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Title: Section 415.40 - Extended care of residents with traumatic brain injury

Effective Date


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.


VOLUME C (Title 10)