Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 100.1 - ADULT RESIDENTIAL CARE HOMES › Subchapter 1 - GENERAL REQUIREMENTS › Section 11-100.1-2 - Definitions

Current through June, 2024
As used in this chapter:
"Abuse" means the willful infliction of injury,
					 unreasonable confinement, intimidation, or punishment with resulting physical
					 harm or pain or mental anguish, or deprivation by an individual, including a
					 caregiver, of goods or services that are necessary to attain or maintain
					 physical, mental and psychosocial well-being. This presumes that instances of
					 abuse of all residents, even those in a coma, cause physical harm, or pain or
					 mental anguish.
"Activities of daily living", or "ADL" means basic
					 services required to be provided by the facility for benefit of residents in
					 order to obtain and maintain a license and shall include, but not be limited
					 to, the following: personal care, shelter, protection, supervision, assistance,
					 guidance or training, planned activities, food service, laundering of personal
					 clothing, recognition of and provision for changes in health status, and
					 arrangement for and transportation to medical and dental offices.
"Adult residential care home", or "ARCH" means any
					 facility providing twenty four hour living accommodations, for a fee, to adults
					 unrelated to the family, who require at least minimal assistance in the
					 activities of daily living, personal care services, protection, and health care
					 services, but who do not need the professional health services of an
					 intermediate, skilled nursing, or acute care facility. It does not include
					 facilities operated by the federal government. There shall be two types of
					 ARCHs:
(1) Type I home for five or less residents; and
(2) Type II home for six or more residents.
"Advanced directive" means a written or oral declaration
					 made by a competent adult, instructing his or her physician to provide,
					 withhold, or withdraw life-sustaining procedures under certain conditions such
					 as a terminal condition or where the resident has a permanent loss of ability
					 to communicate with others due to irreversible brain injury or coma. (An
					 advanced directive is often referred to as a living will.)
"Advanced practice registered nurse", or "APRN" means a
					 registered nurse who is licensed pursuant to chapter 457, HRS.
"Ambulatory" means the ability to move on foot from place
					 to place without human assistance.
"ARCH resident" means a person unrelated to the primary
					 care giver and licensee who resides in an ARCH. Individuals residing in an ARCH
					 require minimal assistance in the activities of daily living, and do not need
					 assistance from skilled, professional personnel on a regular long-term
					 basis.
"Assistive devices" means a physical or mechanical
					 apparatus or equipment required by an individual for ambulation or
					 mobility.
"Cardiopulmonary resuscitation certification", or "CPR
					 certification" means verification that an individual has satisfactorily
					 completed a course provided by a nationally approved source that contains
					 instruction and required participation in an emergency first aid procedure that
					 consists of opening and maintaining a resident's airway, providing 'artificial
					 ventilation by means of rescue breathing, and providing artificial circulation
					 by means of external cardiac compression.
"Care plan" means a written plan developed by the
					 resident, resident's family, legal guardian or surrogate, case manager, staff
					 of the ARCH or expanded ARCH, and resident's physician or APRN that articulates
					 the overall plan of care to be provided to the resident by the ARCH or expanded
					 ARCH with the purpose of achieving the optimal level of function of the
					 resident.
"Case manager" (as it applies to an expanded ARCH) means
					 an individual other than the licensee or staff of the expanded ARCH who is
					 licensed in the state as a registered nurse or social worker and possesses the
					 skills and knowledge required to deal with the long term care needs of the
					 geriatric population. This individual shall have the ability to plan, locate,
					 coordinate, and monitor comprehensive services to meet the individual
					 resident's needs based on a comprehensive assessment of the resident.
"Category 3 adult residential care home" means an ARCH
					 which was established and licensed prior to 1986, and was providing only room
					 and board services to individuals that did not require twenty four hour
					 supervision and personal care services, and whose licensee does not meet
					 requirements as set forth in section
					 11-100.1-8.
"Chemical restraint" means a psychopharmacologic drug that
					 is used for discipline or convenience and not required to treat medical
					 symptoms.
"Comprehensive assessment" means an evaluation which
					 includes, but is not limited to, medically defined conditions and prior medical
					 history, medical status measurement, physical and mental functional status,
					 sensory and physical impairments, nutritional status and requirements, special
					 treatments or procedures, mental psychosocial status, discharge potential,
					 dental condition, activities potential, cognitive status and drug
					 therapy.
"Convenience" means any action taken by the licensee or
					 care giver to control resident behavior or maintain residents with a lesser
					 amount of effort by the licensee or care giver and not in the resident's best
					 interest.
"Day care client" means any person who does not reside in
					 the ARCH or expanded ARCH and requires temporary supervision during the hours
					 that the 'person's care giver, outside of the ARCH or expanded ARCH, is
					 unavailable. This person requires minimal assistance in the activities of daily
					 living and does not need the professional health services of an intermediate,
					 skilled nursing, or acute care facility. This person does not stay overnight in
					 the ARCH or expanded ARCH but shall be characterized as a resident for purposes
					 of an ARCH'S or expanded ARCH'S licensed capacity.
"Department" means the department of health, State of
					 Hawaii.
"DHS" means the department of human services, State of
					 Hawaii.
"Dietitian" means a person who is registered by the
					 Commission on Dietetics Registration of the American Dietetic Association or is
					 eligible for such registration. "Director" means the director of health, State
					 of Hawaii or designee.
"Discipline" means any action taken by the licensee or
					 care giver for the purpose of punishing or penalizing residents.
"Emergency" means an event or incident occurring while an
					 ARCH or expanded ARCH resident is under the care of a primary care giver or
					 ARCH or expanded ARCH licensee, whereby a resident experiences physical or
					 mental changes which necessitate care or services which cannot be provided by
					 the ARCH or expanded ARCH.
"Expanded ARCH" means any facility providing twenty four
					 hour living accommodations, for a fee, to adults unrelated to the family, who
					 require at least minimal assistance in the activities of daily living, personal
					 care services, protection, and health care services, and who may need the
					 professional health services provided in an intermediate care facility or
					 skilled nursing facility. There shall be two types of expanded ARCHs:
(1) Type I home shall consist of five or less residents
					 with no more than two nursing facility level residents; provided that more
					 nursing facility level residents may be allowed at the discretion of the
					 department; and
(2) Type II home shall consist of six or more residents
					 with no more than twenty per cent of the home's licensed capacity as nursing
					 facility level residents, provided that more nursing facility level residents
					 may be allowed at the discretion of the department; provided further that the
					 department shall exercise its discretion for a resident presently residing in a
					 Type I or Type II home to allow the resident to remain as an additional nursing
					 facility resident based upon the best interest of the resident. The best
					 interest of the resident shall be determined by the department after
					 consultation with the resident, the resident's family, primary physician, case
					 manager, primary care giver and home operator.
"Expanded ARCH resident" means a person that meets the
					 requirements of section
					 321-15.61(a).
"Fire Safety Evaluation System rating", or "FSES" means an
					 assessment conducted by a Life Safety Consultant to ensure compliance with the
					 prescriptive code requirements of the National Fire Protection Association
					 (NFPA) 101 life safety codes.
"First aid certification" means verification that an
					 individual has successfully completed a course that provides instruction on
					 basic first aid principles, including but not limited to rescue breathing
					 procedures.
"Fully ambulatory" means the ability to move on foot from
					 place to place without the use of any mechanical device and/or human
					 assistance.
"Home health agency" means a licensed public or
					 proprietary agency, a private nonprofit organization, or a subdivision of such
					 agency or organization which is primarily engaged in providing direct or
					 indirect skilled nursing services and other therapeutic services under a
					 physician's direction to homebound patients on a part-time or intermittent
					 basis (in a place used as the individual's home). A homebound patient is a
					 person who, because of a condition due to illness or injury, has a restricted
					 ability to leave the place of residence except with the aid of supportive
					 devices including but not limited to, crutches, canes, wheelchairs, walkers,
					 special transportation, or with the assistance of another person; or a person
					 who has a condition which is such that leaving home is medically
					 contraindicated.
"Infection control" means procedures established for the
					 identification, prevention and control of infections.
"Interim care plan" means a care plan developed by a
					 registered nurse for an expanded ARCH resident within forty-eight hours of the
					 expanded ARCH resident's admission to an expanded ARCH. The interim care plan
					 shall identify the immediate needs of the expanded ARCH resident and shall be
					 based on information, including but not limited to physician or APRN progress
					 notes, the hospital discharge summary, and the emergency room discharge. The
					 interim care plan shall provide sufficient information to the licensee or
					 primary care giver and shall set forth a plan to meet the immediate needs of
					 the resident until a comprehensive care plan can be developed within seven days
					 of the expanded ARCH resident's admission to the expanded ARCH.
"Intermediate care facility", or "ICF" means a facility
					 which provides appropriate care to persons:
(1) Referred by a physician;
(2) Who need twenty four hour a day assistance with the
					 activities of daily living;
(3) Who need care provided by licensed nursing and
					 paramedical personnel on a regular, long-term basis; and
(4) Who do not need twenty four hour a day skilled nursing
					 care.
"Licensee" means the person, group of persons, or entity
					 that holds the license to operate an ARCH or expanded ARCH and who is
					 responsible for the supervision of the ARCH or expanded ARCH and the residents
					 therein.
"Licensed capacity" means the number of residents and the
					 type of residents permitted by the director, pursuant to these rules and
					 chapter
					 321, HRS, in a particular ARCH or
					 expanded ARCH, and so stated on the particular ARCH's or expanded ARCH'S
					 license.
"Licensed nurse" means a person who is either a licensed
					 practical nurse or a registered professional nurse.
"Licensed practical nurse", or "LPN" means a person who is
					 licensed as a practical nurse pursuant to chapter 457, HRS.
"Life safety consultant" means an individual who has
					 experience in conducting fire or life safety inspections of facilities
					 utilizing county and national fire codes and standards.
-"Minimal assistance in activities of daily living" means
					 the provision of services including but not limited to, stand-by assistance,
					 set up, verbal cues or prompting, and visual supervision.
"National Fire Protection Association", or "NFPA" means
					 the association that publishes the national fire codes.
"Neglect" means failure to provide goods and services
					 necessary to avoid physical harm, mental anguish or mental illness, with
					 complete disregard for negative consequences or negative resident outcome which
					 may arise.
"Nurse aide" means a person who performs a variety of
					 duties relating to patients and patient care under the supervision of a nurse,
					 including but not limited to assisting patients in all activities of daily
					 living. A nurse aide may also assist a nurse by changing bed linens, delivering
					 messages, and sterilizing instruments, serving and collecting food trays, and
					 helping patients get out of bed, bathe, and dress.
"Nursing facility level of care" means the level of care
					 provided at skilled nursing facilities or at intermediate care
					 facilities.
"Occupational therapist" means a person who is currently
					 registered or eligible for registration by the American Occupational Therapy
					 Association, and who meets the qualifications under chapter 457G, HRS.
"Personal care services" means daily personal attention
					 and care, including but not limited to skin, nails, hair, teeth, and oral
					 hygiene in addition to any therapeutic regimen ordered by the resident's
					 physician or APRN.
"Physical restraint" means any manual method or physical
					 or mechanical device, material, or equipment attached or adjacent to the
					 resident's body that the individual cannot remove easily which restricts
					 freedom of movement or normal access to one's body.
"Physical therapist" means a person who is licensed as a
					 physical therapist under chapter 461J, HRS.
"Physician" means a person who is licensed to practice
					 medicine or osteopathy under chapters 453 or 460, HRS.
"Plan of correction" means a plan developed by the
					 licensee to address deficiencies in the operation of an ARCH or expanded ARCH
					 as detected by the department pursuant to an inspection and/or complaint
					 investigation that shall include preventive measures to ensure compliance with
					 this chapter and chapter 321, HRS, and the time frame in which these
					 corrections shall take place.
"Primary care giver" means the licensee or the individual
					 designated as the primary care giver by the licensee pursuant to section
					 11-100.1-8.
"Provisional licensure" means a temporary license issued
					 by the department that allows the licensee additional time to correct
					 deficiencies without putting the immediate health, welfare and safety of
					 residents at risk.
"Registered professional nurse" means a person who is
					 licensed as a registered nurse under chapter
					 457,
					 HRS.
"Regular business hours" means the hours between 7:45 a.m
					 and 4:30 p.m., Monday to Friday, inclusive, except for state holidays.
"Representative payee" means an individual who meets the
					 requirements of the Social Security Administration to receive a Social Security
					 payment on behalf of a resident of an ARCH or expanded ARCH pursuant to 42
					 U.S.C. §1605.
"Resident of a category 3 ARCH" means a person unrelated
					 to the primary care giver who resides in the category 3 ARCH, for a fee, and
					 requires room and board which includes a place to sleep, the preparation of
					 meals and laundering of personal clothing. These residents do not require
					 assistance with activities of daily living, and when such care is required, the
					 resident shall be transferred to an appropriate facility.
"Responsible agency" means any public or private agency
					 that has responsibility for the health, welfare, or financial support of the
					 resident.
"Self preservation" means the ability of an ARCH or
					 expanded ARCH resident to ambulate without physical assistance, and the ability
					 of the resident to follow directions and take appropriate action in exiting an
					 ARCH or expanded ARCH in the, event of an emergency.
"Skilled nursing" means care and services provided by a
					 licensed nurse.
"Skilled nursing facility", or "SNF" means a health
					 facility which provides skilled nursing and related services to residents who
					 require medical or nursing care, or rehabilitation services, including but not
					 limited to physical therapy, occupational therapy and speech therapy
					 services.
"Social model of care" means the provision of care that
					 promotes the individuality, dignity, choice, independence, and privacy of an
					 ARCH or expanded ARCH resident in a home-like atmosphere and that provides 'for
					 the inclusion of the resident, the resident's family, and resident's surrogate
					 in the development of the resident's schedule of activities and/or care plan
					 and in all decision-making affecting the resident.
"Social worker" means a person licensed as a social worker
					 pursuant to chapter 467E, HRS.
"Special diet" means a diet ordered by a physician or APRN
					 that is prescribed as part of the medical nutrition therapy of an ARCH or
					 expanded ARCH resident.
"Specialized care" means any care that is identified in
					 the care plan that requires training and monitoring by a registered
					 nurse.
"Staff" means a nurse aide[,] who works in a Type II ARCH,
					 and performs a variety of duties for residents under the supervision of a
					 registered nurse.
"Standard precautions" means guidelines developed by the
					 Center for Disease Control (CDC) which are designed to reduce the risk of
					 transmission of blood borne and other pathogens from both recognized and
					 unrecognized sources of infection, including recommendations to prevent cross
					 contamination between residents.
"Substitute care giver" means an adult who is authorized
					 by the licensee or primary care giver to temporarily take charge of an ARCH or
					 expanded ARCH while the licensee or primary care giver is absent and who
					 possesses the requirements as specified in section
					 11-100.1-9(a) through
					 (e) as applicable.
"Surrogate" means an individual, other than an ARCH or
					 expanded ARCH resident's agent or guardian, authorized under chapter 327E, HRS,
					 to make a healthcare decision for the resident.
"Type I ARCH" means a facility which is licensed for a
					 capacity not to exceed five residents.
"Type II ARCH" means a facility which is licensed for a
					 capacity of six or more residents.
"Tuberculosis clearance" means a negative tuberculin skin
					 test or chest x-ray, which indicates freedom from any infectious or
					 communicable disease.
"Waiver" means an exemption to a rule.
Whenever the singular is used in this chapter it can
					 include the plural.