Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 67 - General Provisions for Elder Group Homes, Assisted Living Programs, and Adult Day Services › Rule 481-67.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
The following definitions apply to this chapter and to
				  481-Chapters 68, 69, and 70.
"Activities of daily living "
means the
				  following self-care tasks: bathing, dressing, grooming, eating, transferring,
				  toileting, and ambulation.
"Ambulatory"
or
"ambulation"
means physically and cognitively able to walk without aid of another
				  person.
"Applicable requirements"
means Iowa Code
				  chapters 135C, 231B, 231C, 231D, 235B, 235E, and 562A, this chapter, and
				  481-Chapters 68, 69, and 70, as applicable, and includes any other applicable
				  administrative rules and provisions of the Iowa Code.
"Assignment"
means the distribution of work
				  for which each staff member, regardless of certification or licensure status,
				  is responsible during a given work period and includes a nurse directing an
				  individual to do something the individual is already authorized to do.
"Assistance "
means aid to a tenant who
				  self-directs or participates in a task or activity or who retains the mental or
				  physical ability, or both, to participate in a task or activity. Cueing of the
				  tenant regarding a particular task or activity shall be construed to mean the
				  tenant has participated in the task or activity.
"Blueprint"
means copies of all completed
				  drawings, schedules, and specifications that have been certified, sealed, and
				  signed by an Iowa-licensed architect or Iowa-licensed engineer of record. The
				  department may allow electronic transfer of blueprints pursuant to
				  policy.
"Certified staff"
means certified nursing
				  assistants (CNAs) and certified medication assistants (CMAs) employed by the
				  program.
"Dementia "
means an illness characterized
				  by multiple cognitive deficits which represent a decline from previous levels
				  of functioning and includes memory impairment and one or more of the following
				  cognitive disturbances: aphasia, apraxia, agnosia, and disturbance in executive
				  functioning.
"Department"
means the department of
				  inspections and appeals.
"Director"
means the director of the
				  department of inspections and appeals.
"Direct supervision "
means the provision of
				  guidance and oversight of a delegated nursing task through the physical
				  presence of the licensed nurse to observe and direct certified and noncertified
				  staff.
"Elope "
means that a tenant who has
				  impaired decision-making ability leaves the program without the knowledge or
				  authorization of staff.
"Global Deterioration Scale"
or
"GDS"
means the seven-stage scale for assessment of primary
				  degenerative dementia developed by Dr. Barry Reisberg.
"Health care professional"
means a
				  physician, physician assistant, registered nurse or advanced registered nurse
				  practitioner licensed in Iowa by the respective licensing board.
"Health-related care "
means services
				  provided by a registered nurse or a licensed practical nurse, on a part-time or
				  intermittent basis, and services provided by other licensed health care
				  professionals, on a part-time or intermittent basis. "Health-related care"
				  includes nurse-delegated assistance.
"Human service professional"
means an
				  individual with a bachelor's degree in a human service field including, but not
				  limited to: human services, gerontology, social work, sociology, psychology, or
				  family science. Two years of experience in a human service field may be
				  substituted for up to two years of the required education. For example, an
				  individual with an associate's degree in a human service field and two years of
				  experience in a human service field is a human service professional.
"Impaired decision-making ability"
means a
				  lack of capacity to make safe and prudent decisions regarding one's own routine
				  safety as determined by the program manager or nurse or means having a GDS
				  score of five or above.
"Independent reviewer"
means an attorney
				  licensed in the state of Iowa who is not currently and has not been employed by
				  the department in the past eight years, or has not appeared in front of the
				  department on behalf of a health care facility in the past eight years.
				  Preference shall be given to an attorney with background knowledge, experience
				  or training in long-term care.
"Indirect supervision "
means the provision
				  of guidance and oversight of a delegated nursing task through means other than
				  direct supervision, including written and verbal communication.
"Instrumental activities of daily living"
means those activities that reflect the tenant's ability to perform household
				  and other tasks necessary to meet the tenant's needs within the community,
				  which may include but are not limited to shopping, housekeeping, chores, and
				  traveling within the community.
"Medication setup "
means assistance with
				  various steps of medication administration to support a tenant's autonomy,
				  which may include but is not limited to routine prompting, cueing and
				  reminding, opening containers or packaging at the direction of the tenant,
				  reading instructions or other label information, or transferring medications
				  from the original containers into suitable medication dispensing containers,
				  reminder containers, or medication cups.
"Modification "
means any addition to or
				  change in physical dimensions or structure, except as incidental to the
				  customary maintenance of the physical structure of the program's
				  facility.
"Monitoring"
means an on-site evaluation of
				  a program, a complaint investigation, or a program-reported incident
				  investigation performed by the department to determine compliance with
				  applicable requirements. A monitor who performs a monitoring for the department
				  shall be a registered nurse, human service professional, or another person with
				  program-related expertise.
"Noncertified staff"
means unlicensed and
				  uncertified personnel employed by the program.
"Nurse delegation "
means the action of a
				  registered nurse, advanced registered nurse practitioner, or licensed practical
				  nurse to direct competent certified and noncertified staff to perform selected
				  nursing tasks in selected situations. The decision of a nurse to delegate is
				  based on the delegation process, including assessment, planning,
				  implementation, supervision, and evaluation of the tenant, nursing tasks,
				  personnel, and the situation. The nurse, as a licensed professional, retains
				  accountability for the delegation process and the decision to delegate.
				  Licensed practical nurses may delegate within the scope of their license with
				  the supervision of a registered nurse.
"Occupancy agreement"
or
"contractual
				  agreement"
means a written contract entered into between a program and
				  a tenant that clearly describes the rights and responsibilities of the program
				  and the tenant and other information required by applicable requirements. An
				  occupancy agreement may include a separate signed lease and signed service
				  agreement.
"Part-time or intermittent care "
means
				  licensed nursing services and professional therapies that are provided in
				  combination with nurse-delegated assistance with medications or activities of
				  daily living and do not exceed 28 hours per week or, for adult day services, 4
				  hours per day.
"Personal care "
means assistance with the
				  essential activities of daily living which may include but are not limited to
				  transferring, bathing, personal hygiene, dressing, and grooming that are
				  essential to the health and welfare of a tenant.
"Physician extender"
means nurse
				  practitioners, clinical nurse specialists, and physician assistants.
"Preponderance of the evidence"
means that
				  the evidence, considered and compared with the evidence opposed to it, produces
				  the belief in a reasonable mind that the allegations are more likely true than
				  not true.
"Program "
means one or more of the
				  following, as applicable: an elder group home as defined in Iowa Code section
				  231B.1 and
				  481-Chapter 68, an assisted living program as defined in Iowa Code section
				  231C.1
				  and 481-Chapter 69, or adult day services as defined in Iowa Code section
				  231D.1 and
				  481-Chapter 70.
"Program staff"
means all employees of the
				  program, regardless of certification or licensure status.
"Qualified professional"
means a facility
				  plant engineer familiar with the type of program being provided, or a licensed
				  plumbing, heating, cooling, or electrical contractor who furnishes regular
				  service to such equipment.
"Recognized accrediting entity"
means a
				  nationally recognized accrediting entity that the department recognizes as
				  having specific program standards equivalent to the program standards
				  established by the department.
"Regulatory insufficiency"
means a violation
				  of an applicable requirement.
"Remodeling"
means a modification of any
				  part of an existing building, an addition of a new wing or floor to an existing
				  building, or a conversion of an existing building.
"Restraints "
means any chemical or manual
				  method which restricts freedom of movement or normal access to one's body or
				  any physical or mechanical device, material or equipment which is attached or
				  adjacent to the tenant's body that the tenant cannot remove easily and which
				  restricts freedom of movement or normal access to one's body.
"Routine "
means more often than not or on a
				  regular customary basis.
"Self-administration "
means a tenant's
				  taking personal responsibility for all phases of medication except for any
				  component assigned to the program under medication setup, and may include the
				  tenant's use of an automatic pill dispenser.
"Service plan"
means the document that
				  defines all services necessary to meet the needs and preferences of a tenant,
				  whether or not the services are provided by the program or other service
				  providers.
"Significant change"
means a major decline
				  or improvement in the tenant's status which does not normally resolve itself
				  without further interventions by staff or by implementing standard
				  disease-related clinical interventions that have an impact on the tenant's
				  mental, physical, or functional health status.
"Substantial compliance "
means a level of
				  compliance with applicable requirements such that any identified regulatory
				  insufficiency poses no greater risk to tenant health or safety than the
				  potential for causing minimal harm.
"Tenant"
means an individual who receives
				  services through a program. In the context of adult day services, "tenant"
				  means a participant as defined in 481-Chapter 70.
"Tenant advocate "
means the office of
				  long-term care resident's advocate established in Iowa Code section
				  231.42.
"Tenant's legal representative "
means a
				  person appointed by the court to act on behalf of a tenant or a person acting
				  pursuant to a power of attorney. In the context of adult day services,
				  "tenant's legal representative" means a participant's legal representative as
				  defined in 481-Chapter 70.
"Waiver"
means action taken by the
				  department that suspends in whole or in part the requirements or provisions of
				  a rule.