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4658.0525 REHABILITATION NURSING CARE.

Subpart 1.

Program required.

A nursing home must have an active program of rehabilitation nursing care directed toward assisting each resident to achieve and maintain the highest practicable physical, mental, and psychosocial well-being according to the comprehensive resident assessment and plan of care described in parts 4658.0400 and 4658.0405. Continuous efforts must be made to encourage ambulation and purposeful activities.

Subp. 2.

Range of motion.

A supportive program that is directed toward prevention of deformities through positioning and range of motion must be implemented and maintained. Based on the comprehensive resident assessment, the director of nursing services must coordinate the development of a nursing care plan which provides that:

A.

a resident who enters the nursing home without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and

B.

a resident with a limited range of motion receives appropriate treatment and services to increase range of motion and to prevent further decrease in range of motion.

Subp. 3.

Pressure sores.

Based on the comprehensive resident assessment, the director of nursing services must coordinate the development of a nursing care plan which provides that:

A.

a resident who enters the nursing home without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates, and a physician authenticates, that they were unavoidable; and

B.

a resident who has pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.

Subp. 4.

Positioning.

Residents must be positioned in good body alignment. The position of residents unable to change their own position must be changed at least every two hours, including periods of time after the resident has been put to bed for the night, unless the physician has documented that repositioning every two hours during this time period is unnecessary or the physician has ordered a different interval.

Subp. 5.

Incontinence.

A nursing home must have a continuous program of bowel and bladder management to reduce incontinence and the unnecessary use of catheters. Based on the comprehensive resident assessment, a nursing home must ensure that:

A.

a resident who enters a nursing home without an indwelling catheter is not catheterized unless the resident's clinical condition indicates that catheterization was necessary; and

B.

a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.

Subp. 6.

Activities of daily living.

Based on the comprehensive resident assessment, a nursing home must ensure that:

A.

a resident is given the appropriate treatments and services to maintain or improve abilities in activities of daily living unless deterioration is a normal or characteristic part of the resident's condition. For purposes of this part, activities of daily living includes the resident's ability to:

(1)

bathe, dress, and groom;

(2)

transfer and ambulate;

(3)

use the toilet;

(4)

eat; and

(5)

use speech, language, or other functional communication systems; and

B.

a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.

Subp. 7.

Nasogastric tubes, gastrostomy tubes, and feeding syringes.

Based on the comprehensive resident assessment, a nursing home must ensure that:

A.

a resident who has been able to eat enough independently or with assistance is not fed by nasogastric tube or feeding syringe unless the resident's clinical condition demonstrates that use of a nasogastric tube or feeding syringe was unavoidable; and

B.

a resident who is fed by a nasogastric or gastrostomy tube or feeding syringe receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal feeding function.

Subp. 8.

Prosthetic devices.

A nursing home must assist residents to adjust to their disabilities and to use their prosthetic devices.

Subp. 9.

Hydration.

Residents must be offered and receive adequate water and other fluids to maintain proper hydration and health, unless fluids are restricted.

Statutory Authority:

MS s 144A.04; 144A.08; 256B.431

History:

20 SR 303

Published Electronically:

October 11, 2007