La. Admin. Code tit. 48 § I-8569

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-8569 - Behavior Management

A. Description of Methods Used

1. The ICF/DD shall have a written description of the methods of behavior management to be used on a facility-wide level. This description shall include:

a. definitions of appropriate and inappropriate behaviors of individuals; and

b. acceptable staff responses to inappropriate behaviors.

2. The description shall be provided to all the ICF/DD's staff.

3. An ICF/DD shall have a clearly written list of rules and regulations governing conduct for individuals in care of the ICF/DD. These rules and regulations shall be made available to each staff member, each individual and, where appropriate, the legally responsible person.

B. Any behavior management plan that limits the rights of the individual shall be approved by the Human Rights Committee and consented to by the client or his/her representative or guardian.

C. Prohibition on Potentially Harmful Responses. An ICF/DD shall prohibit the following responses to individuals by staff members:

1. any type of physical hitting or other painful physical contact except as required for medical, dental or first aid procedures necessary to preserve the individual's life or health;

2. requiring an individual to take an extremely uncomfortable position;

3. verbal abuse, ridicule or humiliation;

4. withholding of a meal, except under a physician's order;

5. denial of sufficient sleep, except under a physician's order;

6. requiring the individual to remain silent for a long period of time;

7. denial of shelter, warmth, clothing or bedding;

8. assignment of harsh physical work;

9. physical exercise or repeated physical motions;

10. denial of usual services; and

11. denial of visiting or communication with family.

D. Time-Out Procedures

1. An ICF/DD with eight beds or less shall not use time out procedures.

2. An ICF/DD using time-out procedures involving seclusion of individuals in an unlocked room for brief periods shall have a written policy governing the use of time-out procedures. This policy shall ensure that time-out procedures are used only when less restrictive measures are not feasible;

3. Written orders by a physician for time-out procedures shall state the reasons for using time-out and the terms and conditions under which time-out will be terminated or extended, specifying a maximum duration of the use of the procedure which shall under no circumstances exceed one hour.

4. Emergency use of time-out shall be approved by the administrator or his/her designee for a period not to exceed one hour. The ICF/DD shall immediately notify the individual's physician if emergency use of time-out is implemented.

5. When an individual is in time-out, a staff member shall exercise direct physical observation of the individual.

6. An individual in time-out shall not be denied access to bathroom facilities.

7. An ICF/DD shall not use time out on an as needed basis.

E. Restraints

1. The facility may employ physical restraints only:

a. as an integral part of an individual program plan that is intended to lead to less restrictive means of managing and eliminating the behavior for which the restraint is applies;

b. as an emergency measure, but only if absolutely necessary to protect the client or others from injury; or

c. as a health related protection prescribed by a physician, but only if absolutely necessary during the conduct of a specific medical or surgical procedure, or only if absolutely necessary for client protection during the time that a medical condition exists.

2. Authorization to use or extend restraints as an emergency measure must be:

a. in effect no longer than 12 consecutive hours; and

b. obtained as soon as the client is restrained or stable.

3. The facility shall not issue orders for restraint on a standing or as needed basis.

4. A client placed in restraints shall be checked at least every 30 minutes by staff trained in the use of restraints, released from the restraint as quickly as possible, and a record of these checks and usage shall be kept.

5. Restraints shall be designed and used so as not to cause physical injury to the client and so as to cause the least possible discomfort.

6. Opportunity for motion and exercise shall be provided and a record of such activity must be kept.

7. Barred enclosures shall not be more than three feet in height and must not have tops.

F. Human Rights Committee. The facility must designate and use a specially constituted committee or committees consisting of members of facility staff, parents, legal guardians, clients (as appropriate), qualified persons who have either experience or training in contemporary practices to change inappropriate client behavior and persons with no ownership or controlling interest in the facility to:

1. review, approve, and monitor individual programs designed to manage inappropriate behavior and other programs that, in the opinion of the committee, involve risks to client protection and rights;

2. insure that these programs are conducted only with the written informed consent of the client, parents (if the client is a minor) or legal guardian; and

3. review, monitor and make suggestions to the facility about its practices and programs as they relate to drug usage, physical restraints, time-out rooms, application of painful or noxious stimuli, control of inappropriate behavior, protection of client rights and funds, and any other areas that the committee believes need to be addressed.

La. Admin. Code tit. 48, § I-8569

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:3200 (December 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2180-2180.5.