216 R.I. Code R. 216-RICR-40-10-17.6

Current through June 12, 2024

Section 216-RICR-40-10-17.6 - Patient Care Management

17.6.1Rights of Patients

A. Each patient/client of a home nursing care provider or home care provider has the right to be informed of his or her rights under R.I. Gen. Laws § 23-17-19.1 and the home nursing care provider or home care provider must protect and promote the exercise of these rights.

B. The home nursing care provider or home care provider must provide the patient/client with a written notice of the patient/client rights in § 17.6.1(E) of this Part in advance of furnishing care to the patient/client or during the initial evaluation visit before the initiation of treatment.

C. A copy of the written notice of rights signed by the patient/client will be maintained in the patient/client record by the home nursing care provider or home care provider and in the patient/client's home. The home nursing care provider or home care provider must maintain documentation showing that it has complied with the requirements of this Section.

D. The provisions of § 17.6 of this Part shall not apply to nursing services or home health services conducted by and for those who rely exclusively upon spiritual means through prayer alone in accordance with the creed or tenets of a recognized church or religious denomination.

E. In addition to the rights stated in R.I. Gen. Laws § 23-17-19.1:

1. No charge shall be made for furnishing a health record or part thereof to a patient, his/her attorney or authorized representative if the record or part thereof is necessary for the purpose of supporting an appeal under any provision of the Social Security Act (42 U.S.C. § 301et seq.) and the request is accompanied by documentation of the appeal. A provider shall furnish a health record requested pursuant to this Section within thirty (30) days of the request.

17.6.2Confidentiality

A. Disclosure of any health care information relating to individuals shall be subject to the provisions of the "Confidentiality of Health Care Communication and Information Act", R.I. Gen. Laws Chapter 5-37.3, and other relevant statutory and federal requirements.

17.6.3Admission and Discharge Policies

A. Providers shall establish policies pertaining to eligibility for admission to and discharge from home nursing care provider or home care provider services. Such policies shall be based on the following criteria:

1. Pre-admission assessment of patient care needs;

2. Reasonable expectations of the home nursing care provider's or home care provider's capability to respond to the medical and nursing needs of the patient;

3. Plan of care;

4. Constraints imposed by limitation of services, family conditions;

5. Community or other resources to ensure continuity of patient care; and

6. Such other criteria as may be deemed appropriate.

17.6.4Alzheimer's Operational Plan

A. Every healthcare facility as defined in R.I. Gen. Laws § 23-17-2 shall complete and implement an operational plan for the recognition and management of patients with Alzheimer's disease or dementia.

1. Such plan shall include a protocol for the following:

a. Identifying the signs and symptoms of cognitive impairments, including Alzheimer's disease;

b. Management of clients/patients with Alzheimer's disease;

c. Training of clinical and non-clinical staff; and

d. Advance care planning and resources for family members.

2. Such plan shall be maintained by the healthcare facility and made available to the licensing agency upon request.

17.6.5Clinical Records

A. Accurate and complete clinical records maintained in accordance with accepted professional standards shall be kept on each patient and filed in an accessible location within the home nursing care provider or home care provider. Such records shall contain no less than the following information:

1. Identifying data (name, address, date of birth, gender, date of admission or readmission);

2. Sources of patient referral;

3. Name of attending clinician (including address and telephone number);

4. Original plan of care for services provided;

a. Personal care objectives;

b. Homemaker objectives, as appropriate;

5. Documentation of each patient contact;

6. Changes in and reviews of the patient's plan of care, signed by responsible professional;

7. Documentation of an executed advance directive (if any) and a copy of the advance directive, if provided to the facility by the patient; and

8. Discharge summaries.

B. Home nursing care provider or home care provider personnel involved in the care of patients shall participate, to the extent possible, in developing care plans. When practical, designated home nursing care provider or home care provider personnel shall complete a "Continuity of Care" form as approved by the Director for each patient who is discharged to another health care facility, such as a hospital or nursing facility, or other facility licensed under the provisions of R.I. Gen. Laws Chapter 23-17. Said form shall be provided to the receiving facility, agency, or provider prior to, upon transfer, or discharge of the patient. (See the Department's website for the approved form: health.ri.gov).

C. Records shall be maintained by the home nursing care provider or home care provider for a period of at least seven (7) years following the date of discharge and shall be safeguarded against loss or unauthorized use. This requirement shall also apply to computerized or electronic records.

1. Records shall be maintained by the home nursing care provider or home care provider for a minimum of seven (7) years after a minor patient turns eighteen (18) years of age.

D. Each home nursing care provider or home care provider shall have written policies and procedures to govern the use and removal of records and determine the conditions for release of information in accordance with statutory provisions pertaining to confidentiality.

17.6.6Nursing Assistant Services

A. Each home nursing care provider or home care provider that chooses to provide home nursing care and home care as provided in this Part shall be subject to the same training requirements for nursing assistants and the duties of the individuals shall be the same as those prescribed in Subchapter 05 Part 22 of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.

B. Supervision of Nursing Assistants

1. Supervision of nursing assistants shall be directed to the management of patients'/clients' care and services, the performance of duties, and shall be available at all times during the established hours of operation of the home nursing care provider or home care provider and at such other times as they are providing services to patients/clients.

2. Supervision of nursing assistants as employees of a home nursing care provider or home care provider:

3. Nursing assistant services shall be:

a. Provided in accordance with a plan of care; and

b. Monitored/supervised no less than once every three (3) months by a professional (registered) nurse or other appropriate health care professional who is licensed in Rhode Island; and

c. Provided in accordance with Subchapter 05 Part 22 of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.

d. Such supervision shall include the following duties:

(1) Conducting the initial in-home assessment prior to commencement of service, unless documented extraordinary circumstances prevent such timing. In these cases the initial in-home assessment must be conducted within forty-eight (48) hours. Subsequent assessments and direct supervision of the Nursing Assistant (at least one supervisory session) must be conducted no less than every three (3) months thereafter or more frequently as the condition of the patient/client may require;

(2) Involving other professional disciplines where personal care is provided, as may be deemed necessary to ensure the provision of quality care;

(3) Developing, reviewing and revising the plan of care, as the condition of the patient/client may require but no less than once every three (3) months;

(4) Assigning only delegable duties as set forth in Subchapter 05 Part 22 of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs for Nursing Assistants;

(5) On-site monitoring the performance of Nursing Assistants no less than once every three (3) months and maintaining appropriate records of such monitoring;

(6) Coordinating the management of services (inter- and intra-agency);

(7) Monitoring the clinical record for each patient/client which includes appropriate recording of the plan of care, services rendered, and which is signed by the person rendering services; and

(8) Such other functions and activities as may be deemed necessary and appropriate.

17.6.7Reporting of Communicable Diseases

A. Each facility shall report promptly to the Rhode Island Department of Health, Division of Disease Control, cases of communicable diseases designated as "reportable diseases" by the Director, when such cases are diagnosed in accordance with the most current Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental, and Occupational Diseases.

216 R.I. Code R. 216-RICR-40-10-17.6

Amended effective 3/24/2022
Amended effective 5/6/2024