you have any further questions, please let us know. Sincerely, (Miss) GENE BEACH, Associate Regional Commissioner. RULES, REGULATIONS AND STANDARDS FOR NURSING HOMES FOR THE MENTALLY RETARDED IN OREGON [Editor's Note: Unless otherwise specified sections 23-330 through 23–368 of this chapter of the Oregon Administrative Rules Compilation were adopted by the Board of Health October 7, 1969 and filed with the Secretary of State October 9, 1969, as Administrative Order HB 226, Effective October 9, 1969]. 23-330 Definitions. (1) A "Nursing Home for the Mentally Retarded" means any institution or health care facility which: (a) Operates and maintains facilities and a wide range of services exclusively for two or more mentally retarded residents in whom there is subaverage general intellectual functioning which originates during the developmental period and is associated with impairment in adaptive behavior. (b) Provides one or any combination of classes of care as defined in section 23-346 (6) (a) through (e) of these rules. (2) "Hospital Licensing Law" means ORS 441.005 to 441.080. (3) "Board" or "State Board of Health" means the Oregon State Board of Health. (4) "Registered Nurse" means a person graduated from an accredited school of nursing and currently registered through the Oregon State Board of Nursing. (5) "Licensed Practical Nurse" means a person licensed through the Oregon State Board of Nursing as a practical nurse. (6) "Nursing Aide" means a person working under the direct supervision of a registered nurse or a licensed practical nurse. 23-332. Application for License. All persons contemplating the operation of a nursing home for the mentally retarded shall apply to the Board for a license on a form provided by the Board and remit the license fee required by law at least 30 days before the opening of the nursing home. 23-334. Issuance of License. (1) An applicant must be of reputable character and suitable temperament and understanding of the needs of mentally retarded individuals and how and what services and programs are necessary to meet these needs. (2) If the institution applying for a license is a governmental institution, no license fee for the facility will be required; however, to qualify for licensure as a nursing home for the mentally retarded the facility must be operated in accordance with all the requirements of ORS 678.510 to 678.990. This would require the payment of a nursing home administrator's fee. (3) Every nursing home for the mentally retarded shall have a distinctive name which is to be used in applying for a license and shall not be changed without first notifying the board in writing. (4) Each license shall specify the maximum allowable number of beds on each floor of each building comprising the nursing home for the mentally retarded. It shall also state the classes of care the facility will provide. (5) A separate license shall be required for each nursing home for the men, tally retarded when more than one nursing home for the mentally retarded is operated under the same management; provided, however, that separate licenses are not required for separate buildings on the same grounds used by the same nursing home for the mentally retarded. (6) The license shall be conspicuously posted in the office where residents are admitted. (7) No person or institution licensed pursuant to the provisions of ORS, Chapter 441, shall in any manner or by any means assert, represent, or imply that such person or institution is or may render care or services other than that which is permitted by or which is within the scope of the license issued to such person or institution by the Board. 23-336 Expiration and Renewal of License. (1) Each license to operate a nursing home for the mentally retarded shall expire on June 30th following the date of issue, and if a renewal is desired the licensee shall make application at least 30 days prior to the expiration date upon a form prescribed by the Board. (2) Each nursing home for the mentally retarded shall submit an annual report which shall be upon a form prescribed by the Board. (3) When an applicant has failed to obtain a license because of non-compliance, an application for the new licensing year shall be considered as a new application rather than a renewal. 23-338 Denial or Revocation of License. A license may be withheld or denied or revoked if the Board finds upon investigation that any illegal act affecting the welfare of a resident in the nursing home for the mentally retarded has been permitted, aided or abetted by the person or persons in charge of the home, or by either of them. 23-340 Return of License, Each license certificate in the licensee's possession shall be returned to the Board immediately on the suspension or revocation of the license, or if the operation is discontinued by the voluntary action of the licensee. 23-342 Submissions of Plans. (1) Prior to construction of a new building or an addition to an existing building or remodeling of an existing building, plans drawn by an architect or plans drawn to scale (using the standard 4" or " scale) with the appropriate architectural symbols, shall be submitted to the Board for approval with respect to compliance with these standards. Note: The Board recommends that all construction conform to the standards found in the latest edition of the Uniform Building Code as adopted by the Pacific Coast Building Officials Conference. (2) The water supply, plumbing, sewerage and garbage disposal systems shall be approved by the State Plumbing Division and the County Sanitarian. 23-344. Location and Communication. (1) Location and accessibility should be considered in planning new nursing home for the mentally retarded facilities. (2) Telephones to summon help in case of fire or other emergency, shall be adequate in number and shall be so located as to be quickly accessible from all parts of the building. 23-346. Building (1) Buildings to be used as nursing homes for the mentally retarded shall be suitable for such usage. They shall be subject to approval of the Board, and must comply with the building codes of local municipalities and county planning and building permits. (2) The walls and floors shall be such as to permit frequent washing or cleaning and the stairs shall be covered with a non-skid material. The building shall be kept clean and sanitary and in good repair, and vector free. Kitchen, bathrooms and utility rooms shall have smooth enameled or equally washable surfaces. (3) All stairways shall be provided with handrails. (4) Each resident's room or ward area shall be an outside room or area. (5) Individual's sleeping quarters shall be of sufficient size to allow for adequate service and nursing procedures and to permit the placing of beds at least three feet apart. (6) The size of the service areas and sleeping areas will be determined by the level of care required and applicable to the classifications as follows: (a) Class I Nursing Home for the Mentally Retarded. In this category are residents without physical disabilities and no behavior problems and minimum mental retardation. These residents are potential candidates for vocational rehabilitation and return to a community environment. As such the environment should be normalized to include the following: (A) Not more than four residents to a ward. (B) The ward to have 70 square feet per bed with a chair and either a separate clothes locker or a common clothes closet for the ward residents. (C) Residents in this group shall also have a day area based on twenty square feet per resident. This area may also serve for other activities such as recreation, dining or education. (D) Toilets serving residents in this category shall have toilet seats, be enclosed with a door and in ratio of one toilet per 15 residents and one lavatory per 10 residents. If male and female residents are housed together, separate toilets and lavatories for male and female residents are provided. (E) The window area of the four-bed wards shall be no less than one-tenth of the floor area. (F) There shall be one tub and shower for every 30 residents. (G) Paraphanelia for good grooming such as mirrors, combs, brushes, tooth brushes, etcetera shall be available. (H) Residents up to age 10 may be housed together and share common toilet and bathing facilities. Over age 10, the sexes shall not be mixed and separate toilet and bathing facilities shall be provided for each sex. In each resident case, a physician evaluation shall be required for proper placement. (b) Class II Nursing Home for the Mentally Retarded. Individuals in this grouping are similar to Class I except the degrees of mental retardation are greater and maximum program objectives are aimed at placing the resident in a sheltered environment. Environmental factors such as room sizes, bath rooms, et cetera would be the same as Class I. (c) Class III Nursing Home for the Mentally Retarded. Individuals in this grouping age severely mentally retarded with little or no behavior problem or physical disibilities. Educational Efforts shall be directed to the development of self-help skills. Often groups under the age of puberty with both boys and girls in residential wards are programmed together in the development of self-help skills, group interrelationship, et etcera. This shall apply to all children in all age groups. 47-530-70-pt. 2- -13 |