[Code of Federal Regulations]
[Title 38, Volume 2]
[Revised as of July 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR51.90]

[Page 828-829]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
          CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS (CONTINUED)
 
PART 51--PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES--Table 
of Contents
 
                          Subpart D--Standards
 
Sec. 51.90  Resident behavior and facility practices.

    (a) Restraints. (1) The resident has a right to be free from any 
chemical or physical restraints imposed for purposes of discipline or 
convenience. When a restraint is applied or used, the purpose of the 
restraint is reviewed and is justified as a therapeutic intervention.
    (i) Chemical restraint is the inappropriate use of a sedating 
psychotropic drug to manage or control behavior.
    (ii) Physical restraint is any method of physically restricting a 
person's freedom of movement, physical activity or normal access to his 
or her body. Bed rails and vest restraints are examples of physical 
restraints.
    (2) The facility management uses a system to achieve a restraint-
free environment.
    (3) The facility management collects data about the use of 
restraints.
    (4) When alternatives to the use of restraint are ineffective, a 
restraint must be safely and appropriately used.

[[Page 829]]

    (b) Abuse. The resident has the right to be free from mental, 
physical, sexual, and verbal abuse or neglect, corporal punishment, and 
involuntary seclusion.
    (1) Mental abuse includes humiliation, harassment, and threats of 
punishment or deprivation.
    (2) Physical abuse includes hitting, slapping, pinching, or kicking. 
Also includes controlling behavior through corporal punishment.
    (3) Sexual abuse includes sexual harassment, sexual coercion, and 
sexual assault.
    (4) Neglect is any impaired quality of life for an individual 
because of the absence of minimal services or resources to meet basic 
needs. Includes withholding or inadequately providing food and hydration 
(without physician, resident, or surrogate approval), clothing, medical 
care, and good hygiene. May also include placing the individual in 
unsafe or unsupervised conditions.
    (5) Involuntary seclusion is a resident's separation from other 
residents or from the resident's room against his or her will or the 
will of his or her legal representative.
    (c) Staff treatment of residents. The facility management must 
develop and implement written policies and procedures that prohibit 
mistreatment, neglect, and abuse of residents and misappropriation of 
resident property.
    (1) The facility management must:
    (i) Not employ individuals who--
    (A) Have been found guilty of abusing, neglecting, or mistreating 
individuals by a court of law; or
    (B) Have had a finding entered into an applicable State registry or 
with the applicable licensing authority concerning abuse, neglect, 
mistreatment of individuals or misappropriation of their property; and
    (ii) Report any knowledge it has of actions by a court of law 
against an employee, which would indicate unfitness for service as a 
nurse aide or other facility staff to the State nurse aide registry or 
licensing authorities.
    (2) The facility management must ensure that all alleged violations 
involving mistreatment, neglect, or abuse, including injuries of unknown 
source, and misappropriation of resident property are reported 
immediately to the administrator of the facility and to other officials 
in accordance with State law through established procedures.
    (3) The facility management must have evidence that all alleged 
violations are thoroughly investigated, and must prevent further 
potential abuse while the investigation is in progress.
    (4) The results of all investigations must be reported to the 
administrator or the designated representative and to other officials in 
accordance with State law within 5 working days of the incident, and 
appropriate corrective action must be taken if the alleged violation is 
verified.

(Authority: 38 U.S.C. 101, 501, 1710, 1741-1743)