New Jersey Administrative Code › Title 8 - HEALTH › Chapter 36 - STANDARDS FOR LICENSURE OF ASSISTED LIVING RESIDENCES, COMPREHENSIVE PERSONAL CARE HOMES, AND ASSISTED LIVING PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 8:36-1.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter, shall
				  have the following meanings, unless the context clearly indicates otherwise:
"Activities of daily living (ADL)" means the functions or tasks
				  for self-care, which are performed either independently or with supervision or
				  assistance. Activities of daily living include dressing, bathing, toilet use,
				  transfer, locomotion, bed mobility, and eating.
"Advanced practice nurse" means an individual who is certified by
				  the New Jersey State Board of Nursing in accordance with N.J.S.A. 45:11-23 et
				  seq.
"Aging in place" means a process whereby individuals remain in
				  their living environment despite the physical and/or mental decline and growing
				  needs for supportive services that may occur in the course of aging. For aging in
				  place to occur, services are added, increased, or adjusted to compensate for the
				  individual's physical and/or mental decline.
"Assistance with transfer" means providing the physical
				  assistance of no more than two facility staff while the resident moves between bed
				  and a standing position or between bed, chair or wheelchair.
"Assisted living" means a coordinated array of supportive
				  personal and health services, available 24 hours per day, to residents who have been
				  assessed to need these services including persons who require nursing home level of
				  care. Assisted living promotes resident self direction and participation in
				  decisions that emphasize independence, individuality, privacy, dignity, and homelike
				  surroundings.
"Assisted living program" means the provision of or arrangement
				  for meals and assisted living services, when needed, to the tenants (also known as
				  residents) of publicly subsidized housing which because of any Federal, State, or
				  local housing laws, rules, regulations or requirements cannot become licensed as an
				  assisted living residence. An assisted living program may also provide staff
				  resources and other services to a licensed assisted living residence and a licensed
				  comprehensive personal care home.
"Assisted living program provider" means an organization licensed
				  by the New Jersey Department of Health to provide all services required of an
				  assisted living program.
"Assisted living residence" means a facility that is licensed by
				  the Department of Health to provide apartment-style housing and congregate dining
				  and to assure that assisted living services are available when needed, for four or
				  more adult persons unrelated to the proprietor. Apartment units offer, at a minimum,
				  one unfurnished room, a private bathroom, a kitchenette, and a lockable door on the
				  unit entrance.
"Assisted living values" means the organization, development and
				  implementation of services and other facility or program features so as to promote
				  and encourage each resident's choice, dignity, independence, individuality and
				  privacy in a homelike environment. Assisted living values promote the concepts of
				  aging in place and shared responsibility.
"Available" means ready for immediate use (pertaining to
				  equipment) or capable of being reached (pertaining to personnel), unless otherwise
				  defined.
"Bedridden" means physically unable to rise from bed, even with
				  assistance with transfer from the bed.
"Bounded choice" means limits placed on a resident's choice as a
				  result of an assessment, in accordance with
				  N.J.A.C.
				  8:36-5.18, which indicates that such resident's
				  choices or preferences place the resident or others at a risk of harm or lead to
				  consequences which violate the norms of the facility or program or the rights of
				  others.
"Center" or "Centers" means ecologically designed compact forms
				  of development and redevelopment that are necessary to assure efficient
				  infrastructure and protection of natural resources in the various regions of the
				  State of New Jersey pursuant to the State Plan for Development and Redevelopment
				  created pursuant to the requirements of the State Planning Act, N.J.S.A. 52:18A-196
				  through 207.
"Certificate of Need and Licensing Program" or "Program" means a
				  unit of the Department for which the contact information is Certificate of Need and
				  Licensing Program, New Jersey Department of Health, PO Box 358, Trenton, NJ
				  08625-0358, (609) 292-6552.
"Choice" means the number of opportunities and viable options
				  available to residents to act on their preferences and to exercise control over
				  their lives.
"Cohorting" means the practice of grouping patients who are or are
				  not colonized or infected with the same organism to confine their care to one area
				  and prevent contact with other patients.
"Commissioner" means the Commissioner of the New Jersey
				  Department of Health.
"Communicable disease" means an illness due to a specific
				  infectious agent or its toxic products which occurs through transmission of that
				  agent or its products from a reservoir to a susceptible host.
"Comprehensive personal care home" means a facility which is
				  licensed by the Department of Health to provide room and board and to assure that
				  assisted living services are available when needed, to four or more adults unrelated
				  to the proprietor. Residential units in comprehensive personal care homes house no
				  more than two residents and have a lockable door on the unit entrance.
"Continuing care retirement community" means a facility that has
				  received a certificate of authority pursuant to the Continuing Care Retirement
				  Community Regulation and Financial Disclosure Act, N.J.S.A. 52:27D-330 et
				  seq.
"Customized resident medication package" means a unit-of-use
				  package prepared by a pharmacist for a specific resident comprising a series of
				  containers and containing two or more prescribed solid oral dosage forms, and so
				  designed or labeled as to indicate the day and time, or period of time, that the
				  contents within each container are to be taken.
"Defibrillator" means a medical device heart monitor and
				  defibrillator that has received approval of its pre-market notification filed
				  pursuant to 21 U.S.C. §
										360.(k) from the United States Food and Drug
				  Administration, is capable of recognizing the presence or absence of ventricular
				  fibrillation or rapid ventricular tachycardia, is capable of determining, without
				  intervention by an operator, whether defibrillation should be performed, and upon
				  determining that defibrillation should be performed, automatically charges and
				  requests delivery of an electrical impulse to an individual's heart.
"Department" means the New Jersey Department of Health.
"Dignity" means the self-worth of a resident. Dignity is enhanced
				  and supported when the facility or program, and its staff and policies and
				  procedures, demonstrate courtesy, respect the resident's right to make decisions,
				  and allow personal assistance and care to be provided in privacy, with acceptance of
				  disabilities and emphasis on abilities. (See
				  N.J.A.C.
				  8:36-1.2(b)).
"Direct supervision" means supervision on the premises.
"Division of Health Facility Survey and Field Operations" or
				  "Division" means a unit of the Department for which the contact information is
				  Division of Health Facility Survey and Field Operations, New Jersey Department of
				  Health, PO Box 367, Trenton, NJ 08625-0358, (800) 792-9770
"Documented" means written, signed, and dated.
"Drug regimen review" means an individual resident record review
				  conducted by the consultant or provider pharmacist, including, but not limited to,
				  laboratory tests, dietary requirements, medication administration records,
				  physician's, advanced practice nurse's, or physician assistant's and nurse's
				  clinical notes, physician's, advanced practice nurse's, or physician assistant's
				  orders and progress notes, in order to monitor for potentially significant adverse
				  drug reactions, drug-to-drug and drug-food interactions, allergies,
				  contraindications, rationality of therapy, drug use evaluation and laboratory test
				  results.
"Employee" means a person who is gainfully employed in the
				  assisted living facility on a full- or part-time basis and for whom a record of
				  hours worked and wages paid are maintained and who meets the health, age and other
				  requirements of this chapter. Reimbursement for such employment may include
				  salaries, wages, room and board, or any combination thereof. A person placed in the
				  assisted living facility under a purchase of care or service agreement by the
				  facility, or the resident, is not considered an employee.
"Full-time" means a time period established by the facility as a
				  full working week as defined in the facility's policies and procedures.
"Governing authority" means the organization, person, or persons
				  designated to assume legal responsibility for the management, operation, and
				  financial viability of the facility.
"Guardian" means a person appointed by a court of competent
				  jurisdiction to handle the affairs and protect the rights of any resident of the
				  facility who has been declared a mental incompetent. Guardian does not include a
				  person affiliated with the facility, its operations or personnel, unless so ordered
				  by the court.
"Half-time" means a time period established by the facility as a
				  half working week as defined in the facility's policies and procedures.
"Health care facility" means a facility defined in N.J.S.A.
				  26:2H-1 et seq., and amendments thereto.
"Health Care Plan Review Unit" means a unit within the Division of
				  Codes and Standards in the New Jersey Department of Community Affairs for which the
				  contact information is PO Box 817, Trenton, NJ 08625-0817, (609) 633-8151.
"Health care service" means any service provided to a resident of
				  an assisted living residence or comprehensive personal care home that is ordered by
				  a physician and required to be provided or delegated by a licensed, registered or
				  certified health care professional. Any other service, whether or not ordered by a
				  physician, that is not required to be provided by a licensed, registered or
				  certified health care professional is not to be considered a health care service.
				  For purposes of this definition, a certified health care professional excludes
				  certified homemaker/home health aides, certified nurse aides, certified personal
				  care assistants, and certified medication aides.
"Homelike environment" means a residential setting where a sense
				  of family and community pervades to foster emotional attachment to people and place
				  and in which a resident's preferred lifestyle, habits and use of personal belongings
				  are encouraged and supported.
"Hospice" means a program of palliative and supportive services
				  provided to terminally ill persons and their families in the form of physical,
				  psychological, social, and spiritual care.
"Independence" means the support and enhancement of resident
				  capabilities and facilitation of resident abilities so that the resident's
				  preferences and choices may be implemented within a barrier-free environment.
"Individuality" means each resident's unique needs, capabilities,
				  personalities, backgrounds and preferences.
"Job description" means written specifications developed for each
				  position in the facility, containing the qualifications, duties and
				  responsibilities, and accountability required of employees in that position.
"Licensed nursing personnel" (licensed nurse) means registered
				  professional nurses or practical nurses licensed by the New Jersey Board of Nursing
				  in accordance with N.J.A.C. 13:37.
"Managed risk" means the process of balancing resident choice and
				  independence with the health and safety of the resident and other persons in the
				  facility or program. If a resident's preference or decision places the resident or
				  others at risk or is likely to lead to adverse consequences, such risks or
				  consequences are discussed with the resident, and, if the resident agrees, a
				  resident representative, and a formal plan to avoid or reduce negative or adverse
				  outcomes is negotiated, in accordance with the provisions of
				  N.J.A.C.
				  8:36-5.18.
"Managed risk agreement" means the written formal plan developed
				  in consideration of shared responsibility, bounded choice and assisted living values
				  and negotiated between the resident and the facility or program to avoid or reduce
				  the risk of adverse outcomes which may occur in an assisted living environment.
"Medication administration" means a procedure in which a
				  prescribed medication or biological is given to a resident by an authorized
				  individual in accordance with all laws and regulations governing such procedures.
				  The complete process of administration includes:
1. Removing an individual dose from a previously
				dispensed, properly labeled container (including a unit dose or unit-of-use
				container);
2. Verifying it with the
				prescriber's orders;
3. Giving the
				individual dose to the resident;
4.
				Seeing that the resident takes it (if oral); and
5. Recording the required information, including
				but not limited to the method of administration, time administered, initials of
				individuals who administered the medication, and effect of the medication when "prn"
				or as-needed medications are administered.
"Medication administration record" or "MAR" means an individual
				  resident record that contains, but is not limited to: resident name, date of birth,
				  diagnosis(es), age, physician, name and medication strength, dosage form, route of
				  administration, frequency, date and time of administration, initials of individual
				  administering the medication, a section containing the full signature and title of
				  each individual who initials the MAR, date medication ordered, stop date if
				  applicable, allergies, and all other professionally acceptable information
				  appropriate to MARs.
"Medication aide" means a person who is qualified in accordance
				  with N.J.A.C.
				  8:36-9.2.
"Medication Aide Training Competency and Evaluation Program" or
				  "MATCEP" means a Department approved minimal 30-hour training course conducted by a
				  Department approved registered professional nurse and registered pharmacist, to
				  instruct certified nurse aides, certified homemaker/home health aides or certified
				  personal care assistants, in the administration of medications to residents, within
				  assisted living residences, comprehensive personal care homes and assisted living
				  programs.
"Medication dispensing" means a procedure entailing the
				  interpretation of the original or direct copy of the prescriber's orders for a
				  medication or a biological and, pursuant to that order, the proper selection,
				  measuring, labeling, packaging, and issuance of the medication or biological to a
				  resident or a service unit of the facility, in conformance with all applicable
				  Federal, State, and local rules and regulations.
"Medication error" means any preventable event that may cause or
				  lead to inappropriate medication use or resident harm, while the medication is in
				  the control of the health care professional. Such events may be related to
				  professional practice, health care products, procedures, and systems including:
				  prescribing; order communication; product labeling, packaging and nomenclature;
				  compounding; dispensing; distribution; administration; education; monitoring; and
				  use. The error may or may not be seen by the surveyor during an observation of a
				  resident receiving medication.
"Nursing home-level care" means that an individual requires
				  "nursing facility services" as defined at
				  N.J.A.C.
				  8:85-2.1. Nursing home-level care is provided to
				  individuals who have chronic medical condition(s) resulting in moderate to severe
				  impairments in physical, behavioral, cognitive, and/or psychosocial functioning. The
				  need for nursing home-level care and services is determined by a registered
				  professional nurse and identified in a plan of care.
"Nursing supervision" means services which are provided to a
				  resident whose condition requires continued monitoring of vital signs and physical
				  and cognitive status. Such services shall be medically complex enough to require
				  ongoing assessment, planning, or intervention by a nurse; required to be performed
				  by or under the supervision of licensed nursing personnel or other professional
				  personnel for safe and effective performance; required on a daily basis; and
				  consistent with the nature and severity of the resident's condition or the disease
				  state or stage.
"Pain management," in accordance with
				  N.J.A.C.
				  8:43E-6, means the assessment of pain and, if
				  appropriate, treatment in order to assure the needs of patients or residents of
				  health care facilities who experience problems with pain are met. Treatment of pain
				  may include the use of medications or application of other modalities and medical
				  devices such as, but not limited to, heat or cold, massage, transcutaneous
				  electrical nerve stimulation (TENS), acupuncture, and neurolytic techniques such as
				  radiofrequency coagulation and cryotherapy.
"Personal care" means services supportive to residents' care and
				  comfort, including, but not limited to, assistance with activities of daily living.
				  Except as required by these rules, personal care need not be provided by a personal
				  care assistant.
"Personal care assistant" means an individual who is qualified in
				  accordance with N.J.A.C. 8:36-9.1.
"Pharmacist" means an individual who is licensed by the New Jersey
				  State Board of Pharmacy, in accordance with
				  N.J.A.C.
				  13:39-3.
"Physician" means an individual who is licensed or authorized by
				  the New Jersey State Board of Medical Examiners to practice medicine in the State of
				  New Jersey, in accordance with N.J.A.C. 13:35.
"Physician assistant" means an individual who is licensed by the
				  New Jersey State Board of Medical Examiners, pursuant to N.J.S.A. 45:9-27.10 et seq.
"Privacy" means a resident's degree of control over a specific
				  physical area and/or time; levels of intimacy with family and others; and
				  communication and contact with others outside the facility or program environment.
"Program site" means a licensed assisted living residence, a
				  licensed comprehensive personal care home or a publicly subsidized housing unit
				  whose tenants may voluntarily be receiving the services of a licensed assisted
				  living program provider.
"Publicly subsidized housing" means any housing for which the
				  construction costs and/or the permanent financing have been underwritten with funds
				  from any local, State or Federal entity (including low-income housing tax credits)
				  for the purpose of making the housing affordable to persons with incomes below the
				  area median. For the purpose of this definition, "publicly subsidized housing" can
				  also mean rental housing developments in which all individual units available for
				  rent are receiving rental assistance from a local, State, or Federal entity in order
				  to make the units affordable to individuals with incomes below the area
				  median.
"Religious and recreational activities" includes any religious,
				  social, or recreational activity that is consistent with the resident's preferences
				  and choosing, regardless of whether the activity is coordinated, offered, provided,
				  or sponsored by facility staff or by an outside activities provider.
"Resident" means an individual who lives in an assisted living
				  residence or comprehensive personal care home or is a tenant in publicly subsidized
				  housing who voluntarily participates in an assisted living program.
"Residential unit" means a separate apartment or unit where one
				  or more individuals reside within the assisted living residence or a room or rooms
				  where residents reside within a comprehensive personal care home.
"Responsible person" means a person who has been designated by
				  the resident and who has agreed to assist the resident, as needed, in arranging for
				  health, social and financial services or making decisions regarding such
				  services.
"Self administration" means a procedure in which any medication
				  is taken orally, injected, inserted, or topically or otherwise administered by a
				  resident to himself or herself.
"Shared responsibility" means that residents (and if the resident
				  wishes, the resident's family) and providers of assisted living services share
				  responsibility for planning and decision making affecting residents. To participate
				  fully in shared responsibility, residents shall be provided with clear and
				  understandable information about the possible consequences of their decision-making,
				  in accordance with the provisions of
				  N.J.A.C.
				  8:36-5.18(a)2.
"Shift" means a time period defined as a full working day by the
				  facility in its policy manual.
"Signature" means, at a minimum, the first initial and full
				  surname and title (for example, R.N., L.P.N., D.D.S., M.D., D.O., R.Ph.) of an
				  individual, legibly written with his or her own hand. A controlled electronic
				  signature system may be used.
"Social isolation" means a state of isolation, wherein a resident
				  of a long-term care facility is unable to engage in social interactions and
				  religious and recreational activities with other facility residents or with family
				  members, friends, and external support systems.
"Specialized long-term care" or "specialized care" means the care
				  of individuals who must use a respirator or mechanical ventilator, and the care of
				  individuals with severe behavior management problems, such as combative, disruptive,
				  and aggressive behaviors.
"Staff education plan" means a written plan which describes a
				  coordinated program for employee education for each service, including inservice
				  programs and on-the-job training.
"Staff orientation plan" means a written plan for the orientation
				  of each new employee to the duties and responsibilities of the service to which he
				  or she has been assigned, as well as to the personnel policies of the facility.
"Supervision" means authoritative procedural guidance by a
				  qualified individual for the accomplishment of a function or activity within his or
				  her sphere of competence, with initial direction and periodic on-site inspection of
				  the actual act of accomplishing the function or activity.
"Total bed complement" means the resident census.
"Unit dose drug distribution system" means a system in which
				  medications are delivered to the resident areas in single unit packaging, and which
				  meets the following criteria:
1. Each
				medication shall be individually wrapped and labeled with the generic or trade
				(brand) name and strength of the medication, lot number or reference code,
				expiration date, and manufacturer's name, and shall be ready for administration to
				the resident;
2. Cautionary instructions
				shall appear on the resident's record of medication administration, and the system
				shall include provisions for noting additional information, including, but not
				limited to, special times or routes of administration and storage conditions;
				and,
3. Commercial repackagers shall
				comply with 21 CFR
				201.1, incorporated herein by reference, as
				amended and supplemented, and N.J.A.C. 8:39.
"Unit-of-use" means a system in which medications are delivered
				  to the resident areas either in single unit packaging, bingo or punch cards, blister
				  or strip packs, or other system where each medication is physically separate.
				  Individually labeled unit dose medications may be combined in a "bingo or punch
				  card" to create a unit-of-use drug distribution system.
1. Labeling shall conform to paragraph 1 in the
				definition of "unit dose drug distribution system" above.
2. Cautionary instructions shall appear on the
				resident's record of administration and/or unit-of-use package, and the system shall
				include provisions for noting additional information, including, but not limited to,
				special times or routes of administration and storage
				conditions.