Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-1 - Definitions

Current through 2024-29, July 17, 2024
The following terms shall have the meanings as
				  specified:
"Abuse"
means the infliction of injury,
				  unreasonable confinement, intimidation or cruel punishment with resulting
				  physical harm or pain or mental anguish, sexual abuse or exploitation or the
				  willful deprivation of essential needs. "Willful", as used in this definition
				  of abuse, means the individual must have acted deliberately, not that the
				  individual must have intended to inflict injury or harm.
"Activities Coordinator"
means a person with one
				  of the following qualifications:
a. Completion of a training course approved by the Department
				  of Education; or
b. A Registered Occupational Therapist or an Occupational
				  Therapy Assistant; or
c. A degree in Therapeutic Recreation.
"Administrator"
means a person licensed under
				  the provisions of Section
				  32 MRSA
				  Section61, having the authority and
				  responsibility for the operation of the institution and for staff performance
				  in caring for residents in accordance with applicable legal requirements and
				  policies approved by the governing authority.
"Adult Day Services"
means the care and
				  supervision of consumers who attend the facility during day time or night time
				  hours, but are not residents of the facility.
"Advance Directives"
means a written document
				  signed by the resident, guardian or agent under durable power of attorney,
				  giving or withholding consent or approval related to medical or other
				  professional care, counsel, treatment or service for the resident, in the event
				  that the resident becomes unable to provide that direction.
"Ambulatory"
means a person who is physically
				  and mentally capable of moving from place to place without the aid of another
				  person.
"Applicant"
means any person in whose behalf an
				  application for a license is submitted.
"Approved"
means acceptable to the
				  Department.
"Automatic Call System"
means an audio and
				  visual alert system in which residents may press a button, and nursing
				  personnel are automatically notified by means of a light or a buzzer that a
				  resident is calling for assistance.
"Certified Nursing Assistant (CNA)"
means a
				  person who has successfully completed a training program or course with a
				  curriculum prescribed by the Maine State Board of Nursing, or is deemed to have
				  had comparable training according to rules established by the Maine State Board
				  of Nursing and whose duties are assigned by a Registered Professional
				  Nurse.
"Certified Nursing Assistant/Medications
				  (CNA/M)"
means a certified nursing assistant who has satisfactorily
				  completed the standardized medication course for certified nursing assistants,
				  the curriculum for which is prescribed by the Maine State Board of
				  Nursing.
"Charge Nurse/Nurse Manager"
means the licensed
				  nurse on duty who is assigned responsibility for the supervision of nursing
				  services during a particular shift.
"Clinical Record"
means the medical record
				  maintained on each resident in accordance with professional standards and
				  practices.
"Convenience"
means any action taken by the
				  facility to control resident behavior or maintain residents with a lesser
				  amount of effort by the facility and not in the residents' best
				  interest.
"Danger"
means a situation or condition of abuse,
				  neglect, exploitation, or serious harm or immediate risk thereof.
"Department"
means the Department of Human
				  Services.
"Dependent Adult"
means any adult who is wholly
				  or partially dependent upon one or more other persons for care or support,
				  either emotional or physical, and who would be in danger if that care or
				  support were withdrawn.
"Dietetic Service Supervisor,"
to be used
				  interchangeably with Food Service Supervisor, means a person who:
a. Is a qualified dietitian; or
b. Is a graduate of a dietetic technician program, approved
				  by the American Dietetic Association; or is a graduate of the Dietary Managers
				  Association approved course and has passed the Certifying Board for Dietary
				  Managers credentialing exam; or
c. Is a graduate of a State-approved course in food service
				  supervision; or
d. Has training and experience in food service supervision
				  and management in a military service, equivalent to the requirements in (b) or
				  (c) above.
"Dietitian"
means any individual currently
				  licensed to practice dietetics in the State of Maine.
"Direct Care"
means hands-on care provided to
				  residents, including, but not limited to feeding, bathing, toileting, dressing,
				  lifting, moving residents, treatments, and medication administration. Direct
				  care does not include food preparation, housekeeping or laundry services except
				  in circumstances when such services are required to meet the needs of an
				  individual resident on a given occasion.
"Direct Care Provider"
means Registered
				  Professional Nurses and Licensed Practical Nurses, Certified Nursing
				  Assistants, and Personal Support Specialists who provide direct care to nursing
				  facility residents.
"Director of Nursing/Director of Nursing
				  Services"
means a Registered Professional Nurse who has the
				  responsibility for the management and direction of nursing services.
"Discipline"
is defined as any action taken by
				  the facility for the purpose of punishing or penalizing residents.
"Distinct Part"
means a physically separate unit
				  that is clearly identifiable from the remainder of the facility. The "distinct
				  part" must represent an entire, physically identifiable unit, consisting of all
				  the beds within that unit, such as a separate building, floor, wing, or ward.
				  Several rooms at one end of a hall, or a side of a corridor, may be accepted as
				  a "distinct part" only if they constitute a wing or ward. Various beds
				  scattered throughout the facility would not comprise a "distinct part". The
				  "distinct part" of a facility provides a level of care distinguishable from
				  other levels of care in the facility.
"Exploitation"
means the illegal or improper use
				  of an incapacitated or dependent adult or his/her resources for another's
				  profit or advantage.
"Facility"
means a skilled nursing facility
				  (SNF) or a nursing facility (NF) or a distinct part of an institution.
"Feeding Assistants"
are paid staff, who have
				  successfully completed a State approved training program and who assist
				  residents with their meals. Feeding assistants are not considered direct care
				  staff.
"Food Service Supervisor"
has the same meaning
				  as "Dietetic Service Supervisor".
"Incapacitated Adult"
means any adult who is
				  impaired by reason of mental illness, mental deficiency, physical illness or
				  disability to the extent that he/she lacks sufficient understanding or capacity
				  to make or communicate responsible decisions concerning his/her person, or to
				  the extent the adult cannot effectively manage or apply his/her estate to
				  necessary ends.
"Incident and Accident"
means any occurrence
				  which affects the safety, health, or well-being of a resident, staff or
				  visitor. This could include falls, lacerations, abuse, bruises (whether origin
				  is known or unknown), etc.
"Infection Control Program"
means a program that
				  is designed to provide a safe, sanitary, and comfortable environment for the
				  residents and to help prevent the development and transmission of disease and
				  infection.
"In-Service Training Program"
means a program of
				  orientation and continuing education for all employees.
"Interdisciplinary Team"
is used interchangeably
				  with Multidisciplinary Team (MDT) and means the attending physician, a
				  registered nurse and other appropriate staff and residents/family and others of
				  their choice, in disciplines as determined by the resident's needs.
"Legend Drug"
or prescription drug means those
				  drugs that are required by Federal or state law or rule to be dispensed only on
				  prescription.
"Licensed Practical Nurse (LPN)"
means an
				  individual currently licensed to practice practical nursing in the State of
				  Maine.
"Maine Registry of Certified Nursing Assistants"
is a listing of certified nursing assistants who meet the educational
				  requirements of the Maine State Board of Nursing. The Registry includes
				  notation of conviction(s) and/or substantiations of resident abuse, neglect
				  and/or misappropriation of residents' property by the CNA in accordance with
				  the Rules and Regulations Governing the Functioning of the Maine Registry of
				  Certified Nursing Assistants.
"Medical Director"
means a physician contracted
				  by the facility to provide consultation regarding resident care policies and
				  services and to participate in related committees.
"Medication Error"
means the administration of
				  any medication incorrectly; i.e., dosage, selection of drug, selection of
				  resident, time or method of administration, omission of prescribed medication,
				  or the administration of a medication without a valid order.
"Mental Retardation and Mental Illness"
mean, as
				  defined for Pre-Admission Screening and Annual Resident Review (PASARR)
				  requirements:
Mental Retardation
is "significantly subaverage
				  general intellectual functioning existing concurrently with deficits in
				  adaptive behavior and manifested during the developmental period".
Mental Illness
is a primary or secondary
				  diagnosis of a mental disorder as defined in the American Psychiatric
				  Association Diagnostic and Statistical Manual (DSM-III 1R), current edition,
				  and which does not include dementia.
"Minimum Data Set (MDS)"
means the
				  state-approved resident assessment instrument.
"Multilevel Facilities"
means any nursing
				  facilities that are located on the same contiguous grounds with licensed
				  assisted living services, congregate housing services or home health
				  services.
"Multidisciplinary Team"
(MDT) may be used
				  interchangeably with Interdisciplinary Team and refers to the attending
				  physician, a registered nurse and other appropriate staff and residents/family
				  and others of their choice, in disciplines as determined by the residents'
				  needs.
"Neglect"
means a threat to an adult's health or
				  welfare by physical or mental injury or impairment, lack of protection or
				  prevention from these, or the deprivation of or lack of essential needs.
				  Neglect occurs on an individual basis when a resident receives a lack of care
				  (e.g., absence of frequent monitoring for a resident known to be incontinent,
				  resulting in being left to lie in urine or feces).
"Nursing Assistant"
means an individual who is
				  enrolled in a training program for assistants to nurses, for which the
				  curriculum has been approved by the Maine State Board of Nursing.
"Nursing Facility or Nursing Home"
means a
				  facility licensed by the Department to provide nursing services.
"Nursing Staff"
means Registered Professional
				  Nurses, Licensed Practical Nurses, Certified Nursing Assistants, Certified
				  Nursing Assistants/Medications and nursing assistants.
"Personal Support Specialist (PSS)"
means an
				  individual who has successfully completed Departmentally-approved course
				  requirements and is registered as a PSS in accordance with 10-144 CMR Ch. 129,
				  Rules and Regulations Governing In-Home Personal Care and Support Workers, and
				   22
				  MRS §1717.
"Pharmacist"
means an individual currently
				  registered as a pharmacist in the State of Maine.
"Physician"
means an individual currently
				  licensed to practice medicine or osteopathy in the State of Maine.
"Potentially Hazardous Foods"
means any food or
				  ingredient, natural or synthetic, capable of supporting the rapid and
				  progressive growth of infectious or toxigenic microorganisms.
"Pre-Admission Screening"
means the procedure
				  that screens each applicant for admission to a nursing facility in order to
				  ensure that the facility does not admit an individual with mental illness or
				  mental retardation, unless the Department has determined that the individual
				  requires the level of care furnished by the facility.
"Principles of Reimbursement"
means the
				  principles of reimbursement for nursing facilities promulgated from time to
				  time by the Department.
"Prospective Case-Mix Reimbursement System"
means a method of paying health care providers rates that are established in
				  advance. These rates take into account the fact that some residents are more
				  costly to care for than others.
"Qualified Social Worker"
means a person holding
				  a current and valid license as required by State law to practice social work
				  services.
"Registered Nurse" or "Registered Professional
				  Nurse"
means an individual currently licensed to practice professional
				  nursing in the State of Maine.
"Resident"
means a person who resides and
				  receives services or care in a nursing facility.
"Resident Assessment Instrument (RAI)"
means a
				  standardized approach for applying a problem identification process. It gathers
				  definitive information on a resident's strengths and needs which must be
				  addressed in an individual care plan.
"Resident Assessment Protocol (RAP)"
means the
				  required structured approach to resident assessment and problem
				  identification.
"Respite Care"
means care anticipated to be
				  provided for a period of thirty (30) days or less for the purpose of
				  temporarily relieving a family member or other caregiver from his or her daily
				  caregiving duties. All nursing facility regulations shall apply to admissions
				  for respite care.
"Restraint"
means any device which is intended
				  to restrict freedom of movement or access to one's body or any medication which
				  alters cognition or behavior and which is used for discipline or convenience
				  and is not required to treat medical symptoms.
"Physical Restraints"
are defined as 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 and
				  which restricts freedom of movement or normal access to one's body.
"Chemical Restraint"
is defined as a
				  psychopharmacologic drug that is used for discipline or convenience and is not
				  required to treat medical symptoms.
"Risk"
means that there is reasonable cause to
				  believe that injury, hazard, damage or loss may occur.
"Safe Temperatures"
as applied to potentially
				  hazardous foods, means internal temperatures of 41 degrees Fahrenheit or below
				  (for cold food) and 140 degrees Fahrenheit or above (for hot foods), unless
				  otherwise specified in these regulations, and 0 degrees Fahrenheit or below for
				  frozen foods.
"Serious Harm"
means:
a. Serious physical injury;
b. Serious mental injury or impairment evidenced by severe
				  anxiety, depression, or withdrawal, untoward aggressive behavior, or similar
				  dysfunctional behavior; or
c. Sexual abuse or exploitation.
"Skilled Nursing Care,"
for the purpose of these
				  regulations, means that:
a. The service would constitute a skilled service where the
				  inherent complexity of a service prescribed for a resident is such that it can
				  be safely and effectively performed only by or under the direct supervision of
				  professional nursing personnel;
b. The restoration potential of a resident is not the
				  deciding factor in determining whether a service is to be considered skilled or
				  unskilled. Even where full recovery or medical improvement is not possible,
				  skilled care may be needed to prevent, to the extent possible, deterioration of
				  the condition or to sustain current capacities; and
c. A service that is generally unskilled would be considered
				  skilled where, because of special medical complications, its performance or
				  supervision and the observation of the resident necessitates the use of skilled
				  nursing personnel.
"Skilled Nursing Facility"
is a nursing facility
				  which is certified to provide Medicare-reimbursed skilled nursing
				  services.
"Specialized Rehabilitative Services"
means
				  services such as physical therapy, speech-hearing therapy, and occupational
				  therapy.
"Specialized Unit"
means a unit that provides
				  the care to meet the specific needs of special groupings of residents, i.e.,
				  residents with Alzheimer's or head trauma, etc.
"Transfer Agreement"
means an agreement with one
				  or more hospitals which provides reasonable assurance that transfer of
				  residents will be effected between facilities whenever such transfer is
				  medically appropriate.