Kentucky nursing home responsiveness requirements

Any person — expressly including nurses, physicians, and care-facility employees and caretakers — who has reasonable cause to suspect that an adult has been abused, neglected, or exploited must report immediately to the Cabinet for Health and Family Services, and the licensed facility must maintain written policies assuring that such reports are made and that every allegation is thoroughly investigated internally while the investigation is pending.

Any person, including but not limited to physician, law enforcement officer, nurse, social worker, cabinet personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with the provisions of this chapter. ... An oral or written report shall be made immediately to the cabinet upon knowledge of suspected abuse, neglect, or exploitation of an adult.

Kentucky does not write its own substantive operating rules for licensed nursing facilities — the licensure regulation is a single section that requires a nursing facility to comply with all of 42 C.F.R. 483.1-483.95, so the entire federal Requirements for Participation (including 483.12 abuse/neglect, 483.30, 483.35, 483.73 emergency preparedness, and 483.75 QAPI) applies as a matter of Kentucky licensure law.

A nursing facility licensed under this administrative regulation shall comply with federal, state, and local laws and regulations pertaining to the operation of the facility, including compliance with the laws and regulations specified in this subsection. (a) A nursing facility shall comply with the requirements of 42 C.F.R. 483.1-483.95.

A nursing home must have a standing arrangement with one or more physicians to furnish necessary medical care in an emergency when the resident's own physician is not immediately available, must post an on-call schedule with physician names and telephone numbers at each nursing station, and must have written emergency procedures covering immediate care, who to notify, and what reports to prepare.

The facility shall have an arrangement with one (1) or more physicians who shall be available to furnish necessary medical care in case of an emergency if the physician responsible for the care of the resident is not immediately available. 2. A schedule listing the names and telephone numbers of physicians and the specific days each is on call shall be posted in each nursing station.

A nursing home must provide 24-hour nursing services with enough personnel on duty at all times to meet residents' total needs, must have at least one RN or LPN on duty at all times responsible for resident nursing care, and — the closest Kentucky analog to a duty to be reachable by telephone — must have a registered nurse on call whenever only a licensed practical nurse is on duty.

There shall be twenty-four (24) hour nursing services with a sufficient number of nursing personnel on duty at all times to meet the total needs of residents. ... There shall be at least one (1) registered nurse or licensed practical nurse on duty at all times who shall be responsible for the nursing care of residents. 2. If a licensed practical nurse is on duty, a registered nurse shall be on call.

Every resident of a Kentucky long-term-care facility has a statutory right of access to a telephone at a convenient location within the facility for making and receiving calls, a right to associate and communicate privately with persons of their choice and to send and receive unopened personal mail, and a right to have their responsible party notified immediately of any accident, sudden illness, disease, unexplained absence, or anything unusual involving the resident.

(21) Residents shall have access to a telephone at a convenient location within the facility for making and receiving telephone calls. ... (11) Residents may associate and communicate privately with persons of their choice and send and receive personal mail unopened. ... (22) The resident's responsible party or family member or his guardian shall be notified immediately of any accident, sudden illness, disease, unexplained absence, or anything unusual involving the resident.

Kentucky has no free-standing emergency preparedness regulation for nursing homes, but 902 KAR 20:048 carries a thin state-written analog to the federal communication-plan and emergency-contact-list duty: the facility must have established emergency procedures that specify who is to be notified and what reports are to be prepared; every employee must receive orientation and annual in-service training on emergency and disaster procedures, documented in the employee record; and each resident's medical record must carry the current name and telephone number of the resident's physician or practitioner and the name, address and telephone number of the responsible family member, guardian or other responsible person. Read with § 3(1)(d)2 (a schedule of physician names and telephone numbers posted at each nursing station), these are the only Kentucky-drafted contact-list requirements. They are materially narrower than 42 C.F.R. 483.73 -- there is no state requirement for a written emergency preparedness plan, a risk assessment, an all-hazards approach, or contact lists for federal, state, tribal, regional or local emergency management agencies.

There shall be established procedures for emergency situations that: a. Address immediate care of the resident; b. Persons to be notified; and c. Reports to be prepared. ... Documentation of orientation and in-service training shall be maintained in the employee's record and shall include: ... c. Emergency and disaster procedures ... Each record shall include: 1. Identification information, including: ... e. Name and telephone number of the resident's physician or health care practitioner; f. Name, address, and telephone number of the resident's responsible family member, guardian, or other responsible person;

A nurse call station must be installed at every resident bed and in every resident toilet, bath, and shower room; the calls placed from toilet, bath, and shower rooms must be emergency calls; every call must register at the nurses' station and light a visible signal in the corridor at the resident's door and in the clean workroom, soiled workroom, and nourishment station; and the nurse call system must be tied to the facility's emergency generator, which must carry it within ten seconds of a normal power failure.

A nurses' calling station shall be installed at each patient bed and in each patient toilet, bath, and shower room. The nurses' call in toilet, bath, or shower rooms, shall be an emergency call. All calls shall register at the nurses' station and shall actuate a visible signal in the corridor at the patients' door, in the clean workroom, soiled workroom, and nourishment station of the nursing unit. Nurses' call systems which provide two (2) way voice communications shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operative.

Kentucky has a free-standing statutory QAPI analog. Every health care facility licensed under KRS Chapter 216B -- which includes nursing homes (902 KAR 20:048) and nursing facilities (902 KAR 20:300), and expressly excludes only personal care homes, family care homes and boarding homes -- must develop comprehensive quality assurance or improvement standards that include an ongoing written internal QA/QI program, written guidelines for quality care studies and monitoring, performance and clinical outcomes-based criteria, written remedial-action procedures, a data gathering and assessment plan, a peer review process, and a summary of process outcomes and follow-up actions. The standards must be made available to the public on request during business hours. The statute's closing sentence lets a facility satisfy it with the federal QAPI rules that already apply to nursing facilities, so 42 C.F.R. 483.75 compliance suffices -- but the state duty exists independently and binds nursing homes that are not federally certified.

All health care facilities and services licensed under this chapter, with the exception of personal care homes, family care homes, and boarding homes, shall develop comprehensive quality assurance or improvement standards adequate to identify, evaluate, and remedy problems related to the quality of health care facilities and services. These standards shall be made available upon request to the public during regular business hours and shall include: (a) An ongoing written internal quality assurance or improvement program; (b) Specific, written guidelines for quality care studies and monitoring; (c) Performance and clinical outcomes-based criteria; (d) Procedures for remedial action to correct quality problems, including written procedures for taking appropriate corrective action; (e) A plan for data gathering and assessment; (f) A peer review process; and (g) A summary of process outcomes and follow-up actions related to the overall quality improvement program for the health care facility or service. Current federal or state regulations which address quality assurance and quality improvement requirements for nursing facilities, intermediate care facilities, and skilled care facilities shall suffice for compliance with the standards in this section.