216 R.I. Code R. 216-RICR-40-10-1.3 - Definitions

A. Wherever used in this Part the following terms shall be construed as follows:

1. "Abuse" means any assault as defined in R.I. Gen. Laws Chapter 11-5, including, but not limited to hitting, kicking, pinching, slapping or the pulling of hair, provided however, unless such is required as an element of offense, it shall not be necessary to prove that the patient or resident was injured thereby, or any assault as defined in R.I. Gen. Laws Chapter 11-37, or any offense under R.I. Gen. Laws Chapter 11-10; or

a. Conduct which harms or is likely to physically harm the resident except where the conduct is a part of the care and treatment, and in furtherance of the health and safety of the resident; or

b. Engaging in a pattern of harassing conduct which causes or is likely to cause emotional or psychological harm to the resident, including but not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient.

2. "Advanced practice registered nurse" or "APRN" means an individual licensed to practice advanced practice registered nursing within one of the following roles: certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA) as defined in R.I. Gen. Laws Chapter 5-34.2, or certified clinical nurse specialist (CNS), and who functions in a population focus. An APRN may serve as a primary-or acute-care provider of record and is licensed in accordance with R.I. Gen. Laws Chapter 5-34.

3. "Alzheimer dementia special care unit or program" means a distinct living environment within a nursing facility that has been physically adapted to accommodate the particular needs and behaviors of those with dementia. Such unit provides increased staffing, therapeutic activities designed specifically for those with dementia and trains its staff on an ongoing basis on the effective management of the physical and behavioral problems of those with dementia. The residents of such a unit/program have had a standard medical diagnostic evaluation and have been determined to have a diagnosis of Alzheimer dementia or another dementia.

4. "The licensed bed capacity" means the maximum number of beds a nursing facility is licensed to operate and that may be accommodated within a facility according to the dimensional limitations of §1.19.7 of this Part.

5. "Census" means a point in time count of all residents physically present in a nursing facility and/or not officially discharged from the nursing facility.

6. "Change in operator" means a transfer by the Licensee or the governing body of a licensed nursing facility to any other person (excluding delegations of authority to the medical or administrative staff of the facility) of the Licensee/governing body's responsibility to:

a. Hire or fire the chief executive officer of the nursing facility;

b. Maintain and control the books and records of the nursing facility;

c. Dispose of assets and incur liabilities on behalf of the nursing facility; or

d. Adopt and enforce policies regarding operation of the nursing facility.

e. Comply with State and Federal safety regulations including, specifically, those set forth under § 1.2 of this Part.

7. "Change in owner" of licensed facility applies to both owners and operators and means:

a. In the case of a nursing facility which is a partnership, the removal, addition or substitution of a partner which results in a new partner acquiring a controlling interest in such partnership;

b. In the case of a nursing facility which is an unincorporated solo proprietorship, the transfer of the title and property to another person;

c. In the case of a nursing facility which is a corporation;

(1) A sale, lease, exchange or other disposition of all, or substantially all of the property and assets of the corporation; or

(2) A merger of the corporation into another corporation; or

(3) The consolidation of two or more corporations, resulting in the creation of a new corporation; or

(4) In the case of a nursing facility which is a business corporation, any transfer of corporate stock which results in a new person acquiring a controlling interest in such corporation; or

(5) In the case of a nursing facility which is a non-business corporation, any change in membership which results in a new person acquiring a controlling vote in such corporation.

8. "Consistent assignment" means the same direct care nursing staff, universal workers, and/or self-directed work teams, consistently caring for the same resident(s) the majority of their shifts whenever they are on duty.

9. "Controlling person" means any person in control of a nursing facility directly or indirectly, including all of the following:

a. In the case of a nursing facility which is a limited liability company, or limited liability partnership, a person having a beneficial ownership interest of five percent (5%) or more in the corporation, limited liability company or limited liability partnership to which the nursing facility is licensed;

b. In the case of a nursing facility which is a general partnership or limited partnership, any general partner;

c. In the case of a nursing facility which is a limited liability company, or limited liability partnership any member;

d. A person that operates or contracts with another person for the operation of a nursing facility;

e. Each of the president, vice president, secretary and treasurer of a corporation that is not exempt from taxation under §501(a) of the United States Internal Revenue Code (26 U.S.C. § 501(a)) as an organization described in §501(c)(3) of such code; and

f. Such other ownership interest or relationship as may be determined by the Director.

10. "Credentialing" means the administrative process for reviewing, verifying, and evaluating the qualifications and credentials of licensed physicians, physician assistants and advanced practice registered nurses in accordance with criteria established by the nursing facility for the purpose of granting clinical privileges at the nursing facility.

11. "Declaration of disaster emergency" means a disaster emergency declared by the Governor pursuant to R.I. Gen. Laws § 30-15-9.

12. "Department" means the Rhode Island Department of Health.

13. "Direct care nursing staff" means registered nurses, licensed practical nurses, certified nursing assistants, medication technicians, licensed physical therapists, licensed occupational therapists, licensed speech language pathologists, and physical therapy assistants who are assigned to provide direct nursing care to residents.

14. "Direct caregiver" means a person who receives monetary compensation as an employee of the nursing facility or a subcontractor as a registered nurse, a licensed practical nurse, a medication technician, a certified nursing assistant, a licensed physical therapist, a licensed occupational therapist, a licensed speech-language pathologist, or a physical therapist assistant.

15. "Director" means the Director of the Rhode Island Department of Health.

16. "Drug administration" means an act in which a single dose of a prescribed drug or biological is given to a resident by an authorized person in accordance with this Part.

17. "Employee" means an individual employed, whether directly, by the contract with another entity or as an independent contractor, by a long-term care nursing facility on a part-time or full-time basis.

18. "Equity" means non-debt funds contributed towards the capital costs related to the initial establishment and licensure of a nursing facility or a change in owner or change in operator of a nursing facility which funds are free and clear of any repayment or liens against the assets of the proposed owner and/or licensee and that result in a like reduction in the portion of the capital cost that is required to be financed or mortgaged.

19. "Essential caregiver" means an individual, whether a family member or friend of a resident of a nursing home or long-term care facility, who is designated by the resident or appointed by an individual with decision-making authority for the resident to provide physical or emotional support to the resident during a declaration of disaster emergency.

20. "Family council" means an organized group of the family members, friends, or representatives of nursing facility residents who may meet in private without the presence of nursing facility staff.

21. "Health care facility" means a facility as defined in R.I. Gen. Laws § 23-17-2.

22. "Health care provider" means any person licensed in Rhode Island to provide or otherwise lawfully providing health care services, including, but not limited to, a physician, hospital, intermediate care facility or other health care facility, dentist, nurse, optometrist, podiatrist, physical therapist, psychiatric social worker, pharmacist, or psychologist, and any officer, employee or agent of that provider acting in the course and scope of his or her employment or agency related to or supportive of health services.

23. "High managerial agent" means an officer of a nursing facility, the administrator and assistant administrator of the nursing facility, the director and assistant director of nursing services, or any other agent in a position of comparable authority with respect to the formulation of policies of the nursing facility or the supervision in a managerial capacity of subordinate employees.

24. "Hours of direct nursing care" means the actual hours of work performed per patient day by a direct caregiver.

25. "Immediate jeopardy" means a situation in which the nursing facility's noncompliance or alleged noncompliance with one (1) or more state or federal requirements or conditions has caused, or is likely to cause, serious injury, harm, impairment or death to a resident; or shall be defined in accordance with 42 C.F.R. Part 489 or any subsequent applicable federal regulations.

26. "Lessee" means the person that leases the real property of a nursing facility from its owner. The term "lessee" includes any sublessees of the lessee.

27. "Licensee" means the holder of a nursing facility license issued by the Department.

28. "Licensing agency" means the Rhode Island Department of Health.

29. "Lift team" means health care nursing facility employees specially trained to perform patient lifts, transfers, and repositioning in accordance with a safe patient handling policy.

30. "Long-term care facility or facility" means a health care facility as defined in R.I. Gen. Laws Chapter 23-17, which provides long term health care.

31. "Management company" means a company that provides limited, defined administrative services for a nursing facility owner, operator or lessee. A management company may not discharge functions that are reserved to the operator/licensee/governing body. The nursing facility owner, operator or lessee that engages a management company remains responsible for the services provided by the management company.

32. "Medication technician or aide" means a nursing assistant who has satisfactorily completed a Rhode Island-approved course in drug administration and who may administer oral or topical drugs (with the exception of Schedule II drugs) in accordance with the requirements of §1.16.10(A) of this Part.

33. "Mistreatment" means the inappropriate use of medications, isolation, or use of physical or chemical restraints as punishment, for staff convenience, as a substitute for treatment or care, in conflict with a physician's order, or in quantities that inhibit effective care or treatment, which harms or is likely to harm the patient or resident.

34. "Musculoskeletal disorders" means conditions that involve the nerves, tendons, muscles, and supporting structures of the body.

35. "Naloxone" or "Narcan" means a particular drug which is a competitive antagonist that binds to the opioid receptors with higher affinity than agonists but does not activate the receptors, effectively blocking the receptor, preventing the human body from making use of opiates and endorphins.

36. "Neglect" means the intentional failure to provide treatment, care, goods and services necessary to maintain the health and safety of the patient or resident, or the intentional failure to carry out a plan of treatment or care prescribed by the physician of the patient or resident, or the intentional failure to report patient or resident health problems or changes in health conditions to an immediate supervisor or nurse, or the intentional lack of attention to the physical needs of a patient or resident including, but not limited to toileting, bathing, meals and safety. Provided, however, no person shall be considered to be neglected for the sole reason that he or she relies on or is being furnished treatment in accordance with the tenets and teachings of a well-recognized church or denomination by a duly accredited practitioner thereof.

37. "Net operating revenue" means net patient revenue plus other operating revenue.

38. "Nourishing snack" means a verbal offering of, or unrestricted access to, items, single or in combination, from the basic food groups.

39. "Nursing facility" means a licensed health care facility, building, or portion thereof or an identifiable unit or distinct part thereof, however named, that provides twenty-four (24) hour inpatient and residential nursing, therapeutic, restorative or preventive and supportive nursing care services for two (2) or more residents unrelated by blood or marriage whose assessed health condition requires continuous nursing care and supervision. Resident services shall be based on person-centered principles, however named, that enhance a resident's quality of life by ensuring the nexus of control in the living environment is resident-directed, puts the emphasis on resident autonomy and individual choices, facilitates communication and mutual respect among the residents and staff, and meets the requirements herein.

40. "Nursing assistant" means a nursing, orderly, or home health aide who is a paraprofessional trained to give personal care and related health care and assistance based on his or her level of preparation to individuals who are sick, disabled, dependent, or infirmed pursuant to the provisions of R.I. Gen. Laws § 23-17.9-2.

41. "Nursing service" means a service organized, staffed and equipped to provide nursing care to residents on a continuous basis.

42. "Occupational therapist" means a person licensed to practice occupational therapy in this State, pursuant to the provisions of R.I. Gen. Laws Chapter 5-40.1.

43. "Operator" shall have the same meaning as contained in R.I. Gen. Laws § 23-17-65. Operator responsibilities, such as day-to-day operation of the nursing facility, including employment and supervision of the nursing facility staff, adoption and enforcement of nursing facility policies, disposition of assets and incurring of liabilities on behalf of the nursing facility, controlling the books and records of the nursing facility, conducting repairs, replacements or improvements to the physical plant of the nursing facility, and accounting for the personal needs funds of the residents of the nursing facility, are nondelegable.

44. "Owner" of a nursing facility means the person that owns the real property of the nursing facility. An owner remains responsible for compliance with § 1.19 of this Part.

45. "Person" means any individual, trust or estate, partnership, corporation (including associations, joint stock companies), limited liability company, State or political subdivision or instrumentality of a state.

46. "Person-centered care" means a holistic model that takes into consideration each resident's physical, mental, and social needs in the development of a care and treatment plan and the delivery of services that is driven to the greatest extent possible by resident choice.

47. "Physical therapist" means a person licensed to practice physical therapy in this state, pursuant to the provisions of R.I. Gen. Laws Chapter 5-40.

48. "Physical therapist assistant" means a person licensed in this state to assist in the practice of physical therapy under the supervision of a physical therapist, pursuant to the provisions of R.I. Gen. Laws Chapter 5-40.

49. "Physician" means a person licensed to practice allopathic or osteopathic medicine in this State, pursuant to the provisions of R.I. Gen. Laws Chapter 5-37.

50. "Physician assistant" or "PA" means a person who is qualified by academic and practical training to provide medical and surgical services in collaboration with physicians and pursuant to the provisions of R.I. Gen. Laws Chapter 5-54.

51. "Resident" means a person who resides in a long-term care facility as defined i n R.I. Gen. Laws Chapter 23-17.

52. "Resident attendant" means an individual who is trained to assist residents in a nursing facility with the activities of eating and drinking. A resident attendant shall not include an individual who:

a. Is a licensed health professional, including but not limited to a nursing assistant, registered dietitian; or

b. Volunteers without monetary compensation as authorized by the resident, or the resident's appropriate legal representative.

53. "Residential area" means a distinct living environment within a nursing facility that includes no more than sixty (60) beds.

54. "Resident-directed" means a resident, the resident's family members, and appointed guardians participating in the decision and determination processes that directly impact the personal and collective preferences of the residents and that involve the day to day activities and the operation of the nursing facility or resident-directed home.

55. "Resident-directed home" means the expansion of the bed capacity of a nursing facility pursuant to R.I. Gen. Laws § 23-17-44(e) that includes programs and physical structures that adhere to "Eden Alternative^TM", "Green House^TM", "Small House", or any other resident-directed operational model. Primary characteristics of the model as a condition of license require a decentralization of operational systems in support of resident-directed and person-centered care policies and procedures, self-directed work teams, consistent assignment for direct care givers, and an environment that is non-institutional by design and facilitates resident-directed activities.

56. "Safe patient handling" means the use of engineering controls, transfer aids, or assistive devices whenever feasible and appropriate instead of manual lifting to perform the acts of lifting, transferring, and/or repositioning health care patients and residents.

57. "Safe patient handling policy" means protocols established to implement safe patient handling.

58. "Self-directed work team" means small, organized groups of nursing facility workers who have day-to-day responsibility for managing themselves and their work.

59. "Speech-language pathologist" means a person licensed to practice speech-language pathology in this state, pursuant to the provisions of R.I. Gen. Laws Chapter 5-48.

60. "Standing orders" means orders to be automatically implemented for a class of patients without physician direction for an individual patient within the class.

61. "Substantial evening meal" means an offering of three (3) or more menu items at one time, one (1) of which includes a high-quality protein such as meat, fish, eggs, or cheese. The meal should represent no less than twenty percent (20%) of the day's total nutritional requirements.

62. "This Part" means all parts of the Rhode Island Rules and Regulations for Licensing of Nursing Facilities (216-RICR-40-10-1).

63. "Turnover rate" means the total number of terminations in a given calendar year divided by the average number of personnel employed for the same calendar year and multiplied by one hundred (100) (for the percentage).

64. "Universal worker" means a direct care nursing staff, who is qualified as outlined in §1.14.6 of this Part, and through consistent assignment with residents may perform assistance with dietary, laundry, housekeeping activities, and other related services directly related to meeting the needs of that resident.

Notes

216 R.I. Code R. 216-RICR-40-10-1.3

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 10/2/2023, exp. 1/30/2024(Emergency)
Amended effective 3/7/2024