| (a) Safety Management. A hospice inpatient unit must
maintain a safe physical environment free of hazards for clients,
staff, and visitors.
(1) A hospice inpatient unit must address real or potential
threats to the health and safety of the clients, others, and property.
(2) In addition to §558.256 of this chapter (relating
to Emergency Preparedness Planning and Implementation), a hospice
inpatient unit must have a written disaster preparedness plan that
addresses the core functions of emergency management as described
in subparagraphs (A) - (G) of this paragraph. The facility must maintain
documentation of compliance with this paragraph.
(A) The portion of the plan on direction and control
must:
(i) designate a person by position, and at least one
alternate, to be in charge during implementation of an emergency response
plan, with authority to execute a plan to evacuate or shelter in place;
(ii) include procedures the facility will use to maintain
continuous leadership and authority in key positions;
(iii) include procedures the facility will use to activate
a timely response plan based on the types of disasters identified
in the risk assessment;
(iv) include procedures the facility will use to meet
staffing requirements;
(v) include procedures the facility will use to warn
or notify facility staff about internal and external disasters, including
during off hours, weekends, and holidays;
(vi) include procedures the facility will use to maintain
a current list of who the hospice will notify once warning of a disaster
is received;
(vii) include procedures the facility will use to alert
critical facility personnel once a disaster is identified; and
(viii) include procedures the facility will use to
maintain a current 24-hour contact list for all personnel.
(B) The portion of the plan on communication must include
procedures:
(i) for continued communication, including procedures
during an evacuation to maintain contact with critical personnel and
with all vehicles traveling in an evacuation caravan;
(ii) to maintain an accessible, current list of the
phone numbers of:
(I) client family members;
(II) local shelters;
(III) prearranged receiving facilities;
(IV) the local emergency management agencies;
(V) other health care providers; and
(VI) State and federal emergency management agencies;
(iii) to notify staff, clients, families of clients,
families of critical staff, prearranged receiving facilities, and
others of an evacuation or the plan to shelter in place;
(iv) to provide a contact number for out-of-town family
members to call for information; and
(v) to relocate and track clients during disasters
that require mass evacuations.
(C) The portion of the plan on resource management
must include procedures:
(i) to maintain contracts and agreements with vendors
as needed to ensure the availability of the supplies and transportation
needed to execute the plan to shelter in place or evacuate;
(ii) to develop accurate, detailed, and current checklists
of essential supplies, staff, equipment, and medications;
(iii) to designate responsibility for completing the
checklists during disaster operations;
(iv) for the safe and secure transportation of adequate
amounts of food, water, medications, and critical supplies and equipment
during an evacuation; and
(v) to maintain a supply of sufficient resources for
at least seven days to shelter in place, which must include:
(I) emergency power, including backup generators and
accounts for maintaining a supply of fuel;
(II) potable water in an amount based on population
and location;
(III) the types and amounts of food for the number
and types of clients served;
(IV) extra pharmacy stocks of common medications; and
(V) extra medical supplies and equipment, such as oxygen,
linens, and any other vital equipment.
(D) The portion of the plan on sheltering in place
must:
(i) be developed using information about the building's
construction and Life Safety Code (LSC) systems;
(ii) describe the criteria to be used to decide whether
to shelter in place versus evacuate;
(iii) include procedures to assess whether the building
is strong enough to withstand the various types of possible disasters
and to identify the safest areas of the building;
(iv) include procedures to secure the building against
damage;
(v) include procedures for collaborating with the local
emergency management agencies regarding the decision to shelter in
place;
(vi) include procedures to assign each task in the
sheltering plan to facility staff;
(vii) describe procedures to shelter in place that
allow the facility to maintain 24-hour operations for a minimum of
seven days to maintain continuity of care for the number and types
of clients served; and
(viii) include procedures to provide for building security.
(E) The portion of the plan on evacuation must:
(i) include contracts with prearranged receiving facilities,
including a hospice inpatient facility, skilled nursing facility,
nursing facility, assisted living facility, or hospital, with at least
one facility located at least 50 miles away;
(ii) include procedures to identify and follow evacuation
and alternative routes for transporting clients to a receiving facility
and to notify the proper authorities of the decision to evacuate;
(iii) include procedures to protect and transport client
records and to match them to each client;
(iv) include procedures to maintain a checklist of
items to be transported with clients, including medications and assistive
devices, and how the items will be matched to each client;
(v) include staffing procedures the facility will use
to ensure that staff accompanies evacuating clients when the hospice
transports clients to a receiving facility;
(vi) include procedures to identify and assign staff
responsibilities, including how clients will be cared for during evacuations
and a backup plan for lack of sufficient staff;
(vii) include procedures facility staff will use to
account for all persons in the building during the evacuation and
to track all persons evacuated;
(viii) include procedures for the use, protection,
and security of the identifying information the facility will use
to identify evacuated clients;
(ix) include procedures facility staff will follow
if a client becomes ill or dies in route when the hospice transports
clients to a receiving facility;
(x) include procedures to make a hospice counselor
available when staff accompanies clients during transport by the hospice
to a receiving facility;
(xi) include the facility's policy on whether family
of staff and clients can shelter at the hospice and evacuate with
staff and clients;
(xii) include procedures to coordinate building security
with the local emergency management agencies;
(xiii) include procedures facility staff will use to
determine when it is safe to return to the geographical area;
(xiv) include procedures facility staff will use to
determine if the building is safe for reoccupation; and
(xv) be approved by the local emergency management
coordinator (EMC) at least annually and when updated.
(F) The portion of the plan on transportation must:
(i) describe how the hospice prearranges for a sufficient
number of vehicles to provide suitable, safe transportation for the
type and number of clients being served; and
(ii) include procedures to contact the local EMC to
coordinate the facility's transportation needs in the event its prearrangements
for transportation fail for reasons beyond the facility's control.
(G) The portion of the plan on training must include:
(i) procedures that specify when and how the disaster
response plan is reviewed with clients and family members;
(ii) procedures to review the role and responsibility
of a client able to participate with the plan;
(iii) procedures for initial and periodic training
for all facility staff to carry out the plan;
(iv) the frequency for conducting disaster drills and
demonstrations to ensure staff are fully trained with respect to their
duties under the plan; and
(v) procedures to conduct emergency response drills
at least annually either in response to an actual disaster or in a
planned drill, which may be in addition to or combined with the drills
required by the LSC as specified in subsection (c)(1) of this section.
(b) Physical plant and equipment. A hospice must develop
procedures for controlling the reliability and quality of:
(1) the routine storage and prompt disposal of trash
and medical waste;
(2) light, temperature, and ventilation and air exchanges
throughout the hospice inpatient unit;
(3) emergency gas and water supply; and
(4) the scheduled and emergency maintenance and repair
of all equipment.
(c) Fire protection. Except as otherwise provided in
this subsection:
(1) A hospice must meet the provisions applicable to
the health care occupancy chapters of the 2000 edition of the LSC
of the National Fire Protection Association (NFPA). Chapter 19.3.6.3.2,
exception number 2 of the 2000 edition of the LSC does not apply to
hospices.
(2) In consideration of a recommendation by HHSC, CMS
may waive, for periods deemed appropriate, specific provisions of
the LSC which if rigidly applied would result in unreasonable hardship
for the hospice, but only if the waiver would not adversely affect
the health and safety of clients.
(3) The provisions of the adopted edition of the LSC
do not apply in the State of Texas if CMS finds that a fire and safety
code imposed by State law adequately protects clients in hospices.
(4) Notwithstanding any provisions of the 2000 edition
of the LSC to the contrary, a hospice inpatient unit may place alcohol-based
hand rub dispensers in its facility if:
(A) use of alcohol-based hand rub dispensers does not
conflict with any State or local codes that prohibit or otherwise
restrict the placement of alcohol-based hand rub dispensers in health
care facilities;
(B) the dispensers are installed in a manner that minimizes
leaks and spills that could lead to falls;
(C) the dispensers are installed in a manner that adequately
protects against access by vulnerable populations; and
(D) the dispensers are installed in accordance with
chapter 18.3.2.7 or chapter 19.3.2.7 of the 2000 edition of the LSC,
as amended by NFPA Temporary Interim Amendment 00-1(101), issued by
the Standards Council of the NFPA on April 15, 2004.
(d) Client areas. A hospice inpatient unit must provide
a home-like atmosphere and ensure that client areas are designed to
preserve the dignity, comfort, and privacy of clients. A hospice inpatient
unit must provide:
(1) physical space for private client and family visiting;
(2) accommodations for family members to remain with
the client throughout the night;
(3) physical space for family privacy after a client's
death; and
(4) the opportunity for the client to receive visitors
at any hour, including infants and small children.
(e) Client rooms. A hospice must ensure that client
rooms are designed and equipped for nursing care, as well as the dignity,
comfort, and privacy of clients. A hospice must accommodate a client
and family request for a single room whenever possible. A client's
room must:
(1) be at or above grade level;
(2) contain a suitable bed and other appropriate furniture
for the client;
(3) have closet space that provides security and privacy
for clothing and personal belongings;
(4) accommodate no more than two clients and their
family members; and
(5) provide at least 80 square feet for a client residing
in a double room and at least 100 square feet for a client residing
in a single room.
(f) Toilet and bathing facilities. A client room in
an inpatient unit must be equipped with, or conveniently located near,
toilet and bathing facilities.
(g) Plumbing facilities. A hospice inpatient unit must:
(1) always have an adequate supply of hot water; and
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