This regulation establishes operating standards for nursing facilities in Alaska — non-acute-care settings providing 24-hour nursing and related medical services. Operators must provide a defined array of clinical services (nursing, pharmacy, therapy, social work, dietary, etc.), maintain appropriate physician oversight and staffing ratios, implement resident assessment and care-planning processes, follow restraint and psychoactive-drug use protocols, and conduct monthly pharmacist drug-regimen reviews. Requirements apply regardless of Medicaid certification status.
View official source7 AAC 12.250. Scope. A facility that is not an acute care hospital and that provides nursing care and related medical services over a period of 24 hours each day to individuals admitted because of illness, disease, or physical infirmity is a nursing facility, and must comply with 7 AAC 12.250 - 7 AAC 12.290 . 7 AAC 12.255. Services required. A nursing facility must provide nursing, pharmaceutical, either physical or occupational therapy, social work services, therapeutic recreational activities, dietetic, central supply, laundry, housekeeping, laboratory and radiological services. 7 AAC 12.256. Admissions. The nursing facility must have written policies and procedures to ensure admissions of only those individuals whose needs can be met by the nursing facility directly or in cooperation with community resources. 7 AAC 12.258. Use of restraints or psychoactive drugs. (a) In addition to the rights of patients specified in 7 AAC 12.890 , residents of nursing facilities have the right to be free from physical restraints imposed or psychoactive drugs administered for purposes of discipline or convenience and that are not required to treat the resident's medical symptoms. (b) A resident's medical records must contain evidence of consultation with appropriate health professionals, such as occupational or physical therapists, in the use of less restrictive supportive devices before using physical restraints. The record must also contain evidence of an interdisciplinary team's identification of less restrictive approaches to be used before or in conjunction with the use of psychoactive drugs. (c) If, after a trial period of less restrictive measures, a nursing facility decides that a physical restraint or psychoactive drug would enable and promote greater functional or social independence, the nursing facility must explain the use of the restraint or psychoactive drug to the resident, before its use. If the resident has a legal representative, the explanation must also be given to the resident's legal representative, before its use. The explanation must include a description of the risks and benefits of the use of the restraint or drug. (d) Approval of the use of a restraint or psychoactive drug by a resident, or legal representative must precede its use, except in the case of a medical emergency in which there is a risk of harm to the resident or others. The approval, or the circumstances of the emergency, must be documented in the resident's medical records at the nursing facility. (e) A resident's medical records must contain evidence of an interdisciplinary team's periodic reassessment of the restraint or psychoactive drug to determine its effectiveness and appropriateness for continued use. (f) A nursing home must also meet the requirements at 42 C.F.R. 483.10, 483.12, 483.13, and 483.15, as amended July 1, 1991, regardless of whether the nursing home is certified to receive medicaid payments under 7 AAC 43.170 . 7 AAC 12.260. Medical director. A medical director who is employed by or is a consultant to the nursing facility shall (1) place a resident under the care of a physician; (2) ensure that the use of an investigational drug is properly supervised by a member of the medical staff, that an informed consent form provided by the sponsoring company or agency is used, and that complete records on the drug, including protocol and side effects, are maintained; and (3) supervise the infection control and employee health programs. 7 AAC 12.265. Physician services. (a) Physicians shall review, recap, and sign orders for nursing facility residents at least once every 60 days. (b) A physician shall visit nursing facility residents and make a notation in each resident's medical record of the resident's status every 30 days for the first 90 days, and after that, every 60 days. If the condition of a resident warrants more frequent visits, a physician shall visit a resident as often as necessary. (c) A nursing facility shall ensure that a physician personally approves a recommendation in writing that an individual be admitted. Each resident shall remain under the care of a physician and shall be provided care that is consistent with the plan of care, comprehensive assessment, and needs of the resident. (d) A nursing facility shall ensure that (1) the medical care of each resident is supervised by a physician who assumes the principal obligation and responsibility to manage the resident's medical condition and who agrees to visit the resident as often as necessary to address the resident's medical care needs; (2) another physician will supervise the medical care of the resident when the resident's attending physician is unavailable; and (3) the medical director is informed of the results of all department surveys related to medical service deficiencies and is involved in resolving such problems. (e) A nursing facility shall ensure that the responsible physician (1) participates as a member of the interdisciplinary care team in the development and review of the resident's comprehensive care plan, with the understanding that the minimum level of physician participation in interdisciplinary development and review of the care plan must be a person-to-person conference with the registered nurse who has principal responsibility for development and implementation of the resident's care plan; (2) reviews the resident's total program of care, including medications and treatments, at each regularly scheduled visit; (3) prepares, authenticates, and dates progress notes at each visit; (4) authenticates and dates all orders; and (5) provides for scheduled visits after the initial visit; the responsible physician may alternate between in-person visits and visits by a physician assistant or advanced practice registered nurse in accordance with (f) of this section. (f) A nursing facility may permit a physician to delegate tasks to a physician assistant who is acting within the scope of practice set out under AS 08.64 and 12 AAC 40 , or to an advanced practice registered nurse who is acting under the scope of practice set out under AS 08.68 and 12 AAC 44 . The nursing facility may not permit a physician to delegate a task if state or federal statutes or regulations prohibit the delegation, or if the nursing facility's own policies prohibit the delegation. 7 AAC 12.270. Staff duties. (a) The nursing facility staff shall encourage and assist residents to achieve and maintain their highest level of self-care and independence. A registered nurse, in conjunction with an interdisciplinary team, shall, within 14 days of admission of a resident, ensure completion of the comprehensive resident assessment instrument approved by the department. The assessment shall be reviewed by the nurse and interdisciplinary team no less frequently than quarterly and the plan of care revised as necessary. A reassessment shall be completed, by the nurse and interdisciplinary team, after any major permanent change in condition of the resident, but no less frequently than annually. (b) The nursing facility staff shall give residents the necessary care to prevent pressure ulcers, contractures, and deformities. (c) The nursing facility staff shall implement procedures to prevent and reduce incontinence of residents. These procedures must include (1) a written assessment by a registered nurse within two weeks after admission of an incontinent resident's ability to participate in a bowel or bladder training program; (2) an individualized bowel or bladder training plan for each resident, as appropriate; and (3) a monthly written summary of a resident's performance in the training program. (d) The nursing facility staff shall observe the hydration status of residents, and shall record deviations from the normal status and report the deviations to the charge nurse. 7 AAC 12.275. Nursing and medical services. (a) Except as otherwise specified in this section, a nursing facility must have a registered nurse on duty seven days a week on the day shift and five days a week on the evening shift. A licensed practical nurse must be on duty during all shifts when a registered nurse is not present. A nursing facility must have telephone access to at least one registered nurse at all times and must post the names and phone numbers of those registered nurses at each nurse's station. (b) A nursing facility with more than 60 occupied beds must have two registered nurses on duty during the day shift and one registered nurse on duty during other shifts. (c) A nursing facility that shares the same building as a hospital must have a registered nurse on duty in the nursing facility seven days a week on the day shift. On the evening and night shift, a licensed practical nurse may serve as charge nurse. However, an on-duty registered nurse from the hospital must be available to make rounds at the nursing facility and to be otherwise available as needed during the evening and night shifts when a licensed practical nurse is serving as charge nurse. A nursing facility with 14 or fewer occupied beds may use an on-duty registered nurse from the hospital to meet the night shift nursing requirement set out in this subsection. (d) A nursing facility must have a contract for diagnostic services with a laboratory and x-ray provider approved by the department. (e) A nursing facility must have a contract with a licensed dentist to provide consultation and necessary dental services to residents. (f) In addition to the requirements of this section, a governing body of a facility must provide resources and personnel as necessary to meet resident needs under 7 AAC 12.630 (b)(6). 7 AAC 12.280. Rehabilitation services. (a) A nursing facility must provide a program of rehabilitative nursing care that assists each resident to achieve and maintain an optimal level of self-care and independence, as an integral part of the nursing service. (b) A nursing facility must provide physical, occupational, or speech rehabilitative services for a resident on a full-time, part-time, or consultant basis in accordance with the needs of the resident. (c) A therapist shall evaluate a resident in accordance with a physician's order. The therapist shall then establish an appropriate treatment program in coordination with medical, nursing, and other rehabilitative personnel. (d) The therapist shall report on the resident's progress to the attending physician within two weeks after initiation of rehabilitative services. After that report, the therapist shall reevaluate and note in the resident's medical record the resident's status and treatment plan every 30 days in the case of a resident receiving active rehabilitation and at least every 90 days for other residents. 7 AAC 12.285. Activity program. A nursing facility must provide an activity program that is available to all residents and encourages each resident to attain and maintain function at the highest practicable level. The program must address the intellectual, social, spiritual, creative, cultural, and physical needs, capabilities, and interests of each resident. Also, the program must encourage self-determination and well-being of the residents. If a physician finds a resident as medically able to participate in an activity program, that finding and any conditions of the resident's participation or contra-indications to that participation must be noted in the resident's record at the nursing facility. The activity program coordinator, with an interdisciplinary team, shall develop the resident's individual activity program. The activity program coordinator shall consult as necessary with an occupational or recreational therapist, unless the activity program coordinator meets the requirements of 42 C.F.R. 483.15(f)(2), revised as of October 1, 1991. 7 AAC 12.290. Drug regimen review. (a) A pharmacist must review each resident's prescribed drug regimen once every 30 days, make recommendations, note the possibilities or absence of problems irregularities, or clinically significant results or consequences with the prescribed drug regimen, and report potential problems and concerns to the physician and the director of nursing. Reports of potential problems and concerns shall be acted upon promptly. The nursing facility shall provide for more frequent drug regimen reviews by a pharmacist, if a resident's condition requires them. (b) A potential problem or concern reported under (a) of this section shall be reviewed in accordance with the risk management program under 7 AAC 12.860 .