1,200 HOSPITALS FOR THE MENTALLY RETARDED 1,000 800 600 400 200 0 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 MENTALLY RETARDED, OREGON PUBLIC WELFARE DIVISION 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 persona services in a facility licensed as a nursing home for mentally retarded unde 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 fort in this guide. Care provided in an Intermediate Care Facility could be character ized 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-tim aides with a formal course in training for care of mentally retarded plus neces sary personal services in nursing home beds licensed for care of mentall retarded. b. Personal Care.—Characterized by the provision of personal services in a fa cility 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 perfort these duties in facilities or that these cannot be done by trained relatives in 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 intraver ously). 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 car relating to skin care and contractures as well as lifting to and from chair & intervals when possible, proper positioning, etc. 12. Care of incontinence when required for treatment of skin problems or othe infections and reporting changes in continency or incontinency pattern whic may alert physician to other medical problems. 13. Treatment of persistent conditions such as boils, acne, scabies, fungu etc. 14. Skilled observation of side effects of medication to assist physician i determination if reaction is dose-related, due to individual patient sesitivity ( due to patient's special medical problems. This would include neuromuscula reactions, motor restlessness, dystonias, pseudoparkinsonism, edemas, blood pre behavior, etc. The reporting of these observations to be referred to the physicia sure, or heart rhythm irregularities, skin disorders, jaundice, recurrent psychot behavior, etc. The reporting of these observations to be referred to the physicia for treatment adjustments or change. 15. Planned training and teaching self-help such as performing bodily fun tions (bowel and bladder control), speaking, walking, dressing, self-feedin socializing skills, personal hygiene, learning basic commands, use of prosthet devices. 16. Regular checking of patients whose behavior results in self-abuse ar injury such as inserting objects in body orifices, picking at self, head bangin 17. Control and modification of the following kinds of on-going and recurre behavior: etc. 1. Assaultive or combative 2. Withdrawn 3. Destructive 4. Sexually aggressive 18. Planned service to prevent contractures and musculoskeletal deformities ›r to ease those conditions already existing. 19. Help in eating for those patients who have masticating and/or swallowing ›roblems. Plans for these patients should be recorded and available for all ursing personnel. 20. Carry out plans for opportunity and continued activity of patients in naintaining 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; Mr. Juras, Dr. Domke, and Mr. Arbuckle from Welfare Division; Messrs. Muth, Marrinan, Barker, Burr, Woffinden, and Dr. Vander Slice from the PREP team. 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. (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 mentally 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. |