10-144-113 Me. Code R. § III-2

Current through 2024-51, December 18, 2024

Section 144-113-III-2 - Definitions

The following terms have the meanings as specified.

2.1 "Abuse" means the infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish, sexual abuse or exploitation, or the willful deprivation of essential needs.

2.2 "Activities of Daily Living (hereinafter ADLs)" means tasks routinely performed by a person to maintain bodily functions, including bed mobility, transfers, locomotion, dressing, eating, toileting, bathing and personal hygiene.

2.3 "Adult Day Services" means the care and supervision of consumers who attend the facility during daytime or nighttime hours but are not residents of the facility.

2.4 "Advance Directives" means a document signed by the resident, guardian or agent under durable power of attorney, giving or withholding consent or approval related to medical or other professional care, counsel, treatment or service for the resident, in the event that the resident becomes unable to provide that direction.

2.5 "Aging in Place" means a program of services provided in assisted housing programs that furthers the independence of the resident and respects the privacy and personal choices of the resident, including the choice to continue to reside at home for so long as the assisted housing program, as it is fundamentally designed, is able to meet the needs of the resident. Assisted housing programs provided to residents must be consumer oriented and meet professional standards of quality.

2.6 "Alzheimer's/Dementia Care Unit" means a unit, facility or distinct part of a facility that provides care/services in a designated, separated area for residents with Alzheimer's disease or other dementia. The unit, facility or distinct part provides specialized programs, services and activities, and is locked, segregated or secured to provide or limit access by residents inside and outside the designated or separated area.

2.7 "Applicant" means the person who owns the facility and is applying for a license, or the person who is applying for a license pursuant to a valid lease agreement, contract or other agreement with the owner of the building that delineates the roles and duties under these rules.

2.8 "Assisted Housing Program" means an independent housing with services program, an assisted living program or a program of housing and services provided by a residential care facility or a private non-medical institution.

2.9 "Assisted Housing Services" means the provision by an assisted housing program of housing, activities of daily living and instrumental activities of daily living, personal supervision, protection from environmental hazards, meals, diet care, care management and diversional or motivational activities. These services are further defined as follows:

2.9.1 Personal supervision, meaning awareness of a resident's general whereabouts, even though the resident may travel independently in the community; and, observation and assessment of each resident's functioning or behavior to enhance his or her health or safety or the health or safety of others;

2.9.2 Protection from environmental hazards, meaning mitigation of risk in the physical environment to prevent unnecessary injury or accident;

2.9.3 Assistance with Activities of Daily Living and Instrumental Activities of Daily Living;

2.9.4 Diversional, motivational or recreational activities, meaning activities which respond to residents' interests or which stimulate social interaction, both in individual and group settings;

2.9.5 Dietary services, meaning the provision of regular and therapeutic diets that meet each resident's minimum daily food requirements, as defined by the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences;

2.9.6 Care Management Services, meaning a process of working with a resident to identify his/her needs and strengths, develop a service plan and arrange for and monitor service delivery.

2.10 "Assisted Living Program" means a program of assisted living services provided to residents in private apartments in buildings that include a common dining area, either directly by the provider or indirectly through contracts with persons, entities or agencies. The types of assisted living programs governed by these regulations include:

2.10.1 Type I - an assisted living program that provides medication administration directly or indirectly through contracts with persons, entities or agencies.

2.10.2 Type II - an assisted living program that provides medication administration and nursing services directly or indirectly through contracts with persons, entities or agencies.

2.10.2.1 Services of a Registered Professional Nurse; and/or

2.10.2.2 Registered Professional Nurse coordination and oversight of consumer services provided by unlicensed health care assistive personnel.

2.11 "Assisted Living Services" means the provision by an assisted housing program, either directly by the provider or indirectly through contracts with persons, entities or agencies, of assisted housing services, assisted housing services with the addition of medication administration or assisted housing services with the addition of medication administration and nursing services, defined as follows:

2.11.1 "Administration of medications" means services such as reading labels for residents, observing residents taking their medications, checking the dosage, removing the prescribed dosage, filling a syringe and administering insulin and bee sting kits (when permitted) and the maintenance of a medication record for each resident;

2.11.2 "Nursing services" means services provided by professional nurses licensed pursuant to Title 32, section 2102, subsection 2. It includes coordination and oversight of resident care services provided by unlicensed health care assistive personnel.

2.12 "Certified Nursing Assistant (CNA)" means a person who has successfully completed a training program or course with a curriculum prescribed by the Maine State Board of Nursing or is deemed to have had comparable training according to regulations established by the Maine State Board of Nursing, and whose duties are assigned by a registered professional nurse, and who is currently listed on the Maine Registry of Certified Nursing Assistants.

2.13 "Certified Nursing Assistant/Medications (CNA/M)" means a Certified Nursing Assistant who has satisfactorily completed the standardized medication course for Certified Nursing Assistants, the curriculum for which is prescribed by the Maine State Board of Nursing.

2.14 "Deficiency" means a violation of State licensing regulations.

2.15 "Dementia" means an acquired loss of intellectual functioning (primarily abstract thinking, memory, and judgment) of sufficient severity to interfere with a person's ability to act independently and perform routine daily activities. Symptoms of dementia can include memory loss and the loss or diminution of other cognitive abilities, such as learning ability, judgment, comprehension, attention and orientation to time and place and to oneself. Dementia is not a disease in and of itself but rather a group of symptoms that accompanies certain diseases and conditions. Dementia can be caused by such diseases as Alzheimer's Disease, Pick's Disease, Amyotrophic Lateral Sclerosis (ALS), Parkinson's Disease, Huntington's Disease, Creutzfeldt-Jakob Disease, multi-infarct dementia, etc.

2.16 "Department" means the Maine Department of Health and Human Services.

2.17 "Directed Plan of Correction" means a Plan of Correction issued by the Department which directs how and when to correct cited deficiencies.

2.18 "Distinct Part" means a physically separate unit that is clearly identifiable from the remainder of the facility. Various beds scattered throughout the facility would not comprise a "distinct part". The "distinct part" of a facility provides a level of care distinguishable from other levels of care in the institution.

2.19 "Duly Authorized Licensed Practitioner" means an individual currently licensed in the State of Maine as a physician, physician's assistant or nurse practitioner.

2.20 "Emergency" means either those events that demonstrate that a resident has an urgent medical or psychological need, which requires immediate acute care treatment, poses imminent danger to other residents or a natural disaster, which damages or interrupts vital services to residents or the integrity of the physical plant.

2.21 "Exploitation" means the illegal or improper use of an incapacitated or dependent adult or his/her resources for another's profit or advantage.

2.22 "Failure to Make Timely Correction of Any Deficiency" means that a provider has not remedied a deficiency within the time frame established in a Plan of Correction or Directed Plan of Correction, or, if any extension has been granted by the Department, within the time frame of that extension.

2.23 "False Information" means any written or verbal statement or representation of fact that is not true and that was made intentionally, knowingly or without having taken reasonable steps to ascertain whether or not the information was true.

2.24 "Food Preparation Area" means an area for storing and preparing food in an individual's apartment. This area must include, as a minimum, six (6) square feet of clear countertop, a small refrigerator, bar-type sink, a cabinet for food storage and either two stovetop burners or a microwave oven.

2.25 "Functional Assessment" means a comprehensive evaluation of an individual's health, social, environmental, financial and family or community supports, which will determine the strengths and needs of the individual.

2.26 "Impede or Interfere with the Enforcement of Regulations" means a failure to provide information to the Department that is necessary to determine compliance with licensure regulations or a failure to allow the Department access to an Assisted Housing Program or any part thereof.

2.27 "Independent Housing with Services Program" means a program of assisted housing services provided to residents in private apartments in buildings that include a common dining area, either directly by the provider or indirectly through contracts with persons, entities or agencies.

2.28 "Instrumental Activities of Daily Living (hereinafter IADLs)" includes, but is not limited to, preparing or receiving of a main meal, taking medication, using the telephone, handling finances, banking, shopping, routine housework, laundry and getting to appointments.

2.29 "Legal Representative" means a guardian, conservator, agent under durable power of attorney, representative payee, or other person authorized by law, whose authority extends to the matter under consideration and who has provided the facility with documentation of their legal authority.

2.30 "Licensee" means the person to whom a license is issued.

2.31 "Licensed Administrator" means an individual who holds a valid administrator license issued by the Nursing Home Administrators Licensing Board pursuant to rules adopted under Title 32 M.R.S.A. §61.

2.32 "Licensed Health Care Professional" means health care providers, including physicians, registered professional nurses, licensed practical nurses, physician assistants, nurse practitioners, occupational therapists, speech pathologists, physical therapists, dietitians and social workers who have been authorized to practice a health care profession in accordance with Maine State law.

2.33 "Medication Error" means the administration of any medication incorrectly, e.g., dosage, selection of drug, selection of resident, time or method of administration, omission of prescribed medication, error in documentation or the administration of a medication without a valid order.

2.34 "Neglect" means a threat to an adult's health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these threats.

2.35 "Person" means any individual, owner, corporation, partnership, association, governmental subdivision or any other entity.

2.36 "Pharmacist" means an individual currently licensed as a registered professional pharmacist in the State of Maine.

2.37 "Physician" means an individual currently licensed to practice medicine or osteopathy in the State of Maine.

2.38 "Plan of Correction (hereinafter POC)" means a section of the Statement of Deficiencies completed by the provider, detailing the plan to correct deficiencies and the completion dates.

2.39 "Private Apartment" means a private dwelling unit with an individual bathroom, bedroom and a food preparation area.

2.40 "Private Non-Medical Institution" means a house or other place that, for consideration, is maintained wholly or partly for the purpose of providing residents with assisted living services. Private non-medical institutions are a type of residential care facility that receives MaineCare funds and complies with additional requirements as specified in various sections of these rules. A PNMI provides housing and services to residents in private or semi-private bedrooms in buildings with common living areas and dining areas. It does not include licensed nursing homes, a supported living arrangement certified by the Department of Behavioral and Developmental Services, or a facility licensed as a residential care facility. Following are the types of private non-medical institutions:

2.40.1 Level I - a facility with a licensed capacity of one (1) to two (2) residents.

2.40.2 Level II -a facility with a licensed capacity of three (3) to six (6) residents.

2.40.3 Level III -a facility with a licensed capacity of three (3) to (6) residents and which employs three (3) or more persons who are not owners and are not related to the owner.

2.40.4 Level IV - a facility with a licensed capacity of more than six (6) residents.

2.41 "Provider" means the licensee.

2.42 "Psychotropic Medications" means antipsychotic agents, major tranquilizers, antidepressant agents, anxiolytic agents and hypnotic agents.

2.43 "Qualified Consultant Dietitian" means an individual who is currently licensed to practice dietetics in the State of Maine.

2.44 "Qualified Interpreter" means an interpreter who is able to interpret effectively, accurately and impartially, both receptively and expressively, using any necessary specialized vocabulary.

2.45 "Registered Nurse" or "Registered Professional Nurse (hereinafter RN)" means an individual who is currently licensed by the Maine State Board of Nursing to practice professional nursing.

2.46 "Related by Blood or Marriage" means spouses, parents, children, grandparents, grandchildren, great-grandparents, great-grandchildren, brothers, sisters, aunts, uncles, nephews, nieces, and step-relations.

2.47 "Repeated Deficiency" means a violation of a rule more than once in a two (2) year period.

2.48 "Resident" means any person eighteen (18) years of age or older, who is not related by blood or marriage to the owner or person in charge of the facility or building in which the resident lives and who receives assisted housing services. Any person seventeen (17) years of age, with written permission from the Department, may be a resident.

2.49 "Resident Assessment Instrument (RAI)" is the assessment tool approved by the Department for use by the provider to obtain an accurate standardized, reproducible assessment of each resident's functional capacity. It consists of the Minimum Data Set - Residential Care Assessment instrument (MDS - RCA), the training manual for the MDS-RCA tool, and any updates provided by the Department.

2.50 "Resident Rights" means those rights enumerated in Title 22 M.R.S.A. §7921 et seq. and 22 M.R.S.A. §7853(6) which apply to assisted housing programs, and also they're enumerated in Section 5 of these regulations.

2.51 "Residential Care Facility" means a house or other place that, for consideration, is maintained wholly or partly for the purpose of providing residents with assisted living services. Residential care facilities provide housing and services to residents in private or semi-private bedrooms in buildings with common living areas and dining areas. It does not include licensed nursing homes or a supported living arrangement certified by the Department of Behavioral and Developmental Services. Following are the types of residential care facilities:

2.51.1 Level I - a facility with a licensed capacity of one (1) to two (2) residents.

2.51.2 Level II - a facility with a licensed capacity of three (3) to six (6) residents.

2.51.3 Level III -a facility with a licensed capacity of three (3) to (6) residents and which employs three (3) or more persons who are not owners and are not related to the owner.

2.51.4 Level IV - a facility with a licensed capacity of more than six (6) residents.

2.52 "Residential Services Plan" means a written service plan developed with a resident, based upon an assessment of the resident's needs and abilities and including (as appropriate) habilitative or rehabilitative goals and objectives, program goals and objectives and the resources and methods necessary to implement the plan.

2.53 "Restraints"means any device or other means, except mechanical supports used in normative situations to achieve proper body position and balance:

2.53.1 Which is intended to restrict freedom of movement or access to one's body; or

2.53.2 Any medication which alters cognition or behavior and which is used for discipline or convenience and is not required to treat medical symptoms.

2.54 "Scattered Sites" means facilities with licensed private non-medical institution beds at scattered locations serving a minimum of four eligible members, as long as the service provided consistently fits within the definition of the applicable appendices in accordance with Chapter III, Section 97, of the MaineCare Benefits Manual.

2.55 "Self-Administration of Medication" means a resident takes his/her own medication(s) independent of a staff person obtaining the medication for the individual.

2.56 "Shared Staffing" as defined in 22 M.R.S.A. §7860 means the use of licensed and unlicensed personnel who are employed, directly or under contract, by a long term care facility in more than one level of care provided by a single entity on the same premises.

2.57 "Statement of Deficiencies (hereinafter SOD)" means a document issued by the Department which describes deficiencies in complying with these regulations.

2.58 "Submit" means to deposit in the US mail, hand deliver, fax submission and electronic submission to the Department

2.59 "Tenancy Obligation" means a house rule that does not conflict with these regulations, established by the facility and included in the admission agreement, that all residents must adhere to in order to continue their residence.

2.60 "Unlicensed Health Care Assistive Personnel" means individuals employed to provide hands-on assistance with activities of daily living to individuals in homes, assisted living programs, residential care facilities, private non-medical institutions, hospitals and other health care settings. Unlicensed assistive personnel does not include certified nursing assistants employed in their capacity as certified nursing assistants. Unlicensed Health Care Assistive Personnel are also referred to as Unlicensed Assistive Personnel.

2.61 "Working Days" means weekdays. Legal holidays (when state offices are closed), Saturdays and Sundays are not working days.

10-144 C.M.R. ch. 113, § III-2