OPTIONAL SERVICES

Section 415.36 - Long-term inpatient rehabilitation program for head-injured residents

415.36 Long-term inpatient rehabilitation program for head-injured residents. (a) Definition. A head injury program shall mean a planned combination of services provided in a nursing home unit approved by the commissioner pursuant to Part 710 of this Title as a provider of specialized services for head-injured residents on a designated resident care unit of at least 20 beds. The head-injury program shall be designed specifically to serve medically stable, traumatically brain-injured individuals with an expected length of stay from 3 to 12 months. The program shall provide goal-oriented, comprehensive, interdisciplinary and coordinated services directed at restoring the individual to the optimal level of physical, cognitive and behavioral functioning. The population served shall consist primarily of individuals with traumatically acquired, nondegenerative, structural brain damage resulting in residual deficits and disability. The program shall not admit or retain individuals who are determined to be a danger to self or others.

(b) General requirements. The nursing home shall ensure:

(1) the development and implementation of a planned and systematic program for monitoring and assessing the quality and appropriateness of resident care to assure care is provided in accordance with current standards of professional practice. The quality assurance process shall define methods for the identification and selection of clinical and administrative problems to be reviewed with written documentation of such reviews. The process shall include but not be limited to reviews of clinical records, resident and family complaints and suggestions, incident reports and the resident's response to discharge plans. There shall be documentation that recommendations are followed up, action is taken to resolve identified problems and results of such action are assessed periodically;

(2) sufficient space, equipment and facilities are available to support the clinical, educational and administrative functions of the program in accordance with standards set forth in Parts 711 and 713 of this title;

(3) transfer agreements are in effect with other facilities, in accordance with section 400.9 of this Title for the acceptance of referrals or the transfer of head-injured residents in need of services not available at the facility;

(4) the development and consistent application of written admission and continued stay criteria for this service which include but are not limited to the use of a generally recognized classification system for measuring each individual's physical, affective, behavioral and cognitive level of functioning and the family's capabilities and functioning, and are consistent with the following requirements:

(i) a resident admitted for long-term rehabilitation shall be a person who has suffered a traumatic brain injury with structural nondegenerative brain damage, is medically stable, is not in a persistent vegetative state, demonstrates potential for physical, behavioral and cognitive rehabilitation and may evidence moderate to severe behavior abnormalities. The resident must be capable of exhibiting at least localized responses by reacting specifically but inconsistently to stimuli;

(ii) a resident admitted for coma management shall be a person who has suffered a traumatic brain injury with structural nondegenerative brain damage and is in a coma. The resident may be completely unresponsive to any stimuli or may exhibit a generalized response by reacting inconsistently and nonpurposefully to stimuli in a nonspecific manner; and

(iii) a resident who has diffuse brain damage cause by anoxia, toxic poisoning, cerebral vascular accident, or encephalitis may be admitted to this program if considered appropriate for coma management and long-term rehabilitation;

(5) records are maintained for at least two years identifying persons who were determined by the facility to be ineligible for admission under the head injury program. The records should indicate the reason for ineligibility and any referral action taken;

(6) inservice and continuing education programs which address the medical, physical, cognitive, psychosocial and behavioral needs of head injured residents are conducted on a regular basis for all personnel caring for such residents;

(7) educational programs are conducted for personnel not providing direct care but who come in contact on a regular basis with head-injured residents. The programs should familiarize personnel with the specific needs of these residents; and

(8) education and counseling services are available and offered to the residents and families as needed.

(c) Program management and staffing. There shall be distinct staffing for the direct care services in the head injury program unit.

(1) The program shall be administered by a program director who has at least two years of clinical or administrative experience in head injury rehabilitation programs. The program director has specific responsibilities which include but are not limited to: (i) administrative direction and oversight of the program;

(ii) ongoing review of the program and implementation of program changes as identified; and

(iii) development and implementation of educational programs on an ongoing basis for staff working with head injured residents.

(2) A physician who has advanced training and experience in the care of the head injured shall be responsible for the medical direction and medical oversight of the head injury program.

(3) A qualified specialist in physical medicine and rehabilitation or a physician who has training and experience in the care and rehabilitation of head injured patients or residents shall be responsible for the medical management of each resident.

(4) Head injury programs admitting and retaining residents who also require treatment for psychiatric disorders shall have on staff qualified specialists in psychiatry sufficient in number to meet the needs of these residents. A qualified specialist in psychiatry shall be designated to assist in the development and implementation of policies and procedures governing the provision of services for residents with psychiatric disorders, including criteria for transfer of such residents to an appropriate program which is licensed under the Mental Hygiene Law.

(5) A primary interdisciplinary team of health care professional with special interest, training, experience and expertise in head injury rehabilitation shall be responsible for the assessment, coordinated program and care planning, and direct services for each head injured resident. The interdisciplinary team members shall be specifically assigned to serve head injured resident and the team shall include as a minimum the following types of health care professionals:

(i) physician;

(ii) registered professional nurse;

(iii) physical therapist;

(iv) occupational therapist;

(v) speech-language pathologist;

(vi) social worker;

(vii) dietitian;

(viii) therapeutic recreation specialist; and

(ix) clinical psychologist with at least one year of training in neuropsychology.

(6) Nursing services for the head injury unit shall be under the direction of a registered professional nurse with experience in the provision of rehabilitation nursing for head injured patients or residents.

(7) There shall be at least one registered professional nurse with experience in rehabilitation nursing assigned to each shift on the head injury unit.

(8) Consultative services of qualified specialists shall be available as needed to the head injury program in accordance with resident needs.

(9) Depending upon types of residents being served and individual resident's needs, the program shall provide or make formal arrangements for vocational rehabilitation services and special education services.

(d) Interdisciplinary care planning. (1) A member of the interdisciplinary team managing the resident shall be designated to:

(i) coordinate the overall plan of care and services and identify unmet needs for each resident including discharge and follow-up plans;

(ii) serve as a liaison among resident, family and staff to ensure that resident and family concerns are addressed; and

(iii) serve as a liaison with educational, social and vocational resources in the community which are serving the resident.

(2) A written, comprehensive care plan shall be developed and implemented which establishes rehabilitation goals for each resident. The plan shall be developed on admission by the interdisciplinary team and the attending physician in consultation with the resident, the resident's family and outside agencies, as necessary. The care plan shall be reviewed at least every 14 days and modified according to the resident's needs by the interdisciplinary team. The comprehensive care plan is based upon total and ongoing integrated, interdisciplinary assessments which shall address as a minimum, medical and neurological status, emotional and psychiatric status, nutritional status, the developmental needs of children and adolescents, sensorimotor capacity, cognitive, perceptual and communicative capacity, affect and mood, activities of daily living skills, educational or vocational capacities, sexuality issues and concerns, family counseling and community reintegration needs and recreation and leisure time interests.

(3) A written discharge plan shall be developed within 30 days of admission for each resident as part of the overall care plan and shall include input from all professionals caring for the resident, the resident's family, and as appropriate, any outside agency or resource that will be involved with the resident following discharge.

(4) The family and resident shall receive preparation for discharge through the facility's educational and counseling services. (5) Provision shall be made by the facility for the follow-up of each resident after discharge to assess the resident's response to the discharge plan.

(e) Utilization review monitoring. The facility shall participate with the commissioner or his designee in a program of resident care and services monitoring which shall include but not be limited to review of admissions, care and services provided, continued stays, and discharge planning. The facility shall furnish such records and reports at such frequency as the commissioner or his designee may require and shall make available members of the interdisciplinary resident care team for case conferences as the commissioner or his designee deems necessary.
 

Effective Date: 
Wednesday, April 3, 1991
Doc Status: 
Complete

Section 415.37 - Services for residents with Acquired Immune Deficiency Syndrome(AIDS)

415.37 Services for residents with Acquired Immune Deficiency Syndrome (AIDS).

(a) Applicability. (1) This section applies to a nursing home approved by the commissioner pursuant to Part 710 of this Title as a provider of specialized services for residents with AIDS. Such facility shall provide comprehensive and coordinated health services and programs in accordance with the requirements set forth in this section and this Part, unless a contrary requirement is contained in this section.

(2) For purposes of these regulations, AIDS shall mean acquired immune deficiency syndrome and other human immunodeficiency virus (HIV) related illness.

(b) General requirements. The nursing home shall ensure that:

(1) the facility is staffed and equipped to manage the care and treatment of residents with AIDS requiring nursing home care;

(2) reserved;

(3) a written transfer agreement exists with a designated AIDS center or other hospital for the transfer of residents in need of emergency or acute inpatient care services;

(4) special services are provided to residents in need thereof. Such special services shall include, as a minimum, substance abuse services, case management, HIV education, risk reduction, mental health services and pastoral counseling. These special services may be provided directly by the facility or through a formal arrangement;

(5) a written, comprehensive care plan is developed and implemented for each resident by an interdisciplinary team of health-care professionals in coordination with the case manager and in consultation with the resident or the resident's legal representative. The interdisciplinary team shall include health-care professionals as appropriate to the needs of the AIDS resident, but as a minimum shall include the attending physician, a registered professional nurse and a social worker. The resident care plan is reviewed at least every month by the interdisciplinary team and modified as necessary;

(6) in-service and continuing education programs, which address the medical, psychological, social problems and care needs specific to persons with AIDS, are conducted for all nursing home personnel on a regular basis but not less than every three months. A record of the programs attended shall be maintained for each employee;

(7) staff counseling and supportive services are made available to personnel to address problems related to the care of persons with AIDS; and

(8) as part of the facility's infection control program, infection control policies and procedures specific to AIDS are developed and implemented.

(c) Staffing requirements. The nursing home shall ensure that:

(1) specialty oversight of the AIDS program, including the development of policies and procedures, is provided by a physician who has experience in the care and clinical management of persons with AIDS;

(2) the health care of each resident is under the continuing supervision of an attending physician who sees and evaluates the resident whenever necessary;

(i) physician visits for residents who are assessed as requiring a skilled level of nursing care shall not be less frequent than once per week; and

(ii) physician visits for residents who are assessed as requiring an intermediate level of nursing care based on their ambulant status and other relevant medical factors, shall not be less frequent than once per month;

(3) the facility makes provision for onsite physician coverage sufficient to meet the medical needs of residents seven days a week. This coverage may be part of the routine physician visits or in addition to such visits;

(4) nursing services for the AIDS program are under the supervision of a registered professional nurse with experience in the care and management of persons with AIDS; and

(5) each resident is evaluated by rehabilitation therapy staff to include, as a minimum, physical therapy and occupational therapy staff. Based on the evaluation, a plan of care is developed which establishes restoration or maintenance rehabilitation goals.
 

Effective Date: 
Wednesday, January 28, 1998
Doc Status: 
Complete

Section 415.38 - Long-term ventilator dependent residents

415.38 Long-term ventilator dependent residents. Facilities which admit and care for residents who require nursing home care and continuous or intermittent use of a ventilator shall comply with the following additional requirements pertinent to the care of those residents.

(a) General. The facility shall develop and implement admission, resident care management, transfer and discharge policies and procedures that promote delivery of medical, nursing and respiratory care services consistent with generally accepted standards of professional practice.

(1) Residents shall be congregated within the facility in a single nursing care unit.

(2) Services shall be directed at restoring each resident to his or her optimal level of functioning and assisting each resident to achieve maximum independence from mechanical ventilation.

(3) The facility shall have a transfer agreement with a general hospital which:

(i) is located within twenty minutes travel time of the facility;

(ii) is equipped and staffed for the acute care and management of ventilator dependent patients; and

(iii) has granted privileges to pulmonary care physicians to admit and care for ventilator dependent residents who may require hospital admission.

(4) Laboratory, mental health and diagnostic radiology services appropriate to the needs of the residents shall be readily available either directly or by arrangement.

(5) The facility shall have an effective program of preventive and periodic maintenance of ventilator equipment which meets or exceeds the manufacturer's requirements for the equipment and prevents the spread of infections and communicable disease.

(b) Resident care services:

(1) Physician supervision:

(i) the care of the resident shall be directed by a physician who is a qualified specialist in pulmonology; and

(ii) this physician or other physicians qualified by training and pertinent experience in the care and clinical management of persons requiring respiratory care and requiring use of ventilators shall be available to attend to such residents seven days-a-week, twenty-four hours-a-day. One of these physicians shall see and evaluate the resident as often as necessary but not less than every other week.

(2) All resident care staff shall receive orientation and training appropriate to the care of the ventilator dependent residents to whom they are assigned.

(3) One or more registered professional nurses on each shift shall be assigned to provide care to ventilator dependent residents.

(4) Respiratory therapists shall be available as needed to meet the needs of the residents.

(5) Rehabilitation therapy services shall be available at the facility to meet the needs of the residents.

(6) The facility shall maintain specific supplies appropriate to meeting the care needs of the residents.

(7) Residents shall be assessed as to their ability to be weaned from their ventilatory dependence. Those residents who are assessed as potentially able to be weaned from dependence on support with mechanical ventilation or whose daily use of ventilator support may be reduced shall receive an active program of therapy and other supportive services designed for that resident to reduce or eliminate his or her need for use of a ventilator.

(8) Residents shall be assessed as to their ability to be discharged to home or to a home-like setting with or without supportive services. When such potential is identified, the facility shall initiate an active program of therapy and other supportive services designed to assist the resident in the transition to the new setting. Facility discharge planning staff shall arrange for any home modifications, equipment or assistance expected to be required of the resident in the new setting and document these arrangements in the resident clinical record.
 

Effective Date: 
Wednesday, April 3, 1991
Doc Status: 
Complete

Section 415.39 - Specialized programs for residents requiring behavioral interventions

415.39 Specialized programs for residents requiring behavioral interventions.

(a) General.

(1) Specialized programs for residents requiring behavioral interventions ("the program") shall mean a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less restrictive setting. The program shall provide goal-directed, comprehensive and interdisciplinary services directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning.

(2) The program shall serve residents who are a danger to self or others and who display violent or aggressive behaviors which are typically exhibited as physical or verbal aggression such as clear threats of violence. This behavior may be unpredictable, recurrent for no apparent reason, and typically exhibited as assaultive, combative, disruptive or socially inappropriate behavior such as sexual molestation or fire setting.

(3) The program shall be located in a nursing unit which is specifically designated for this purpose and physically separate from other facility residents. The unit shall be designed in accordance with the provisions as set forth in Subpart 713-2 of this Title.

(4) The facility shall have a written agreement with an inpatient psychiatric facility licensed under the Mental Hygiene Law to provide for inpatient admissions and consultative services as needed.

(5) In addition to the implementation of the quality assessment and assurance plan for this program as required by section 415.27 of this Part, the facility shall participate with the commissioner or his or her designee in a review of the program and resident outcomes. The factors to be reviewed shall include but not be limited to a review of admissions, the care and services provided, continued stays, and discharge planning. The facility shall furnish records, reports and data in a format as requested by the commissioner or his or her designee and shall make available for participation in the review, as necessary, members of the interdisciplinary resident care team.

(b) Admission.

(1) The facility shall develop written admission criteria which are applied to each prospective resident. As a minimum, for residents admitted to the program, there shall be documented evidence in the resident's medical record that:

(i) the resident's behavior is dangerous to him or herself or to others;

(ii) the resident's behavior has been assessed according to severity and intensity;

(iii) within 30 days prior to the date of application to the program, the resident has displayed:

(a) verbal aggression which constitutes a clear threat of violence towards others or self; or

(b) physical aggression which is assaultive or combative and causes or is likely to cause harm to others or self; or

(c) persistently regressive or socially inappropriate behavior which causes actual harm.

(iv) various alternative interventions have been tried and found to be unsuccessful;

(v) the resident cannot be managed in a less restrictive setting; and

(vi) the prospective resident has the ability to benefit from such a program.

(2) Prior to admission, the facility shall fully inform the resident and the resident's designated representative both orally and in writing about the program plan and the policies and procedures governing resident care in this unit. Such policies and procedures shall at a minimum include a statement that the resident's right to leave or be discharged from the program shall be consistent with the rights of other residents in the facility.

(c) Assessment and Care Planning.

(1) The interdisciplinary team shall have determined preliminary approaches and interventions to the severe behavior and recorded them in the resident care plan prior to admission to the unit.

(2) Each resident's care plan shall include care and services which are therapeutically beneficial for the resident and selected by the resident when able and as appropriate. The care plan shall be prepared by the interdisciplinary team, as described in section 415.11 of this Part, which shall include psychiatrist, psychologist, or social worker participation as appropriate to the needs of the resident.

(3) Based on the resident's response to therapeutic interventions, the care plan including the discharge plan shall be reviewed and modified, as needed, but at least once a month.

(d) Discharge.

(1) A proposed discharge plan shall be developed within 30 days of admission for each resident as part of the overall care plan and shall include input from all professionals caring for the resident, the resident and his or her family, as appropriate, and any outside agency or resource that will be involved with the resident following discharge. (2) When the interdisciplinary team determines that discharge of a resident to another facility or community-based program is appropriate, a discharge plan shall be implemented which is designed to assist and support the resident, family and caregiver in the transition to the new setting. Program staff shall be available post-discharge to act as a continuing resource for the resident, family or caregiver.

(3) The resident shall be discharged to a less restrictive setting when he or she no longer meets the admission criteria for this program as stated in subdivision (b) of this section.

(4) A resident discharged to an acute care facility shall be accompanied by a member of the program's direct care staff during transfer. He or she shall be given priority readmission status to the program as his or her condition may warrant.

(5) There shall be a written transfer agreement with any nursing home of origin which allows for priority readmission to such transferring facility when a resident is capable of a safe discharge.

(e) Resident services and staffing requirements.

(1) The program shall consist of a variety of medical, behavioral, counseling, recreational, exercise, and other services to help the resident control or redirect his or her behavior through interventions carried out in a therapeutic environment provided on-site.

(2) There shall be dedicated staffing in sufficient numbers to provide for the direct services in the unit and to allow for small group activities and for one-on-one care.

(3) The unit shall be managed by a program coordinator who is a licensed or certified health care professional with previous formal education, training and experience in the administration of a program concerned with the care and management of individuals with severe behavioral problems. The program coordinator shall be responsible for the operation and oversight of the program. Other responsibilities of the program coordinator shall include:

(i) the planning for and coordination of direct care and services;

(ii) developing and implementing inservice and continuing education programs, in collaboration with the interdisciplinary team, for all staff in contact with or working with these residents;

(iii) participation in the facility's decisions regarding resident care and services that affect the operation of the unit; and

(iv) ensuring the development and implementation of a program plan and policies and procedures specific to this program.

(4) A physician who has specialized training and experience in the care of individuals with severe behavioral or neuropsychiatric conditions shall be responsible for the medical direction and medical oversight of this program and shall assist with the development and evaluation of policies and procedures governing the provision of medical services in this unit.

(5) A qualified specialist in psychiatry who has clinical experience in behavioral medicine and experience working with individuals who are neurologically impaired shall be available on staff or a consulting basis to the residents and to the program.

(6) A clinical psychologist with at least one year of training in neuropsychology shall be available on staff or a consulting basis to the residents and to the program.

(7) A social worker with experience associated with severe behavioral conditions shall be available either on staff or a consulting basis to work with the residents, staff and family as needed.

(8) Other than the program coordinator, there shall be at least one registered professional nurse deployed on each shift in this unit who has training and experience in caring for individuals with severe behaviors.

(9) A full-time therapeutic recreation specialist shall be responsible for the therapeutic recreation program.

(10) The facility shall ensure that all staff assigned to the direct care of the residents have pertinent experience or have received training in the care and management of individuals with severe behaviors.

(11) The facility shall ensure that educational programs are conducted for staff not providing direct care but who come in contact with these residents on a regular basis such as housekeeping and dietary aides. The programs shall familiarize staff with the program and the residents.
 

Effective Date: 
Wednesday, March 16, 1994
Doc Status: 
Complete

Section 415.40 - Extended care of residents with traumatic brain injury

415.40 Extended care of residents with traumatic brain injury. (a) Definitions.

(1) An extended care resident with traumatic brain injury (TBI) shall mean a person who is at least three months post-injury and who has been diagnosed as having a cognitive and/or physical condition that has resulted from traumatically acquired, non-degenerative, structural brain damage, or anoxia, and who in addition:

(i) has participated in an intensive inpatient rehabilitation program for persons with TBI in a hospital or nursing home; and

(ii) has been assessed by a neurologist or physiatrist who determined that the individual would no longer benefit from an intensive rehabilitation program.

(2) TBI residents requiring extended care services may be congregated in one nursing unit or placed with residents on other nursing units, whichever best serves the resident's choice and needs.

(b) Resident care.

(1) The facility shall develop, implement and update admission, resident care, transfer and discharge policies and procedures that promote the delivery of medical, nursing and rehabilitative care services consistent with generally accepted standards of professional practice for the extended care of residents with TBI.

(2) Services shall be provided to maintain each extended care resident with TBI at his or her optimal level of physical, affective, behavioral and cognitive functioning.

(3) There shall be sufficient nursing and social work staff to work with both the extended care resident with TBI and the resident's family.

(4) Rehabilitation therapy services shall be available at the facility to meet the assessed rehabilitative needs of the extended care resident with TBI and shall be utilized to maintain or improve the present level of functioning and to prevent deterioration in the individual's physical, affective, behavioral and cognitive level of functioning.

(5) Resident care staff and other staff members who have regular contact with the extended care resident with TBI shall receive orientation and training concerned with extended care residents with TBI.

(c) Resident assessment and care planning. Facilities that admit an extended care resident with TBI shall comply with the following:

(1) In accordance with section 415.11 of this Part, the facility shall periodically conduct comprehensive assessments of each resident's needs. For those residents who are assessed as potentially able to benefit from restorative rehabilitation therapy services, the facility shall arrange for those services or shall transfer the resident to an appropriate rehabilitation program for TBI individuals.

(2) A professionally recognized classification system for measuring each brain injured individual's physical, affective, behavioral and cognitive level of functioning shall be consistently used as part of the comprehensive resident assessment and as a basis for the development of the resident's comprehensive care plan.

(3) A physician with training and experience in caring for persons with TBI shall participate in the interdisciplinary team assessments and care planning of each resident.

(4) There shall be sufficient numbers of rehabilitation, nursing, activity, and social work staff to accommodate the needs of these residents.

(5) When potential for discharge to home or a home-like setting is identified, the facility shall initiate an active program of therapy and other supportive services designed to assist the resident and family in the transition to the new setting.
 

Effective Date: 
Wednesday, May 5, 1993
Doc Status: 
Complete

Section 415.41 Specialized Programs for Residents with Neurodegenerative Diseases

415.41 Specialized Programs for Residents with Neurodegenerative Diseases. 

(a) General. 

1. “Specialized program” shall mean a discrete unit with a planned array of services, staffing, equipment and physical facilities designed to serve individuals with Neurodegenerative Diseases, and approved pursuant to Part 710 of this Title. The program shall provide goal-directed, comprehensive and interdisciplinary services directed at attaining or maintaining the individual at his or her highest practicable level of physical, affective, behavioral, psychosocial and cognitive functioning. 

2. For purposes of this section, “Neurodegenerative Disease” shall mean Huntington’s disease or Amyotrophic Lateral Sclerosis.  

3. For purposes of this section, and consistent with the requirements of section 415.11 of this Part, the program shall have an “interdisciplinary resident care team” consisting of, at a minimum, the resident’s physician, a registered professional nurse with responsibility for the resident and, depending on the resident’s diagnosis, needs and symptoms, other appropriate staff in disciplines determined to meet the resident’s needs which may include staff assigned to the unit as set forth in subdivision (e) of this section. 

4. The program shall be located in a nursing unit which is specifically designated for this purpose and physically separate from other facility units. Residents of the unit shall have access to all of the facility’s recreational and therapeutic resources, including those resources that are not located in the unit. 

5. The facility shall ensure that sufficient space, equipment and facilities are available to support the clinical, education and administrative functions of the program in accordance with the standards set forth in Parts 711 and 713 of this Title. 

6. In addition to the implementation of the quality assessment and assurance plan for this program as required by section 415.27 of this Part, the facility shall participate with the department in an evaluation of the efficacy and effectiveness of the program and its impact on residents, families and staff. The facility shall collect data and furnish records, reports and data in a format requested by the department and shall make members of the interdisciplinary resident care team available for participation in the evaluation, as requested by the department. The facility shall submit such information to the department for the period ending December 31, no later than ninety days following the end of the calendar year, annually through calendar year 2021. 

7. This section shall be implemented as a Quality Assessment and Performance Improvement (QAPI) project, as described in guidance from the federal Centers for Medicare and Medicaid Services. 

 

(b) Admission. 

1. The facility shall develop written admission criteria for the specialty unit to include the criteria in paragraph (2) of this subdivision and take into account the facility’s goals and objectives regarding outcomes (e.g. minimizing self-inflicted injuries/falls, chorea-related trauma, hospitalization (length of stay), emergency department utilization, bed hold, and satisfaction surveys of residents with Neurodegenerative Diseases staff, families, and others) for residents who live in the specialty unit. The facility shall evaluate the effects of its admission criteria on its success in achieving its goals and objectives for the unit and report its findings to the department no later than ninety days following the end of the calendar year, annually through calendar year 2021. 

2. At a minimum, for residents admitted to the unit, there shall be documented evidence in the resident’s medical record that: 

(i) the resident has been diagnosed with Neurodegenerative Disease based on a medical evaluation by a physician as determined by highly suggestive family history, neurological testing, genetic testing when available, formal consultation setting and/or formal neurological diagnostic consultation. 

(ii) the resident cannot be managed and is not safe, and his or her needs cannot be met, in an available, less restrictive setting; and 

(iii) the resident has the ability to benefit from the specialized care and services available in the unit. 

 

(c) Assessment and Care Planning. 

1. Any assessment of a potential resident must include the admission criteria described in paragraph (2) of subdivision (b). Where feasible, one or more members of the staff of the specialty unit shall conduct an evaluation of the home or current residence, living situation or inpatient setting of the future resident and his or her family prior to admission to discuss care needs. For purposes of this paragraph, “feasible” means the resident’s home or other setting is within reasonable travel distance (in terms of round trip travel time) from either the facility or the home(s) of the staff member(s) conducting the home evaluation. Results of an evaluation shall be used to identify preliminary approaches and interventions appropriate for the resident for purpose of preparing a resident’s care plan.  

2. A care plan shall be prepared by the interdisciplinary resident care team for each resident, taking into account input from the resident and the resident’s family or caregivers, in conformance with the timeframes set forth in section 415.11 of this Part. Each resident’s care plan shall include care and services that are therapeutically beneficial to the resident, appropriate to the resident’s interests and selected by the resident or resident’s caregiver as appropriate. The care plan may require environmental accommodations, as well as results from any evaluation of the home or current residence, living situation, or inpatient setting of the resident. 

3. Based on the resident’s response to therapeutic interventions, as well as the progression of the disease and its impact on the resident’s functioning, health and psychosocial status, the resident shall be reassessed and the care plan, including the discharge plan described in the next subsection hereof, shall be reviewed and modified at least once a month for the first three months following admission and then quarterly or upon any significant change in the resident’s condition thereafter. The care plan shall be reviewed by at least three members of the interdisciplinary resident care team and shall include at least one certified nurse aide who is assigned to the resident on a permanent basis. 

4. Facility or unit staff shall initiate a discussion of advance directives in accordance with the provisions of section 400.21 of this Subchapter with the resident and the resident’s family member or other adult, consistent with such section, as soon as practicable following the decision to admit the resident to the unit. 

 

(d) Discharge. 

1. The facility shall develop written discharge criteria for the specialty unit, which at a minimum shall address the provisions of paragraph (5) of this subdivision. 

2. The resident and his or her family and caregivers shall be notified of discharge criteria upon admission. 

3. A written discharge plan shall be developed within 30 days of admission for each resident as part of the overall care plan and shall include input from all professionals caring for the resident, the resident’s family and caregivers, as appropriate, and any outside agency or resource anticipated to be involved with the resident following discharge. The discharge plan shall be reviewed and modified at least once a month for the first three months following admission and then quarterly or upon any significant change in the resident’s condition thereafter. 

4. When the interdisciplinary resident care team determines that discharge of a resident to another facility or community-based program is appropriate, a discharge plan shall be implemented which is designed to assist and support the resident, family and caregivers in the transition to the new setting. The resident, his or her family, and caregivers, as appropriate, shall receive preparation for discharge from the specialty unit through the facility’s educational and counseling services. 

5. The resident shall be discharged to a less restrictive setting when he or she no longer meets the minimum admission criteria for the unit set forth in paragraph (2) of subdivision (b) of this section or meets other discharge criteria established pursuant to paragraph (1) of this subdivision. 

6. The facility shall evaluate the effects of its discharge criteria on its success in achieving its goals and objectives for the unit and report its findings to the department no later than ninety days following the end of the calendar year, annually through calendar year 2021. 

7. (i) The facility shall have a written agreement with a general hospital or hospitals providing for the transfer of residents in need of emergency or acute inpatient care services. Such hospital(s) shall have expertise in caring for individuals with Neurodegenerative Diseases, except in cases where a general hospital with such expertise is not available within a distance and time considered reasonable by accepted emergency medical standards. 

(ii) In the event a resident of a specialty unit requires transfer to a general hospital:  

(a) When feasible and practicable, a resident who is transferred to a hospital shall be accompanied by an informed member of the program’s direct care staff to ensure continuity of care. For purposes of this paragraph, “feasible” means that round trip travel time between the facility and the hospital is reasonable.  

(b) When it is not feasible for a staff member to accompany the resident to the hospital, the resident’s physician, or the specialty unit’s medical director, or their designee, shall communicate with a physician or another health care practitioner at the receiving hospital at the time of the transfer.  

(c) In either case, the staff member or physician shall provide to the receiving hospital appropriate documentation and other information that may be needed at the time of transfer to ensure continuity of care. 

(d) The resident shall be given priority readmission status to the unit as his or her condition may warrant. 

(e) All transfers shall be conducted in compliance with all other applicable law, including without limitation, section 415.3(h) of this Title. 

 

(e) Program/Unit Staffing Requirements. 

1. The facility shall maintain a level of direct care staff to residents that is appropriate for the required degree of care for the residents in the program unit. 

2. The facility shall ensure that any direct care staff assigned to the unit have been thoroughly trained and educated with regard to the special needs of unit residents, are competent to work in the unit, and are familiar to unit residents. 

3. The assignment of direct care staff must be sufficient to enable timely and appropriate care as determined by resident assessment and to protect both resident and staff safety. In addition to the staff assigned to the unit as specified in this subdivision, the facility shall make available other staff as necessary for the provision of care and services set forth in each resident’s care plan. 

4. The unit shall be managed by a program coordinator who has formal education, training and experience in the administration of a program that focuses on the care and management of individuals with Neurodegenerative Diseases. The program coordinator shall be dedicated only to the specialty unit. The program coordinator shall be responsible for the operation and oversight of the program. Other responsibilities of the program coordinator shall include: 

(i) planning for and coordination of direct care and services; 

(ii) screening prospective admissions; 

(iii) developing and implementing in-service and continuing education programs, in collaboration with the interdisciplinary resident care team, for all staff in contact or working with these residents; 

(iv) participating in the facility's decisions regarding resident care and services that affect the operation of the unit; and 

(v) ensuring the development and implementation of a program plan and policies and procedures specific to this program. 

5. A physician who preferably has specialized training in the care of individuals with Neurodegenerative Diseases shall be responsible for the medical direction and medical oversight of this program and shall assist with the development and evaluation of policies and procedures governing the provision of medical services in this unit. If, at the time the physician is appointed as medical director of the unit, he or she does not have experience in providing care to individuals with Neurodegenerative Diseases, he or she shall have access to physicians who do have such experience. 

6. A psychiatrist shall be available on staff or on a consulting basis (including via telemedicine in conformance with applicable law) to the residents and to the program at a level consistent with residents’ care plans. The facility shall exercise best efforts to utilize a psychiatrist who has clinical experience working with individuals who have Neurodegenerative Diseases. 

7. A clinical psychologist or a licensed clinical social worker shall be available on staff or on a consulting basis (including via telemedicine in conformance with applicable law) to staff, residents, and residents’ family members and caregivers at a level consistent with residents’ care plans. The facility shall exercise best efforts to utilize a clinical psychologist or a licensed clinical social worker who has clinical experience working with individuals who have Neurodegenerative Diseases. 

8. A social worker shall be available either on staff or on a consulting basis to work with the residents, staff and family as needed. The facility shall exercise best efforts to utilize a social worker who has experience working with individuals who have Neurodegenerative Diseases. 

9. There shall be at least one registered professional nurse readily available during each shift in the unit. The facility shall exercise best efforts to utilize registered professional nurses who have training and experience in caring for individuals with Neurodegenerative Diseases. This registered professional nurse may not be the specialty unit program coordinator required under paragraph (4) of this subdivision. 

10. A therapeutic recreation specialist certified by a nationally recognized body which is acceptable to the department shall be responsible for the therapeutic recreation program. 

11. A respiratory therapist shall be available to residents who are no longer able to maintain normal oxygen and carbon dioxide levels. 

 

(f) Program/Unit Service and Environmental Requirements. 

1. The program shall consist of a variety of medical, behavioral, counseling, recreational, exercise, nutritional and other services appropriate to the needs of each individual resident. 

2. Specific services that shall be available to residents who need them include but are not limited to: neurology; pulmonary specialist; psychotherapy; physical, occupational, respiratory and speech therapy; specialized eating and nutritional interventions to maximize independence and prevent unplanned weight loss and dehydration; technology to enable the resident to communicate effectively with staff, family members, caregivers, friends, and other residents; and oral care. Consults as needed shall be provided by but are not limited to surgical, podiatry, optometry, ophthalmology, orthopedic, cardiac, gastroenterology, dental, and hearing licensed professionals. 

3. The therapeutic recreation program shall incorporate the principles of rehabilitation, occupational, physical, nutritional, and speech therapies. 

4. Appropriate activities that accommodate individual residents’ interests shall be available at times that accommodate their waking hours. 

5. Support groups for staff, residents, and residents’ family members and caregivers shall be established and facilitated by the social worker or other counseling professional. 

6. The environment shall be customized to meet the needs and characteristics of residents and minimize injuries to residents and staff. 

(i) Each resident’s living space shall be customized to safely accommodate his or her specific movement and motor control characteristics, and changes in movement and motor control characteristics as the resident’s disease evolves. 

(ii) Such customization may include, but is not limited to, padding around hard surfaces that could harm the resident, staff or visitors; self-protective equipment such as soft helmet, elbow and knee pads; broda chairs (including shower/commode, bariatric, geriatric and glider chairs) with HD special padding if needed; and adequate space to accommodate high amplitude involuntary movements without injury to either the resident, staff or visitors. 

(iii) The unit shall include, in their new construction designs, small recreational and dining room areas where residents can be with their families in privacy and comfort. 

(iv) Units shall include central bathing and toilet facilities that can accommodate two-person assists. In-room toilets and bathing accommodations shall be modified or restricted to ensure resident safety and privacy as described in (i) and (ii). 

7. The unit shall be equipped and staff shall be trained as necessary for the provision and management of non-invasive ventilation for residents for whom this service is appropriate. Supervision shall be provided by a respiratory therapist and pulmonary specialist. 

8. Residents shall not be prevented from participating in research projects and clinical trials that have been approved by an Institutional Review Board (IRB) that is registered with the federal Office of Human Research Protection (OHRP) in the United States department of Health and Human Services and in compliance with the human subjects research requirements at 45 CFR Part 46 as determined by OHRP. To the extent practicable, facilities may facilitate residents’ participation in such research and trials by, for example, becoming trial sites, providing transportation to the trial site, providing assistance to enroll in the research, and working with families to facilitate participation. 

9. The facility shall provide outdoor access to residents. 

 

(g) Program/Unit Training Requirements 

1. The facility shall ensure that all staff assigned to the direct care of the residents have pertinent experience or have received training in the care and management of people with Neurodegenerative Diseases. 

2. Training shall be appropriate to the functions and responsibilities of specific staff in the unit and shall include but not be limited to: 

(i) the Neurodegenerative Disease itself, e.g., signs and symptoms, genetics, diagnosis, management, progression/history of the disease, prognosis and epidemiology; 

(ii) how each type of staff can contribute to better quality of care and quality of life for residents; 

(iii) injury prevention for the resident, staff and visitors; 

(iv) creating an organized environment that minimizes stressors, maintains routines and encourages/maximizes independent functioning and decision-making; 

(v) ensuring adequate hydration and nutrition; and 

(vi) providing and encouraging cognitive stimulation and socialization through passive and active participation in appropriate activities. 

3. Families and informal supports, including the resident’s friends and caregivers, shall also have access to this training as appropriate to their activities in the unit. 

4. The facility shall ensure that educational programs are conducted for staff who do not provide direct care but who come in contact with the residents on a regular basis such as housekeeping and dietary aides. The educational programs shall familiarize staff with the goals of the specialty unit and the needs of residents with Neurodegenerative Diseases.  

Effective Date: 
Wednesday, November 2, 2016
Statutory Authority: 
Public Health Law, Section 2803(2)