Tennessee nursing home responsiveness requirements

Residents have the right to be free from mental and physical abuse; if that right is violated the facility must notify the state agency within five working days and must notify DHS Adult Protective Services immediately.

To be free from mental and physical abuse. Should this right be violated, the facility must notify the department within five (5) working days. The Tennessee Department of Human Services, Adult Protective Services shall be notified immediately as required in T.C.A. § 71-6-103;

Incidents of abuse, neglect, and misappropriation must be reported to the state in accordance with Tenn. Code Ann. § 68-11-211 — a statute that expressly excepts facilities already required to report under 42 CFR 483.13 (redesignated 483.12 in 2016). Medicare/Medicaid-certified nursing homes therefore discharge this duty through the federal report rather than a separate state filing; a facility outside that exception reports to the Health Facilities Commission within seven business days of identifying the incident.

The nursing home shall report all incidents of abuse, neglect, and misappropriation to the Department of Health in accordance with T.C.A. § 68-11-211.

The nursing home's Medical Director must ensure emergency and medical care is delivered whenever a resident's attending physician or that physician's designated alternate cannot be reached.

Ensure the delivery of emergency and medical care when the resident's attending physician or his/her designated alternate is unavailable;

Every nursing home must provide 24-hour nursing service furnished or supervised by an RN, with an LPN or RN on duty at all times and at least two nursing personnel on duty every shift.

Each nursing home must have an organized nursing service that provides twenty-four (24) hour nursing services furnished or supervised by a registered nurse. Each home shall have a licensed practical nurse or registered nurse on duty at all times and at least two (2) nursing personnel on duty each shift.

Staffing must be sufficient to deliver at least two hours of direct care per resident per day, including 0.4 hours of licensed nursing time, with a licensed nurse available for bedside care of any resident when needed.

Nursing homes shall provide a minimum of two (2) hours of direct care to each resident every day including 0.4 hours of licensed nursing personnel time. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the availability of a licensed nurse for bedside care of any resident.

Residents have an enumerated right to talk with and meet anyone in private.

To privately talk and/or meet with and see anyone;

Telephones must be readily accessible to residents, with at least one equipped with sound amplification and reachable from a wheelchair.

Telephones shall be readily accessible and at least one (1) shall be equipped with sound amplification and shall be accessible to wheelchair residents.

The internal emergency plan, including the specific emergency telephone numbers for each disaster type, must be available to all staff and a copy kept readily available at all times at the telephone operator's position or security center.

Copies of the plan(s), either complete or outlines, including specific emergency telephone numbers related to that type of disaster, shall be available to all staff. A copy shall be readily available at all times in the telephone operator's position or at the security center.

The external/community disaster plan, likewise including the disaster-specific emergency telephone numbers, must be available to any staff who would be assigned non-routine duties during such an emergency.

Copies of the plan(s), either complete or outlines, including specific emergency telephone numbers related to that type of disaster, shall be available to staff who would be assigned non-routine duties during these types of emergencies.

Tennessee has NO standalone nurse-call rule; the resident call system requirement reaches nursing homes only because this building-standards rule incorporates the FGI Guidelines for Design and Construction of Health Care Facilities (which contain the nurse call station standards) by reference, with the most stringent applicable requirement controlling.

All facilities shall conform to the current edition of the following applicable codes as approved by the Board for Licensing Health Care Facilities: International Building Code (excluding Chapters 1 and 11) ... National Fire Protection Association (NFPA) NFPA 101 Life Safety Code excluding referenced NFPA 5000; Guidelines for Design and Construction of Health Care Facilities (FGI) including referenced Codes and Standards; U.S. Public Health Service Food Code; and Americans with Disabilities Act (ADA) Standards for Accessible Design.

Tennessee does have a QAPI analog. Every nursing home must maintain an effective, facility-wide performance improvement program that evaluates both resident care and the performance of the organization.

The nursing home must ensure that there is an effective, facility-wide performance improvement program to evaluate resident care and performance of the organization.

The performance improvement program must be ongoing and run off a written plan of implementation, and that plan must reach all resident-care services including contracted services, nosocomial infections and medication therapy, the appropriateness of diagnosis and treatment, and a system for measuring improvement in hand hygiene and influenza vaccination.

The performance improvement program must be ongoing and have a written plan of implementation which assures that: 1. All organized services related to resident care, including services furnished by a contractor, are evaluated; 2. Nosocomial infections and medication therapy are evaluated; 3. All services performed in the facility are evaluated as to the appropriateness of diagnosis and treatment; and 4. The facility shall develop and implement a system for measuring improvements in adherence to the hand hygiene program and influenza vaccination program.

Finding a deficiency is not enough: the facility must develop and implement plans for improvement to address deficiencies the performance improvement program identifies, and must document the outcome of the remedial action.

The facility must develop and implement plans for improvement to address deficiencies identified by the performance improvement program and must document the outcome of the remedial action.

Performance improvement program records are shielded from disclosure, with one exception — they must be produced where disclosure is needed to demonstrate compliance with the performance improvement rule itself. The companion subsection (f) adds that good faith attempts by the performance improvement committee to identify and correct deficiencies will not be used as a basis for sanctions.

Performance improvement program records are not disclosable, except when such disclosure is required to demonstrate compliance with this section.