10-144-118 Me. Code R. § 5.A

Current through 2024-51, December 18, 2024

Section 144-118-5.A - Protection of Clients' Rights

Each facility must have, and shall implement written policies and procedures which ensure the rights of clients as set forth in Title 34-B M.R.S.A., Section5601, et seq. (Rights of Mentally Retarded Persons) and 42 C.F.R., Section 483.420.

Policies and procedures shall require that:

5.A.1. The facility must:

a. Inform, in writing, each client, parent (if the client is a minor), or legal guardian, of the client's rights and the rules of the facility, including:

1. All services available; and

2. Changes in services or charges as they occur during the client's stay.

b. Inform each client, parent (if the client is a minor), or legal guardian, of the client's medical condition, developmental and behavioral status, attendant risks of treatment, and of the right to refuse treatment and ensure the opportunity for the client to participate in planning the total care and medical treatment, unless the physician decides that informing the client is medically contraindicated. This decision must be documented in the client's record.

c. Transfer or discharge clients only for:

1. Medical reasons;

2. The welfare of the client or that of other clients; or

3. Nonpayment, except as prohibited by the Medicaid Program;

d. Advise clients and guardians of their right to appeal, and notify advocacy agencies as appropriate.

e. Allow and encourage individual clients to exercise their rights as clients of the facility, and as citizens of the State of Maine and the United States, including their rights to file complaints, to due process and to vote.

1.The client and parents shall be informed of the advocacy services available, and

2.Opportunity for client participation in the Resident Council or comparable mechanism for client input regarding the rules of conduct for the facility shall be provided.

f.Ensure that clients are not compelled to perform services for the facility;

1.Training tasks may not involve the care or treatment of other clients.

2.Clients shall be encouraged and/or assisted to perform work in the least restrictive setting and at the highest remunerative value of which they are capable.

g. Housekeeping:

A client may be encouraged to perform tasks of a personal housekeeping nature when:

1.They are included in the client's Annual Plan to develop new skills;

2.They require the client to be reasonably responsible for keeping his/her personal areas clean and neat.

h.Ensure that each client is being treated with consideration, respect, and full recognition of his/her dignity and individuality. To that end, the client shall have a right to private communications communications, and have access to telephones with privacy for incoming and outgoing local and long distance calls, except as contraindicated by factors identified within their IPP.

i. Ensure that each client has the right to retain and use personal possessions and his/her own clothing. If necessary, to protect the client or others from imminent injury, the staff may take temporary custody of clothing or personal effects, provided such emergency conditions of custody are documented in the client's record and the possessions are returned to the client as soon as the emergency is over and the return of the possessions would not precipitate another emergency;

j.Ensure that each client shall be dressed in his/her own clothing each day

1.The client shall be assisted in obtaining and, if necessary, provided with adequate, fashionable and seasonable clothing including shoes and coats; and

2.Special or adaptive clothing shall be provided where necessary.

k. Provide for assistance to each client so that the client may

1.Exercise the right to vote.

2. Have the right to religious freedom and practice.

l. Provide privacy for a married client during visits with his/her spouse;

m.As appropriate, provide training in sexuality and socialization to include information on contraception;

n. Ensure that no person shall be admitted to an ICF/MR unless a prior determination is made that residence at the home is the least restrictive habilitation setting appropriate for that person.

1. Clients shall be provided with the least restrictive and most normal living conditions possible. This standard shall apply to dress, grooming, movement, use of free time, and contact and communication with the outside community, including access to educational, vocational and recreational therapy services outside of the facility. Clients shall be taught skills that help them learn how to manipulate their environment and how to make choices necessary for daily living.

2. Clients have a right to habilitation, including medical treatment, education, training and care, suited to their needs, regardless of age, level of retardation or handicapping condition. Each client has a right to a habilitation program which will maximize his/her abilities, enhance his/her ability to cope with his/her environment and create a reasonable expectation of progress toward the goal of independent living.

o.Ensure that clients shall have a right to the least restrictive conditions necessary to achieve the purposes of habilitation. To this end, the facility shall make every attempt to move clients from:

1. More to less structured living;

2. Larger to smaller facilities;

3. Larger to smaller living units;

4. Group to individual residences;

5. Segregated to integrated community living;

6. Dependent to independent living; and in concert with the clients' and/or guardians' preference.

p.Ensure that, unless contraindicated by the client's IPP/Annual Plan, ICFs/MR shall house both male and female clients. Unrelated clients of grossly different ages, developmental levels and social needs shall not be housed in close physical proximity, and clients who are non-ambulatory, deaf, blind, epileptic, or otherwise with a physical disability shall not be grouped with lower functioning clients solely because of such handicaps.

q.Ensure that the facility's rhythm of life shall conform with practices prevalent in the community. For example, older clients ordinarily shall not be expected to live according to the timetable of younger clients.

r. Ensure that clients who are non-ambulatory and have multiple handicaps shall, except where otherwise indicated by a physician's order, spend a major portion of their waking day out of bed, and out of their bedroom, have planned daily activity, and be rendered mobile by suitable methods and devices. Clients shall not stay in beds, cribs, wheelchairs or orthopedic carts all day long, except on the order of a physician, which must be in writing if the order is to remain in effect for more than four (4) hours.

10-144 C.M.R. ch. 118, § 5.A