Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 65 - Intermediate Care Facilities for Persons With Mental Illness (ICF/PMI) › Rule 481-65.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
For the purposes of these rules, the following terms shall
				  have the meaning indicated in this chapter. The definitions set out in Iowa
				  Code section 135C.1 shall be considered
				  incorporated verbatim in the rules. The use of the words "shall" and "must"
				  indicate these standards are mandatory.
"Academic services"
means those activities
				  provided to assist a person to acquire general information and skills which
				  establish the basis for subsequent acquisition and application of
				  knowledge.
"Activity coordinator"
means a person who
				  has completed the state-approved activity coordinator's course.
"Age appropriate"
means those activities,
				  settings, and personal appearance and possessions commensurate with the
				  person's chronological age.
"Chronic mental illness"
(see the definition
				  of "Mental illness").
"Commission"
means the mental health and
				  disability services commission.
"Community living training services"
are
				  those activities provided to assist a person to acquire or sustain the
				  knowledge and skills essential to independent functioning to the person's
				  maximum potential in the physical and social environment. These services may
				  focus on the following areas:
1.
				Independent living skills which include those skills necessary to sustain
				oneself in the physical environment and are essential to the management of
				one's personal property and business. This includes self-advocacy
				skills.
2. Socialization skills
				which include self-awareness and self-control, social responsiveness, group
				participation, social amenities and interpersonal skills.
3. Communication skills which include
				expressive and receptive skills in verbal and nonverbal language, including
				reading and writing.
4. Leisure
				time and recreational skills which include the skills necessary for a person to
				use leisure time in a manner which is satisfying and constructive to the
				person.
5. Parenting skills which
				include those skills necessary to meet the needs of the person's child. This
				service is designed to assist the person with mental illness to acquire or
				sustain the skills necessary for parenting.
"Department"
means the Iowa department of
				  inspections and appeals.
"Dependent adult abuse"
is as defined in
				  rule 481-52.1 (235E).
"Diagnosis"
means the investigation and
				  analysis of the cause or nature of a person's condition, situation or
				  problem.
"Direct care staff"
means those staff
				  persons who provide a homelike environment for the residents and assist or
				  supervise the resident in meeting the goals in the resident's program
				  plan.
"Evaluation services"
means those activities
				  designed to identify a person's current functioning level and those factors
				  which are barriers to maintaining the current level or achieving a higher level
				  of functioning.
"Exploitation"
means the act or process of
				  taking unfair advantage of a resident, or the resident's physical or financial
				  resources for one's own personal or pecuniary profit by the use of undue
				  influence, harassment, duress, deception, false representation or false
				  pretenses.
"Goals"
means general statements of
				  attainable expected accomplishments to be achieved in meeting identified
				  needs.
"Incident"
means all accidental, purposeful,
				  or other occurrences within the facility or on the premises affecting
				  residents, visitors, or employees whether there is apparent injury or where
				  hidden injury may have occurred.
"Individual program plan (IPP)"
means a
				  written plan for the provision of services to the resident that is developed
				  and implemented using an interdisciplinary process that is based on the
				  resident's functional status, strengths, and needs and that identifies service
				  activities designed to enable a person to maintain or move toward independent
				  functioning. The plan identifies a continuum of development and outlines
				  progressive steps and anticipated outcomes of services.
"Informed consent"
means an agreement by a
				  person, or by the person's legally authorized representative, based upon an
				  understanding of:
1. A full
				explanation of the procedures to be followed including an identification of
				those that are and are not experimental;
2. A description of the attendant
				discomforts, risks, and benefits to be expected; and
3. A disclosure of appropriate alternative
				procedures that would be advantageous for the person.
"Interdisciplinary process"
means an
				  approach to assessment, individual program planning, and service implementation
				  in which planning participants function as a team. Each participant utilizing
				  the skills, competencies, insights and perspectives provided by the
				  participant's training and experience focuses on identifying the service needs
				  of the resident and the resident's family. The purpose of the process is for
				  participants to review and discuss, face-to-face, all information and
				  recommendations and to reach decisions as a team. Participants share all
				  information and recommendations, and develop as a team, a single, integrated
				  individual program plan to meet the resident's needs and, when appropriate, the
				  resident's family's needs.
"Interdisciplinary team"
means the group of
				  persons who develop a single, integrated individual program plan to meet a
				  resident's needs for services. The interdisciplinary team consists of, at a
				  minimum, the resident, the resident's legal guardian, if applicable, the
				  resident's advocate, if desired by the resident, a referral agency
				  representative, other appropriate staff members, the resident's attending
				  psychiatrist and QMHP, other providers of services, and other persons relevant
				  to the resident's needs.
"Least restrictive environment"
means the
				  environment in which the interventions in the lives of people with mental
				  illness can be carried out with a minimum of limitation, intrusion, disruption,
				  and departure from commonly accepted patterns of living.
It is the environment which allows residents to participate,
				  to the maximum extent possible, in everyday life and to have control over the
				  decisions that affect them. It is an environment that provides needed supports
				  which do not interfere with personal liberty and do not unduly interfere with a
				  person's access to the normal events of life.
"Legal services"
means those activities
				  designed to assist the person in exercising constitutional and legislatively
				  enacted rights.
"Level of functioning"
means a person's
				  current physiological and psychological status and current academic, community
				  living, self-care and vocational skills.
"Mechanical restraint"
means a device
				  applied to a person's limbs, head or body which restricts a person's movement
				  and includes, but is not limited to, leather straps, leather cuffs, camisoles
				  or handcuffs.
"Mental abuse"
means, but is not limited to,
				  humiliation, harassment, and threats of punishment or deprivation.
"Mental health counselor"
means a person who
				  is certified or eligible for certification as a mental health counselor by the
				  National Academy of Certified Clinical Mental Health Counselors.
"Mental health, mental retardation
				  commission"
means the commission described in Iowa Code section
				  225C.5.
"Mental illness"
means a substantial
				  disorder of thought or mood which significantly impairs judgment, behavior, or
				  the capacity to recognize reality or the ability to cope with the ordinary
				  demands of life. Mental illnesses include the organic and functional psychoses,
				  neuroses, personality disorders, alcoholism and drug dependence, behavioral
				  disorders and other disorders as defined by the current edition of "American
				  Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders."
				  Mental illness is chronic when it is of long duration or marked by frequent
				  recurrences.
"Normalization"
means helping persons, in
				  accordance with their needs and preferences, to achieve a lifestyle that is
				  consistent with the norms and patterns of general society in ways which
				  incorporate the age-appropriate and least restrictive principles.
"Objectives"
means specific, time-limited,
				  and measurable statements showing outcomes or accomplishments necessary to
				  progress toward the goal.
"Physical abuse"
means, but is not limited
				  to, corporal punishment and the use of restraints as punishment.
"Physical injury"
means damage to any bodily
				  tissue to the extent the tissue must undergo a healing process in order to be
				  restored to a sound and healthy condition. It may also mean damage to the
				  extent the bodily tissue cannot be restored to a sound and healthy condition,
				  or results in the death of the resident whose bodily tissue sustained the
				  damage.
"Physical or physiological treatment"
means
				  those activities designed to prevent, halt, control, relieve, or reverse
				  symptoms or conditions which interfere with the physical or physiological
				  functioning of the human body.
"Physical restraint"
means a technique
				  involving the use of one or more of a staff person's arms, legs, hands or other
				  body areas to restrict or control the movements of a resident. This does not
				  include the use of mechanical restraint.
"Physician"
means a person who is currently
				  licensed in Iowa to practice medicine and surgery, osteopathic medicine and
				  surgery, or osteopathy.
"Primary care provider"
means any of the
				  following who provide primary care and meet certification standards:
1. A physician who is a family or general
				practitioner or an internist.
2. An
				advanced registered nurse practitioner.
3. A physician assistant.
"Program"
means a set of related resources
				  and services directed to the accomplishment of a fixed set of goals and
				  objectives for any of the following:
1. Special target populations;
2. The population of a specified geographic
				area(s);
3. A specified purpose;
				and
4. A person.
"Psychiatric nurse"
means a person who meets
				  the requirements of certified psychiatric-mental health nurse practitioner
				  pursuant to 655-Chapter 7, Iowa Administrative Code, or is eligible for
				  certification.
"Psychiatrist"
means a doctor of medicine or
				  osteopathic medicine and surgery who is certified by the American Board of
				  Psychiatry and Neurology or who is eligible for certification.
"Psychologist"
means a person who is
				  licensed to practice psychology in the state of Iowa, or is certified by the
				  Iowa department of education as a school psychologist, or is eligible for
				  certification.
"Psychotherapeutic treatment"
means those
				  activities designed to assist a person in the identification or modification of
				  beliefs, emotions, attitudes, or behaviors in order to maintain or improve the
				  person's functioning in response to the physical, emotional and social
				  environment.
"Qualified mental health professional
				  (QMHP)"
means a person who:
1. Holds at least a master's degree in a
				mental health field, including but not limited to: psychology, counseling and
				guidance, nursing and social work; or is a doctor of medicine (M.D.) or a
				doctor of osteopathic medicine and surgery (D.O.) or a physician assistant;
				and
2. Holds a current Iowa license
				when required by the Iowa licensure law; and
3. Has at least two years of postdegree
				experience, supervised by a mental health professional, in assessing mental
				problems and needs of individuals and in providing appropriate mental health
				services for those individuals. See rule
				481-65.4 (135C) for waiver
				procedures.
"Resident"
means a person who has been
				  admitted to the facility to receive care and services.
"Seclusion"
means the isolation of the
				  resident in a locked room which cannot be opened by the resident.
"Self-care training services"
means those
				  activities provided to assist a person to acquire or sustain the knowledge,
				  habits and skills essential to the daily needs of the person. The activities
				  focus on personal hygiene, general health maintenance, mobility skills and
				  other activities of daily living.
"Service"
means a set of interrelated
				  activities provided to a resident pursuant to the IPP.
"Sexual abuse"
means, but is not limited to,
				  the exposing of pubes to a resident, the exposure of a resident's genitals,
				  pubes, breasts or buttocks for sexual satisfaction, fondling or touching the
				  inner thigh, groin, buttocks, anus or breast of a resident or the clothing
				  covering these areas, sexually suggestive comments or remarks made to a
				  resident, a genital to genital or rectal, or oral to genital or rectal contact,
				  or the commission of a sexual offense under Iowa Code chapter 709 or Iowa Code
				  section 726.2.
"Social worker"
means a person who is
				  licensed to practice social work in the state of Iowa, or who is eligible for
				  licensure.
"Support services"
means those activities
				  provided to or on behalf of a person in the areas of personal care and
				  assistance and property maintenance in order to allow a person to live in the
				  least restrictive environment.
"Transportation services"
means those
				  activities designed to assist a person to travel from one place to another to
				  obtain services or carry out life's activities.
"Verbal abuse"
means, but is not limited to,
				  the use of derogatory terms or names, undue voice volume and rude comments,
				  orders or responses to residents.
"Vocational training services"
means those
				  activities designed to familiarize a person with production or employment
				  requirements and to maintain or develop the person's ability to function in a
				  work setting. This service includes programming which allows or promotes the
				  development of skills, attitudes and personal attributes appropriate to the
				  work setting.
"Work"
means any activity during which a
				  resident provides goods or services for wages.
"Written, in writing or recorded"
means that
				  an account or entry is made in a permanent form.