[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR483.25]



[Page 533-535]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table of

Contents

 

          Subpart B_Requirements for Long Term Care Facilities

 

Sec.  483.25  Quality of care.



    Each resident must receive and the facility must provide the 

necessary care and services to attain or maintain the highest 

practicable physical, mental, and psychosocial well-being, in accordance 

with the comprehensive assessment and plan of care.

    (a) Activities of daily living. Based on the comprehensive 

assessment of a resident, the facility must ensure that--

    (1) A resident's abilities in activities of daily living do not 

diminish unless circumstances of the individual's clinical condition 

demonstrate that diminution was unavoidable. This includes the 

resident's ability to--

    (i) Bathe, dress, and groom;

    (ii) Transfer and ambulate;

    (iii) Toilet;

    (iv) Eat; and

    (v) Use speech, language, or other functional communication systems.

    (2) A resident is given the appropriate treatment and services to 

maintain or improve his or her abilities specified in paragraph (a)(1) 

of this section; and

    (3) 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.

    (b) Vision and hearing. To ensure that residents receive proper 

treatment and assistive devices to maintain vision and hearing 

abilities, the facility must, if necessary, assist the resident--

    (1) In making appointments, and

    (2) By arranging for transportation to and from the office of a 

practitioner specializing in the treatment of vision or hearing 

impairment or the office of a professional specializing in the provision 

of vision or hearing assistive devices.

    (c) Pressure sores. Based on the comprehensive assessment of a 

resident, the facility must ensure that--

    (1) A resident who enters the facility without pressure sores does 

not develop pressure sores unless the individual's clinical condition 

demonstrates that they were unavoidable; and

    (2) A resident having pressure sores receives necessary treatment 

and services to promote healing, prevent infection and prevent new sores 

from developing.

    (d) Urinary Incontinence. Based on the resident's comprehensive 

assessment, the facility must ensure that--

    (1) A resident who enters the facility without an indwelling 

catheter is not catheterized unless the resident's clinical condition 

demonstrates that catheterization was necessary; and



[[Page 534]]



    (2) 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.

    (e) Range of motion. Based on the comprehensive assessment of a 

resident, the facility must ensure that--

    (1) A resident who enters the facility 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

    (2) A resident with a limited range of motion receives appropriate 

treatment and services to increase range of motion and/or to prevent 

further decrease in range of motion.

    (f) Mental and Psychosocial functioning. Based on the comprehensive 

assessment of a resident, the facility must ensure that--

    (1) A resident who displays mental or psychosocial adjustment 

difficulty, receives appropriate treatment and services to correct the 

assessed problem, and

    (2) A resident whose assessment did not reveal a mental or 

psychosocial adjustment difficulty does not display a pattern of 

decreased social interaction and/or increased withdrawn, angry, or 

depressive behaviors, unless the resident's clinical condition 

demonstrates that such a pattern was unavoidable.

    (g) Naso-gastric tubes. Based on the comprehensive assessment of a 

resident, the facility must ensure that--

    (1) A resident who has been able to eat enough alone or with 

assistance is not fed by naso-gastric tube unless the resident's 

clinical condition demonstrates that use of a naso-gastric tube was 

unavoidable; and

    (2) A resident who is fed by a naso-gastric or gastrostomy tube 

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 eating 

skills.

    (h) Accidents. The facility must ensure that--

    (1) The resident environment remains as free of accident hazards as 

is possible; and

    (2) Each resident receives adequate supervision and assistance 

devices to prevent accidents.

    (i) Nutrition. Based on a resident's comprehensive assessment, the 

facility must ensure that a resident--

    (1) Maintains acceptable parameters of nutritional status, such as 

body weight and protein levels, unless the resident's clinical condition 

demonstrates that this is not possible; and

    (2) Receives a therapeutic diet when there is a nutritional problem.

    (j) Hydration. The facility must provide each resident with 

sufficient fluid intake to maintain proper hydration and health.

    (k) Special needs. The facility must ensure that residents receive 

proper treatment and care for the following special services:

    (1) Injections;

    (2) Parenteral and enteral fluids;

    (3) Colostomy, ureterostomy, or ileostomy care;

    (4) Tracheostomy care;

    (5) Tracheal suctioning;

    (6) Respiratory care;

    (7) Foot care; and

    (8) Prostheses.

    (l) Unnecessary drugs--(1) General. Each resident's drug regimen 

must be free from unnecessary drugs. An unnecessary drug is any drug 

when used:

    (i) In excessive dose (including duplicate drug therapy); or

    (ii) For excessive duration; or

    (iii) Without adequate monitoring; or

    (iv) Without adequate indications for its use; or

    (v) In the presence of adverse consequences which indicate the dose 

should be reduced or discontinued; or

    (vi) Any combinations of the reasons above.

    (2) Antipsychotic Drugs. Based on a comprehensive assessment of a 

resident, the facility must ensure that--

    (i) Residents who have not used antipsychotic drugs are not given 

these drugs unless antipsychotic drug therapy is necessary to treat a 

specific condition as diagnosed and documented in the clinical record; 

and

    (ii) Residents who use antipsychotic drugs receive gradual dose 

reductions, and behavioral interventions, unless clinically 

contraindicated, in an effort to discontinue these drugs.



[[Page 535]]



    (m) Medication Errors. The facility must ensure that--

    (1) It is free of medication error rates of five percent or greater; 

and

    (2) Residents are free of any significant medication errors.

    (n) Influenza and pneumococcal immunizations--(1) Influenza. The 

facility must develop policies and procedures that ensure that--

    (i) Before offering the influenza immunization, each resident or the 

resident's legal representative receives education regarding the 

benefits and potential side effects of the immunization;

    (ii) Each resident is offered an influenza immunization October 1 

through March 31 annually, unless the immunization is medically 

contraindicated or the resident has already been immunized during this 

time period;

    (iii) The resident or the resident's legal representative has the 

opportunity to refuse immunization; and

    (iv) The resident's medical record includes documentation that 

indicates, at a minimum, the following:

    (A) That the resident or resident's legal representative was 

provided education regarding the benefits and potential side effects of 

influenza immunization; and

    (B) That the resident either received the influenza immunization or 

did not receive the influenza immunization due to medical 

contraindications or refusal.

    (2) Pneumococcal disease. The facility must develop policies and 

procedures that ensure that--

    (i) Before offering the pneumococcal immunization, each resident or 

the resident's legal representative receives education regarding the 

benefits and potential side effects of the immunization;

    (ii) Each resident is offered a pneumococcal immunization, unless 

the immunization is medically contraindicated or the resident has 

already been immunized;

    (iii) The resident or the resident's legal representative has the 

opportunity to refuse immunization; and

    (iv) The resident's medical record includes documentation that 

indicates, at a minimum, the following:

    (A) That the resident or resident's legal representative was 

provided education regarding the benefits and potential side effects of 

pneumococcal immunization; and

    (B) That the resident either received the pneumococcal immunization 

or did not receive the pneumococcal immunization due to medical 

contraindication or refusal.

    (v) Exception. As an alternative, based on an assessment and 

practitioner recommendation, a second pneumococcal immunization may be 

given after 5 years following the first pneumococcal immunization, 

unless medically contraindicated or the resident or the resident's legal 

representative refuses the second immunization.



[56 FR 48873, Sept. 26, 1991, as amended at 57 FR 43925, Sept. 23, 1992; 

70 FR 58851, Oct. 7, 2005]