216-40-10 R.I. Code R. § 1.15

Current through June 20, 2024

Section 216-RICR-40-10-1.15 - Reporting of Resident Abuse or Neglect, Accidents and Death

A. Any physician, physician assistant, nurse or other employee of a nursing facility who has reasonable cause to believe that a resident has been abused, exploited, mistreated, neglected or experiences an injury of unknown origin, as outlined in R.I. Gen. Laws Chapter 23-17.8 shall make, within twenty-four (24) hours of the receipt of said information, a report to the licensing agency and to the office of the State long-term care ombudsman. Any person required to make a report pursuant to this section shall be deemed to have complied with these requirements if a report is made to a high managerial agent. Once notified, the administrator or the director of nursing services shall be required to meet the above reporting requirements.

1. All reports, as required by this Part, shall be provided to the licensing agency in writing via facsimile or electronic transmission to DOH.OFR@health.ri.gov on forms supplied by the licensing agency. A copy of each report shall be retained by the nursing facility for review during subsequent inspections by the licensing agency.

2. The nursing facility shall maintain evidence that all allegations of abuse, neglect, and/or mistreatment have been thoroughly investigated and that further potential abuse has been prevented while the investigation is in progress. Appropriate corrective action shall be taken, as necessary. The results of said investigation shall be reported to the licensing agency within five (5) business days.

B. Accidents/incidents resulting in hospital admission or accidents/incidents resulting in death in the nursing facility of any resident shall be reported in writing to the licensing agency within twenty-four (24) hours or before the end of the next working day. A copy of each report shall be retained by the nursing facility for review during subsequent surveys.

C. The death of any resident of a nursing facility occurring within twenty-four (24) hours of admission or prior to the performance of a physical examination in accordance with § 1.16.5(C) of this Part, shall be reported to the Office of the State Medical Examiners.

D. In addition, all resident deaths occurring within a nursing facility which are sudden or unexpected, suspicious or unnatural, the result of trauma, remote or otherwise or when unattended by a physician shall be reported to the nursing facility medical director and to the Office of the State Medical Examiners in accordance with R.I. Gen. Laws Chapter 23-4.

E. Reporting requirements, pursuant to R.I. Gen. Laws Chapter 23-17.8 must be posted.

F. Report all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property; immediately, but not later than two (2) hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than twenty-four (24) hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury (in accordance with 42 C.F.R. § 483.12(c)(1)).

G. Any elopement of a resident that results in police being called must be reported in writing to the licensing agency within twenty-four (24) hours or by the end of the next business day.

H. Unscheduled implementation of fire/evacuation/disaster plan. Report immediately via phone (401) 222-5200, then fax the information to the licensing agency within three (3) business days.

1.15.1Medical Records

A. A medical record shall be established and maintained for every person admitted to a nursing facility in accordance with accepted professional standards and practices. The administrator shall have ultimate responsibility for the maintenance of medical records; such responsibility may be delegated in writing to a staff member.

B. Entries in the medical record relating to treatment, medication, diagnostic tests and other similar services rendered shall be made by the responsible persons at the time of administration. Only physicians shall enter or authenticate medical opinions or judgment.

C. All accidents, including falls, whether resulting in an injury or not, shall be immediately recorded in the resident's record.

D. Detailed descriptions of all pressure ulcers, or other skin lesions, shall be recorded in the resident's record.

E. Each medical record shall contain sufficient information to identify the resident and to justify diagnosis, treatment, care and documented results and shall include as deemed appropriate:

1. Identification data;

2. Pre-admission screening including mental status (or PASARR (Pre-Admission Screening and Annual Resident Review), where appropriate);

3. Medical history;

4. Plan of care and services provided;

5. Physical examination reports;

6. Admitting diagnosis;

7. Diagnostic and therapeutic orders;

8. Consent forms;

9. Physicians', physician assistants', and advance practice registered nurse practitioners' progress notes and observations;

10. Nursing notes;

11. Medication and treatment records, including any immunizations;

12. Laboratory reports, X-ray reports, or other clinical findings; consultation reports;

13. Documentation of all care and services rendered (e.g., dental reports, physical and occupational therapy reports, social service summaries, podiatry reports, inhalation therapy reports, etc.);

14. Resident referral forms;

15. Diagnosis at time of discharge; and

16. Disposition and final summary notes.

F. At time of discharge, a discharge summary, summarizing the resident's stay, shall be completed promptly and signed by the attending physician, advanced nurse practitioner or physician assistant.

G. Medical records of discharged residents shall be completed within a reasonable period of time (not to exceed sixty (60) days) with all clinical information pertaining to the resident's stay made part of the resident's medical record.

H. Confidentiality of medical records shall be governed by the provisions of R.I. Gen. Laws Chapter 5-37.3 and the following;

1. Only authorized personnel shall have access to the records.

2. The nursing facility shall release resident's medical information only with the written consent of the resident, parent, guardian or legal representative in accordance with R.I. Gen. Laws Chapter 5-37.3.

I. Provisions shall be made for the safe storage of medical records to safeguard them against loss, destruction or unauthorized use.

J. All medical records, either original or accurately reproduced, shall be preserved for a minimum of five (5) years following discharge or death of the resident in accordance with R.I. Gen. Laws Chapter 23-3.

1. Medical records of minors, however, shall be kept for at least five (5) years after such minor would have reached the age of eighteen (18) years.

K. The medical records of all residents shall be opened for inspection to duly authorized representatives of the licensing agency whose duty it is to enforce the Regulations herein consistent with § 1.15.5(P)(1) of this Part.

1. Information contained in medical records gathered and collected for the purpose of enforcing this Part is confidential in nature and shall not be publicly disclosed by any person obtaining such information by virtue of his office, unless by court order or as otherwise required by law.

1.15.2Transfer Agreements, Contracts, or Agreements

A. The nursing facility shall have in effect transfer agreements with one (1) or more hospitals for the provision of hospital care or other hospital services to be made available promptly to the residents of the nursing facility, as needed. The written transfer agreement shall ensure:

1. Timely transfer or admission of residents between the hospital and the nursing facility, whenever deemed medically appropriate in writing by a physician;

2. Interchange of medical and other information necessary or useful in the care and treatment of residents transferred or to determine the kind of care the resident requires that includes, but is not limited to the following:

a. Clear statement of the reason(s) resident is being transferred to the hospital or for consultation;

b. Name of resident, address, insurance status;

c. Name of attending physician and his or her telephone number;

d. Resident's next-of-kin and his or her telephone number;

e. Name of contact staff person at the nursing facility;

f. List of all diagnoses and complaints;

g. List of all current medications, including adequate indications for use;

h. Recent x-ray reports and laboratory reports, as applicable;

i. Existence, and copies, of any advance directives;

j. Any additional information as cited in the "Continuity of Care" form ("Long Form") available from the licensing agency; and

3. Security and accountability for the resident's personal effects during transfer.

B. Designated nursing facility personnel shall complete, in its entirety:

1. The "Continuity of Care" form approved by the licensing agency, for each resident who is discharged to another health care facility, such as a hospital, or who is discharged home, or any other licensed residential program, with follow-up home care required. Said form shall be provided to the receiving facility, care agency, or appropriate treating provider (e.g., primary care physician) prior to or upon transfer of the resident; or

2. The appropriate "Short Form", approved by the licensing agency, for each resident who is transferred to an emergency care facility, or to a physician's office, or other scheduled consultative appointment, prior to or upon transfer of the resident.

3. In the event of an emergency situation that requires a partial or full evacuation of residents, the nursing facility may supplement the Continuity of Care form with forms available through the State's Long-Term Care Mutual Aid Plan, or any form(s) as directed by the Licensing agency.

C. If the nursing facility does not employ full-time qualified professional personnel to render required services, or obtains services from an outside source, arrangements for such services shall be made through written agreements or contracts.

1. The responsibilities, functions, objectives, terms of agreement, financial arrangements, charges and other pertinent requirements shall be clearly delineated in the terms of any contract negotiated by a nursing facility.

2. All contracts or agreements negotiated by a nursing facility shall be consistent with the policies established in accordance with § 1.13.1(D) of this Part concerning conflict of interest.

3. Each consultant or outside source providing services to a nursing facility shall submit monthly reports as services are provided. Said reports and contracts shall be kept on file for inspection for a period of no less than three (3) years.

1.15.3Financial Interest Disclosure

A. Any nursing facility licensed pursuant to R.I. Gen. Laws Chapter 23-17 which refers clients/residents to another such licensed nursing facility or to an assisted living facility licensed pursuant to R.I. Gen. Laws Chapter 23-17.4 or a Supported Care Home, licensed pursuant to R.I. Gen. Laws Chapter 23-17.24, or to a certified adult day care program in which the referring entity has a financial interest shall, at the time a referral is made, disclose in writing the following information to the client/resident:

1. That the referring entity has a financial interest in the nursing facility or provider to which the referral is being made;

2. That the client/resident has the option of seeking care from a different nursing facility or provider which is also licensed and/or certified by the State of Rhode Island to provide similar services to the client/resident.

B. The referring entity shall also offer the client/resident a written list prepared by the Department of all such alternative licensed and/or certified facilities or providers. Said written list may be obtained by contacting:

Rhode Island Department of Health,

Center for Health Facilities Regulation 3 Capitol Hill, Room 306

Providence, RI 02908

401.222.2566

C. Non-compliance with §§ 1.15.4(A) and (B) of this Part shall constitute grounds to revoke, suspend or otherwise discipline the licensee or to deny an application for licensure by the Director, or may result in imposition of an administrative penalty in accordance with R.I. Gen. Laws Chapter 23-17.10.

1.15.4Rights of Residents

A. As part of the procedure for admission of a resident to a nursing facility a written contract shall be entered into between the said resident or his next of kin or legal representative and the nursing facility and the following Rules shall be observed in accordance with R.I. Gen. Laws Chapter 23-17.5 (Rights of Nursing Patients).

B. Each resident shall be offered treatment without discrimination as to gender, gender identity or expression, sexual orientation, age, race, color, marital status, familial status, religion, national origin, disability, or source of payment or profession.

C. Each resident shall be treated and cared for with consideration, respect and dignity and shall be afforded his right to privacy to the extent consistent with providing adequate medical care and with efficient administration.

D. Each resident shall have the right to choose his or her own physician subject to the physician's concurrence.

E. Each resident or responsible party shall be fully informed, as evidenced by the resident's written acknowledgment, prior to or at the time of admission or during stay, of all Rules and Regulations and policies pertaining to rights of residents and governing resident conduct and responsibilities.

F. Each resident or responsible party shall be informed in writing, prior to, or at the time of admission and during stay, of services available and of related charges including all charges not covered either under Federal and/or State programs by other third (3rd) party payers or by the nursing facility's basic per diem rate.

G. Each resident admitted to a nursing facility shall be and remain under the care of a physician as specified in policies adopted by the governing body.

H. Each resident shall be informed by a physician of his medical condition unless medically contraindicated, (as documented by a physician in his medical record), and shall participate in the planning and selection of his medical treatment and care.

I. If it is proposed that a resident be used in any human experimentation project, the resident shall first be thoroughly informed in writing of such proposal and shall be offered the right to refuse to participate in such project. A resident who, after being thoroughly informed, wishes to participate must execute a written statement of informed consent. The informed consent documentation shall be maintained on file in the nursing facility.

J. Residents shall be encouraged and assisted to voice their grievances through a documented grievance mechanism established by the nursing facility, involving residents, staff and relatives of residents, which will ensure resident's freedom from restraints, interference, coercion, discrimination or reprisal.

1. There shall be prompt efforts by the nursing facility staff to resolve resident's grievances.

K. Residents shall not be subject to mental and physical abuse and shall be free from chemical and (except in emergencies) physical restraints.

1. Restraining devices are generally prohibited. A controlling device to be used for the protection of the resident may be utilized only as ordered in writing and signed by a physician, physician assistant, or advanced practice registered nurse. The length of time, the purpose and the kind of restraint shall be specified in the physician's, physician assistant's, or advanced practice registered nurse's order.

2. If after a trial of less restrictive measures, the nursing facility decides that a physical restraint would enable and promote greater functional independence, then the use of the restraining device must first be explained to the resident, family member, or legal representative, and if the resident, family member or legal representative agrees to this treatment alternative, then the restraining device may be used for the specific periods for which the restraint has been determined to serve the purpose defined above. This does not allow the use of restraints for convenience sake.

3. The restraining device must be authorized by the physician, physician assistant, or advanced practice registered nurse for use for specific periods for which the restraint has been determined to serve the purpose defined in § 1.15.4(K)(2) of this Part. This does not allow the use of restraints for convenience sake.

L. A resident shall not be required to perform services for the nursing facility that are not included for therapeutic purposes in his plan of care.

M. Residents may meet with and participate in activities of social, religious and community groups at their discretion unless medically contraindicated per written medical order.

N. Residents may associate and communicate privately with persons of their choice and shall be allowed freedom and privacy in sending and receiving mail.

1. Posted reasonable visiting hours must be maintained in each nursing facility, with a minimum of four (4) hours daily. The nursing facility must provide immediate access to residents by properly identified appropriate government personnel, family members, physicians, and relatives. However, the resident reserves the right to refuse visitation by any of the aforementioned.

2. All health care providers, as licensed under the provisions of R.I. Gen. Laws Chapters 5-29 or 5-37 and all health care facilities, as defined in R.I. Gen. Laws § 23-17-2(5) shall be required to note in their residents' permanent medical records, the name of individual(s) not legally related by blood or marriage to the resident, who the resident wishes to be considered as immediate family member(s), for the purpose of granting extended visitation rights to said individual(s), so said individual(s) may visit the resident while he or she is receiving inpatient health care services in a nursing facility.

a. A resident choosing to designate said individual(s) as immediate family members for the purpose of extending visitation rights may choose up to five (5) individuals and do so either verbally or in writing. This designation shall be made only by the resident and can be initiated and/or rescinded by the resident at any time, either prior to, during, or subsequent to an inpatient stay at the nursing facility.

b. The full names of individual(s) so designated, along with their relationship to the resident, shall be recorded in the resident's permanent medical records, both at the inpatient nursing facility and with the resident's primary care physician.

c. In the event the resident has not had the opportunity to have said designation recorded in his or her medical records, a signed statement in the resident's own handwriting attesting to the designation of said individual(s) as an immediate family member for the purpose of extending visitation right during the provision of health care services in an inpatient health care facility, along with their relationship to said individual(s) shall meet all the requirements of § 1.15.5 of this Part. The resident's signature on said signed statement shall be witnessed by two (2) individuals, neither of whom can be the designated individual(s). In the event such signed statement is not available, those designated as agents on a durable power of attorney for health care form shall be allowed visitation privileges.

d. § 1.15.5 of this Part shall not be construed to prohibit legally recognized members of the resident's family from visiting the resident if they have not been so designated through the provisions of § 1.15.5 of this Part. No resident shall be required to designate individual(s) under the provisions of § 1.15.5 of this Part.

O. Residents shall have the right to obtain personal services or to purchase needs outside of the nursing facility.

P. The resident's right to privacy and confidentiality shall extend to all records pertaining to the resident. Release of any records shall be subject to the resident's approval except as otherwise provided by law.

1. The right to privacy and confidentiality relates to the public dissemination of specific information contained within resident records and to the identification of specific individuals, but does not abrogate the responsibility of the licensing agency to review all resident records.

Q. A resident shall have the right to manage his or her own personal financial affairs. The resident may delegate the management of his or her financial affairs to the nursing facility by means of a formal written request. The written request should specify the period of time for which transfer of financial responsibility is desired. If the nursing facility agrees to accept such responsibility, it shall convey acknowledgment of acceptance to the residents in writing. The nursing facility shall have the obligation to conduct the resident's affairs in conformity with State laws and to provide a written accounting statement at least quarterly or at any time upon demand of the resident.

R. Residents shall be assured privacy for visits by the spouse or other partner. If both are residents in the nursing facility, they may share a room unless medically contraindicated per written order of the physician and subject to the availability of such accommodations within the nursing facility.

S. Before transferring a resident to another nursing facility or level of care within a nursing facility, the resident shall be informed of the need for such a transfer and of any alternatives to such a transfer.

1. A resident shall be transferred or discharged only for medical reasons, or for his welfare or that of other residents or for nonpayment of his stay.

2. Reasonable advance notice for transfers to health care facilities other than hospitals shall be given to ensure orderly transfer or discharge and such actions shall be documented in the medical record.

3. Bed-Hold and Readmission: A nursing facility must provide written information pertaining to bed-hold and readmission for residents transferred for hospitalization or therapeutic leave as follows:

a. Notice before transfer: Before a resident of a nursing facility is transferred for hospitalization or therapeutic leave, a nursing facility must provide written information to the resident and a family member or legal representative concerning:

(1) The provisions of the medical assistance program State plan regarding the period (if any) during which the resident will be permitted under the State plan to return and resume residence in the nursing facility; and

(2) The policies of the nursing facility regarding such a period, which policies must be consistent with § 1.15.4(S)(3)(b) of this Part;

b. Notice upon transfer: At the time of the transfer of a resident to a hospital or for therapeutic leave, a nursing facility must provide written notice to the resident and a family member or legal representative of the duration of any period described in § 1.15.4(S)(3)(c) of this Part; except in an emergency, said notice must be given within twenty-four (24) hours of the transfer.

c. Permitting resident to return: A nursing facility must establish and follow a written policy under which a resident:

(1) Who is transferred from the nursing facility for hospitalization or therapeutic leave; and

(2) Whose hospitalization or therapeutic leave exceeds a period paid for under the State plan for the holding of a bed in the nursing facility for the resident, will be readmitted to the nursing facility immediately upon the first availability of a bed of appropriate level of care in a semi-private room in the nursing facility if at time of readmission, the resident requires the services provided by the nursing facility;

(3) Any nursing facility that accepts private payment for purposes of reserving a bed in the nursing facility for a resident who is transferred from the nursing facility for hospitalization or other institutional therapeutic leave, and that resident's medical and health care is being paid for by the State Medical Assistance Program, shall not charge an amount per day for reserving a bed in the nursing facility that exceeds the nursing facility's current Medicaid daily rate; for a minimum of the first five (5) days of said hospitalization or the institutional therapeutic leave.

(4) The Departments of Human Services and of Health shall receive, on a monthly basis, the names from each nursing facility of those persons awaiting readmission under these provisions.

T. A resident shall have the right to live in a tobacco smoke-free environment. It shall be prohibited for any person other than a nursing facility resident to smoke in a nursing facility.

1. Nursing facility residents who smoke may do so only in private or semi-private rooms where both residents smoke, or rooms designated by the administration of the nursing facility.

a. A designated smoking area shall be a room or rooms other than the largest living or assembly room or lounge.

b. A designated smoking area shall be ventilated in such a way that the air therefrom shall not enter other parts of the nursing facility.

2. The resident shall have the right to have his or her pain assessed on a regular basis.

3. Notwithstanding any other provisions of § 1.15.5 of this Part, upon request, patients receiving care through hospitals, nursing facilities, assisted living residences and home health care providers, shall have the right to receive information concerning hospice care, including the benefits of hospice care, the cost, and how to enroll in hospice care.

U. The nursing facility shall respond in a reasonable manner to the request of a resident's physician, certified nurse practitioner and/or a physician assistant for medical services to the resident. The nursing facility shall also respond in a reasonable manner to the resident's request for other services customarily rendered by the nursing facility to the extent the services do not require the approval of the resident's physician, certified nurse practitioner and/or a physician's assistant or are not inconsistent with the resident's treatment.

V. Heat relief: Pursuant to R.I. Gen. Laws § 23-17.5-27, any nursing facility which does not provide air conditioning in every patient room shall provide an air conditioned room or rooms in a residential section(s) of the facility to provide relief to patients when the outdoor temperature exceeds eighty degrees Fahrenheit (80° F).

W. All rights and responsibilities specified in §§ 1.15.4(D), (I), (Q), and (S) of this Part shall devolve, in order of priority, to a resident's guardian, next of kin, sponsoring agency(ies) or representative payor (except when the nursing facility itself is the representative payor) for residents who are:

1. Adjudicated incompetent in accordance with State law; or

2. Found by the physician, physician assistant, or advanced practice registered nurse to be medically incapable of understanding their rights; or

3. Found to exhibit a communication barrier. If however, the communication barrier is one of speaking a language other than English, then an attempt shall be made to find a qualified and competent medical interpreter in accordance with the National Standards on Culturally and Linguistically Appropriate Services (CLAS) and Title VI of the Civil Rights Act for nursing facilities receiving Medicare/Medicaid reimbursements to allow the resident to knowingly exercise his or her rights.

X. Posting a Copy of Rights of Residents: Each nursing facility shall provide each resident or his or her representative upon admission, a copy of the provisions of R.I. Gen. Laws Chapter 23-17.5, entitled "Rights of Nursing Home Patients", and shall display in a conspicuous place, in the nursing facility a copy of the "Rights of Residents" and related information. At a minimum the display must include the following:

1. A summary of the major provisions of the Rights of Residents as set forth in this Part;

2. The address and telephone number of: Health Facilities Regulation, Rhode Island Department of Health, Three Capitol Hill, Providence, R.I. 02908 (Telephone Number: 401-222-2566), the agency which will accept complaints or notice of violations of the provisions of this Part;

3. The results of the most recent State and Federal licensing and certification surveys of nursing facilities must be posted.

4. The telephone number of the State long-term care ombudsman: 401-785-3340.

5. The telephone number of the State Medicaid Fraud Unit: 401-274-4400x2269.

1.15.5Resident and Family Notification

A. When directed to do so by the Department, the nursing facility shall:

1. Notify the resident, or his or her legal representative, the resident's family representative, the resident's attending physicians of record and the nursing facility's medical director, if that resident has been found to be in immediate jeopardy (IJ) to health and safety and/or substandard quality of care.

B. The nursing facility shall provide for notification of changes regarding resident condition as provided in Federal Regulation 42 C.F.R. § 483.10 or successor Regulation.

C. A nursing facility citation for substandard quality of care shall be considered to be a public record ten (10) days following the citation.

1.15.6Essential Caregivers During a Declared Emergency

A. The provisions of this section shall apply for the period commencing fifteen (15) days after a declaration of disaster emergency and last until sixty (60) days after the termination or expiration of the declaration of disaster emergency by executive order, proclamation, or operation of law.

B. Each facility shall allow a resident of a nursing home, or an individual with decision-making authority for the resident, to designate an individual as the resident's essential caregiver during a declaration of a disaster emergency.

C. Qualifications and Caregiver Designation

1. In order to be designated as an essential caregiver to provide in-person physical or emotional support to a resident during a declaration of disaster emergency, the individual must be at least eighteen (18) years old.

2. One (1) essential caregiver may be designated at any given time for each resident.

D. Safety Measures

1. Each facility shall develop and implement safety protocols for essential caregivers within fifteen (15) days of a declaration of disaster emergency. Such protocols must be consistent with the Department, State and Federal guidance. Facilities must update safety protocols in the event of any new guidance from State or Federal partners within seventy-two (72) hours.

2. The safety protocols for an essential caregiver, shall include, but not be limited to, procedures on:

a. Restrictions on travel;

(1) Restrictions on travel must not be more restrictive than travel restrictions for all Rhode Island residents for the declaration of disaster emergency.

b. Enhanced testing for communicable diseases, as applicable; and

(1) Enhanced testing, also known as surveillance testing, for essential caregivers must not be more stringent than surveillance testing required for nursing home staff.

c. Use of personal protective equipment (PPE)

(1) The required PPE for essential caregivers will vary depending on tasks, actions, and nature of emergency.

(2) A nursing home is not required to provide personal protective equipment (PPE) to essential caregivers.

3. An essential caregiver must comply with routine surveillance testing during the course of a declared disaster emergency.

4. The nursing facility shall be responsible for verifying/tracking the testing status, as applicable, of essential caregivers.

5. The essential caregiver must adhere to face-masking, hand hygiene, social distancing, and other safety measures at the direction of nursing facility staff.

6. In accordance with R.I. Gen. Laws § 23-17.5-37(b)(4), a facility that enters a lock down phase to establish safety measures for residents and essential caregivers shall not exceed a period of thirty (30) days. During the lock-down phase, essential caregivers are not permitted to enter.

7. A nursing home may establish additional safety requirements to protect the residents of the nursing home if the requirements meet all of the following criteria:

a. The requirements are directly linked to a declaration of disaster emergency.

b. The requirements are not so burdensome and onerous as to substantially prevent an essential caregiver from being able to physically or emotionally support a resident of the nursing home in person.

E. Administration

1. The nursing facility must establish and implement policies and procedures for designating and utilizing essential caregivers during the period of a declared disaster emergency.

2. The nursing facility must allow an essential caregiver to have regular and sustained in-person visitation and physical access to a nursing home resident.

a. The nursing home must ensure visits with essential caregivers are conducted with a reasonable degree of privacy.

3. The essential caregiver may sign an agreement with the nursing facility that outlines what support and activities will be provided by the essential caregiver.

4. An essential caregiver visit may be suspended in the event of the essential caregiver's failure to comply with the facility requirements or these Regulations during a visit.

5. A nursing home must have a policy or procedure in place for a resident or an individual with decision making authority for the resident, to immediately designate a replacement essential caregiver in the event an essential caregiver is suspended.

6. The nursing facility must have a policy or procedures in place to replace an essential caregiver due to necessary circumstances, including but not limited to, illness or death of the essential caregiver.

7. Nursing facilities shall provide training to essential caregivers that includes, but is not limited, to the following:

a. Infection prevention and control, including proper donning and doffing of PPE, hand hygiene, and mask use;

b. Signs and symptoms of any communicable disease(s) that are associated with the declared disaster emergency;

c. Safety and efficacy of any available vaccination(s) for communicable disease(s) associated with the declared disaster emergency.

1.15.7Family Councils

A. Upon the admission of a resident, the nursing facility shall inform the resident and the resident's family members, in writing, of their right to form a family council, or if a family council already exists, of the date, time, and location of scheduled meetings.

B. If a family council exists, its role shall be to address issues affecting residents generally at the nursing facility, not to pursue individual grievances. Issues may include, but are not limited to:

1. How the nursing facility facilitates resident choice and resident directed activities; and

2. How the nursing facility staff implements person-centered care practices.

C. The family council shall not be entitled to obtain information about individual residents or staff members, or any other information deemed confidential under State or Federal law.

D. No licensed nursing facility may prohibit the formation of a family council.

E. When requested by a member of a resident's family or a resident's representative, a family council shall be allowed to meet in a common meeting room of the nursing facility at least once a month during mutually agreed upon hours.

F. The nursing facility administration shall notify the State long-term care ombudsman of the existence or planned formation of a family council at that nursing facility.

G. The family council may exclude members only for good cause shown, subject to appeal by the excluded party to the State long-term care ombudsman. No member shall be excluded on the basis of race or color, religion, gender, sexual orientation, disability, age, or country of ancestral origin.

H. A nursing facility shall provide its family council with adequate space in a prominent posting area for the display of information pertaining to the family council.

I. Staff or visitors may attend family council meetings at the council's invitation.

J. The nursing facility shall provide a designated staff person who, at the request of the council, shall be responsible for providing assistance to the family council and for responding to recommendations and requests made by the family council.

K. The nursing facility shall consider the recommendations of the family council concerning issues and policies affecting resident care and life at the nursing facility.

1.15.8Reimbursement of Monies Prepaid to Deceased Patient's Estate

A. The nursing facility shall be required to reimburse any monies that have been prepaid on behalf of a deceased patient to the nursing within ninety (90) days of the patient's date of death. Said reimbursement shall be paid to the person(s), institution or other legal entity who has paid the monies, or if there be none, to the deceased patient's estate, and payment shall be made in the amount remaining after all items and services provided or arranged by the nursing have been paid. However, if payment is required to be made to the deceased patient's estate, payment shall not become due until sixty (60) days after the nursing is notified that the estate has been filed.

B. A violation of the provisions of § 1.15.5 of this Part shall constitute a violation of the rights of nursing facility residents.

1.15.9Uniform Reporting System

A. Uniform Reporting System: Each nursing facility shall establish and maintain records and data in such a manner as to make uniform the system of periodic reporting. The manner in which the requirements of this reporting may be met shall be prescribed from time to time in directives promulgated by the Director with the advice of the Health Services Council.

B. Each nursing facility shall report to the licensing agency detailed financial and statistical data pertaining to its operations, services, and facilities. Such reports shall be made at such intervals and by such dates as determined by the Director and shall include but not be limited to the following:

1. Utilization of nursing services;

2. Unit cost of nursing services;

3. Charges for rooms and services;

4. Financial condition of the nursing facility;

5. Quality of care;

6. Quality of life;

7. Resident census; and

8. Licensed nursing hours and turnover.

C. The licensing agency is authorized to make the reported data available to any State agency concerned with or exercising jurisdiction over the reimbursement or utilization of nursing facilities.

D. Each nursing facility shall report information responsive to R.I. Gen. Laws § 23-17-65, annually, by such date and manner, as determined by the Director.

E. The directives promulgated by the Director pursuant to this Part shall be sent to each nursing facility to which they apply. Such directives shall prescribe the form and manner in which the financial and statistical data required shall be furnished to the licensing agency.

216 R.I. Code R. § 216-RICR-40-10-1.15

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 10/2/2023, exp. 1/30/2024(Emergency)
Amended effective 3/7/2024