Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 110 - DEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING › Chapter 005 - LICENSING AND OPERATING RULES FOR NURSING HOMES › Section 13 110 005 - LICENSING AND OPERATING RULES FOR NURSING HOMES

Current through June, 2024
Section 1 GENERAL PROVISIONS
1.1. Statement of Purpose and Scope.
It is the purpose of these rules to implement state and
				  federal law governing the licensing, operation, and standard of care in nursing
				  homes, also referred to in these rules as "nursing facilities" or "facilities",
				  located in the State of Vermont. Compliance with these rules will help each
				  resident attain or maintain the highest practicable physical, mental and
				  psychosocial well-being in accordance with a comprehensive assessment and plan
				  of care and prevailing standards of care and will promote a standard of care
				  that assures that the ability of each resident to perform activities of daily
				  living does not diminish unless the resident's ability is diminished solely as
				  a result of a change in the resident's clinical condition.
1.2. Authority.
These rules are promulgated pursuant to
				  33 V.S.A.
				  §
												7117 to implement the provisions of 33
				  V.S.A. Chapters 71 and 73, 18 V.S.A. Chapter 221, 18 V.S.A. Chapter 231, 42
				  U.S.C. §§ 13951-3 and
				  1396r, and 42 C.F.R. Part 483,
				  Subpart B.
1.3. Exception
				and Severability.
A determination that any provision or application of any
				  provision of these rules is invalid shall not affect the validity of any other
				  provision of these rules or its applicability.
1.4. Effective Date.
These rules are effective June 1, 2018.
1.5. Variances from these Rules.
a. In accordance with
				33 V.S.A.
				§
												7106, the department may grant a
				variance from any provision of these rules if it determines that:
1. strict compliance would impose substantial
				hardship on the licensee;
2. the
				licensee will otherwise meet the goal of the rule; and
3. a variance will not result in less
				protections of the health, safety and welfare of the residents.
b. A variance will not be granted
				from a rule pertaining to residents' rights.
c. Separate federal variance procedures may
				apply for provisions of these rules also contained in federal nursing facility
				regulations.
d. Variances from
				requirements related to fire safety and building construction standards
				regulated by the Vermont Department of Public Safety must be requested from
				that Department.
1.6.
				Definitions.
The words and phrases listed below, as used in these
				  regulations, have the following meanings, unless otherwise specifically
				  provided:
a. "Advance Directive" means
				a written record executed pursuant to 18 V.S.A. Chapter 231, which may include
				appointment of an agent, identification of a preferred primary care clinician,
				instructions on health care desires or treatment goals, an anatomical gift,
				disposition of remains, and funeral goods and services. The term includes
				documents designated under prior law as a durable power of attorney for health
				care or a terminal care document.
b. "Agent" means an adult with capacity to
				whom authority to make health care decisions is delegated under an advance
				directive, including an alternate agent if the agent is not reasonably
				available.
c. "Capacity" means an
				individual's ability to make and communicate a decision regarding the issue
				that needs to be decided.
1. An individual
				shall be deemed to have capacity to appoint an agent if the individual has a
				basic understanding of what it means to have another individual make health
				care decisions for oneself and of who would be an appropriate individual to
				make those decisions, and can identify whom the individual wants to make health
				care decisions for the individual; and
2. An individual shall be deemed to have
				capacity to make a health care decision if the individual has a basic
				understanding of the diagnosed condition and the benefits, risks, and
				alternatives to the proposed health care.
d. "Clinician order for life sustaining
				treatment" (COLST) means a clinician's order or orders for treatment, such as
				intubation, mechanical ventilation, transfer to hospital, antibiotics,
				artificially administered nutrition, or another medical intervention. A COLST
				order is designed for use in outpatient settings and health care facilities and
				may include a DNR order that meets the requirements of
				18 V.S.A.
				§
												9708.
e. "Commissioner" means the Commissioner of
				the Department of Disabilities, Aging and Independent Living.
f. "Department" means the Vermont Department
				of Disabilities, Aging and Independent Living.
g. "Discharge" means movement of a resident
				out of the nursing home, without expectation that the resident will
				return.
h. "Do Not Resuscitate
				Order" (DNR) means a written order of the resident's clinician directing health
				care providers not to attempt resuscitation.
i. "DNR/COLST" means a DNR or COLST, or
				both.
j. "Facility" means a nursing
				home licensed or required to be licensed pursuant to the provisions of 33
				V.S.A. chapter 71.
k. "Informed
				consent" means the consent given voluntarily by an individual with capacity, on
				his or her own behalf or on behalf of another in the role of an agent,
				guardian, or surrogate in the case of DNR/COLST orders, after being fully
				informed of the nature, benefits, risks, and consequences of the proposed
				health care, alternative health care, and no health care.
l. "Interested individual" means:
1. the resident's spouse, adult child,
				parent, adult sibling, adult grandchild, clergy person; or
2. A any adult who has exhibited special care
				and concern for the resident and who is personally familiar with the resident's
				values.
m. "Legal
				representative" means a person appointed by an individual or by a duly
				authorized agency or court, or otherwise authorized by law to act on behalf of
				an individual, and includes the terms "representative payee" and
				"guardian."
n. "Licensee" means the
				person or persons who hold a license to operate a nursing home.
o. "Licensing agency" means the Department's
				Division of Licensing and Protection Survey and Certification Unit.
p. "Life sustaining treatment" means any
				medical intervention, including nutrition and hydration administered by medical
				means and antibiotics, which is intended to extend life and without which the
				resident is likely to die.
q.
				"Medicaid" means the medical assistance program established pursuant to Title
				XIX of the Social Security Act.
r. 
				"Medicare" means the medical insurance program established pursuant to Title
				XVIII of the Social Security Act.
s. "Next of Kin" means the resident's spouse
				or civil union partner, an individual in a long-term relationship of indefinite
				duration, in which the individual has demonstrated an actual commitment to the
				resident similar to the commitment of a spouse, and in which this individual
				and the resident consider themselves to be responsible for each other's
				well-being, the resident's adult children, resident's parents; and the
				resident's adult siblings.
t.
				"Nursing home", which is also referred to in these rules as "nursing facility"
				or "facility", means an institution or a distinct part of an institution
				(excluding intermediate care facilities for individuals with intellectual
				disabilities) which is primarily engaged in providing to its residents:
1. skilled nursing care and related services
				for residents who require medical or nursing care;
2. rehabilitation services for the
				rehabilitation of injured, disabled or sick persons; or
3. on a 24-hour basis, health related care
				and services to individuals who because of their mental or physical condition
				require care and services which can be made available to them only through
				institutional care.
u.
				"Ombudsman" means the individual selected from among individuals with expertise
				and experience in the fields of long-term care and advocacy who heads the
				Office of the State Long-Term Care Ombudsman and is responsible personally, or
				through representatives of the Office of the Long-Term Care Ombudsman, to
				fulfill the functions, responsibilities and duties set forth in the Older
				Americans Act of 1965, as amended.
v. "Options counseling" means providing an
				applicant to or resident of a nursing home with complete information on all
				available long-term care services and benefits for which he or she might be
				eligible and giving him or her the opportunity to make a fully informed choice
				from among the available options and services.
w. "Psychosocial needs" means any combination
				of mental health, emotional, spiritual or behavioral needs, concerns or aspects
				of the resident's life which are identified as important to the
				resident.
x. "Representative Payee"
				means an individual or organization certified by the Commissioner of Social
				Security to receive benefits for or on behalf of a resident pursuant to
				42 U.S.C. §
												1007.
y. "Resident" means an individual admitted
				for care in a nursing home, and, for purposes of these rules, includes, except
				as limited by context, any legal representative or next of kin acting on behalf
				of the resident according to law.
z. "Special Care Unit" means a unit located
				in an identified distinct part of a nursing home and provides an intensity of
				specialized services that is not routinely available in the rest of the
				facility.
aa. "Surrogate" means an
				interested individual who provides or withholds, pursuant to 18 V.S.A. Chapter
				231, subchapter 2, informed consent for a DNR/COLST.
bb. "Transfer" means movement of a resident
				to another bed within the same nursing home or transfer to another health care
				setting with return anticipated.
cc. "Vermont Nurse Aide Registry" means the
				registry established and maintained by the Vermont State Board of Nursing
				containing the names of and other information about all persons who have
				successfully completed a competency evaluation or who have been otherwise
				deemed competent as a nurse assistant by the Vermont State Board of
				Nursing.