The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise. (1) - (4)(No change.) (5)Advanced practice nurse--A registered nurse who is approved by the Texas Board of Nursing [Nurse Examiners (BNE)] to practice as an advanced practice nurse and who maintains compliance with the applicable rules of the Texas Board of Nursing [BNE]. See the Texas Board of Nursing's [BNE's] definition of advanced practice nurse in 22 TAC §221.1 (concerning definitions). (6) - (25)(No change.) (26)Community disaster resources--A local, statewide, or nationwide emergency system that provides information and resources during a disaster, including weather information, transportation, evacuation, and shelter information, disaster assistance and recovery efforts, evacuee and disaster victim resources, and resources for locating evacuated friends and relatives. (27) [(26)] Controlling person--A person with the ability, acting alone or with others, to directly or indirectly influence, direct, or cause the direction of the management, expenditure of money, or policies of an agency or other person. (A)A controlling person includes: (i)a management company or other business entity that operates or contracts with others for the operation of an agency; (ii)a person who is a controlling person of a management company or other business entity that operates an agency or that contracts with another person for the operation of an agency; and (iii)any other individual who, because of a personal, familial, or other relationship with the owner, manager, or provider of an agency, is in a position of actual control or authority with respect to the agency, without regard to whether the individual is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the agency. (B)A controlling person, as described by subparagraph (A)(iii) of this paragraph, does not include an employee, lender, secured creditor, or other person who does not exercise formal or actual influence or control over the operation of an agency. (28) [(27)] Conviction--An adjudication of guilt based on a finding of guilt, a plea of guilty, or a plea of nolo contendere. (29) [(28)] Counselor--An individual qualified under Medicare standards to provide counseling services, including bereavement, dietary, spiritual, and other counseling services to both the client and the family. (30) [(29)] DADS--Department of Aging and Disability Services. (31) [(30)] Day--Any reference to a day means a calendar day, unless otherwise specified in the text. A calendar day includes weekends and holidays. (32) [(31)] Deficiency--A finding of noncompliance with federal requirements resulting from a survey. (33) [(32)] Designated survey office--A DADS Home and Community Support Services Agencies Program office located in an agency's geographic region. (34) [(33)] Dialysis treatment record--For home dialysis designation, a dated and signed written notation by the person providing dialysis treatment which contains a description of signs and symptoms, machine parameters and pressure settings, type of dialyzer and dialysate, actual pre- and post-treatment weight, medications administered as part of the treatment, and the client's response to treatment. (35) [(34)] Dietitian--A person who is currently licensed under the laws of the State of Texas to use the title of licensed dietitian or provisional licensed dietitian, or who is a registered dietitian. (36)Disaster--The occurrence or imminent threat of widespread or severe damage, injury, or loss of life or property resulting from a natural or man-made cause, such as fire, flood, earthquake, wind, storm, wave action, oil spill or other water contamination, epidemic, air contamination, infestation, explosion, riot, hostile military or paramilitary action, or energy emergency. In a freestanding hospice, a disaster includes failure of the heating or cooling system, power outage, explosion, and bomb threat. (37) [(35)] End stage renal disease (ESRD)--For home dialysis designation, the stage of renal impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life. (38) [(36)] Freestanding hospice--An agency that provides hospice services to clients of the agency who are residing at the agency's physical location including inpatient and respite care. (39) [(37)] Functional need--Needs of the individual that require services without regard to diagnosis or label. (40) [(38)] Health assessment--A determination of a client's physical and mental status through inventory of systems. (41) [(39)] Home and community support services agency--A person who provides home health, hospice, or personal assistance services for pay or other consideration in a client's residence, an independent living environment, or another appropriate location. (42) [(40)] Home health aide--An individual working for an agency who meets at least one of the requirements for home health aides as defined in §97.701 of this chapter (relating to Home Health Aides). (43) [(41)] Home health medication aide--A person permitted under the Health and Safety Code, Chapter 142, Subchapter B. (44) [(42)] Home health service--The provision of one or more of the following health services required by an individual in a residence or independent living environment: (A)nursing, including blood pressure monitoring and diabetes treatment; (B)physical, occupational, speech, or respiratory therapy; (C)medical social service; (D)intravenous therapy; (E)dialysis; (F)service provided by unlicensed personnel under the delegation or supervision of a licensed health professional; (G)the furnishing of medical equipment and supplies, excluding drugs and medicines; or (H)nutritional counseling. (45) [(43)] Hospice--A person licensed under this chapter to provide hospice services, including a person who owns or operates a residential unit or an inpatient unit. (46) [(44)] Hospice services--Services, including services provided by unlicensed personnel under the delegation of a registered nurse or physical therapist, provided to a client or a client's family as part of a coordinated program consistent with the standards and rules adopted under this chapter. These services include palliative care for terminally ill clients and support services for clients and their families that: (A)are available 24 hours a day, seven days a week, during the last stages of illness, during death, and during bereavement; (B)are provided by a medically directed interdisciplinary team; and (C)may be provided in a home, nursing facility, residential unit, or inpatient unit according to need. These services do not include inpatient care normally provided in a licensed hospital to a terminally ill person who has not elected to be a hospice client. For the purposes of this definition, the word "home" includes a person's "residence" as defined in this section. (47) [(45)] Independent living environment--A client's residence, which may include a group home or foster home, or other settings where a client participates in activities, including school, work, or church. (48) [(46)] Individual/family choice and control--Individuals and families who express preferences and make choices about how their support service needs are met. (49) [(47)] Individualized service plan--A written plan prepared by the appropriate health care personnel for a client of a home and community support services agency licensed to provide personal assistance services. (50) [(48)] Inpatient unit--A facility that provides a continuum of medical or nursing care and other hospice services to clients admitted into the unit and that is in compliance with: (A)the conditions of participation for inpatient units adopted under Social Security Act, Title XVIII (42 United States Code §1395 et seq.); and (B)standards adopted under this chapter. (51) [(49)] IRoD--Informal review of deficiencies. An informal process that allows an agency to refute a deficiency or violation cited during a survey. (52) [(50)] JCAHO--Joint Commission on Accreditation of Healthcare Organizations. An independent, nonprofit organization for standard-setting and accrediting in-home care and other areas of health care. (53) [(51)] Licensed vocational nurse--A person who is currently licensed under Occupations Code, Chapter 301, as a licensed vocational nurse. (54)Life Safety Code (also referred to as NFPA 101)--The Code for Safety to Life from Fire in Buildings and Structures, Standard 101, of the National Fire Protection Association (NFPA). (55) [(52)] Manager--An employee or independent contractor responsible for providing management services to a home and community support services agency for the overall operation of a home and community support services agency including administration, staffing, or delivery of services. Examples of contracts for services that will not be considered contracts for management services include contracts solely for maintenance, laundry, or food services. (56) [(53)] Medication administration record--A record used to document the administration of a client's medications. (57) [(54)] Medication list--A list that includes all prescription and over-the-counter medication that a client is currently taking, including the dosage, the frequency, and the method of administration. (58)Mitigation--An action taken to eliminate or reduce the probability of a disaster, or reduce a disaster's severity or consequences. (59) [(55)] Notarized copy--A sworn affidavit stating that attached copies are true and correct copies of the original documents. (60) [(56)] Nursing facility--An institution licensed as a nursing home under the Health and Safety Code, Chapter 242. (61) [(57)] Nutritional counseling--Advising and assisting individuals or families on appropriate nutritional intake by integrating information from the nutrition assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status, with the goal being health promotion, disease prevention, and nutrition education. Nutritional counseling may include the following: (A)dialogue with the client to discuss current eating habits, exercise habits, food budget, and problems with food preparation; (B)discussion of dietary needs to help the client understand why certain foods should be included or excluded from the client's diet and to help with adjustment to the new or revised or existing diet plan; (C)a personalized written diet plan as ordered by the client's physician or practitioner, to include instructions for implementation; (D)providing the client with motivation to help the client understand and appreciate the importance of the diet plan in getting and staying healthy; or (E)working with the client or the client's family members by recommending ideas for meal planning, food budget planning, and appropriate food gifts. (62) [(58)] Occupational therapist--A person who is currently licensed under the Occupational Therapy Practice Act, Occupations Code, Chapter 454, as an occupational therapist. (63) [(59)] Original active client record--A record composed first-hand for a client currently receiving services. (64) [(60)] Palliative care--Intervention services that focus primarily on the reduction or abatement of physical, psychosocial, and spiritual symptoms of a terminal illness. (65) [(61)] Parent agency--An agency that develops and maintains administrative controls and provides supervision of branch offices and alternate delivery sites. (66) [(62)] Parent company--A person, other than an individual, who has a direct 100% ownership interest in the owner of an agency. (67) [(63)] Person--An individual, corporation, or association. (68) [(64)] Personal assistance services--Routine ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes: (A)personal care; (B)health-related services performed under circumstances that are defined as not constituting the practice of professional nursing by the Texas Board of Nursing [Nurse Examiners] through a memorandum of understanding with DADS in accordance with Health and Safety Code, §142.016; and (C)health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or that a registered nurse determines do not require delegation. (69) [(65)] Personal care--The provision of one or more of the following services required by an individual in a residence or independent living environment: (A)bathing; (B)dressing; (C)grooming; (D)feeding; (E)exercising; (F)toileting; (G)positioning; (H)assisting with self-administered medications; (I)routine hair and skin care; and (J)transfer or ambulation. (70) [(66)] Physical therapist--A person who is currently licensed under Occupations Code, Chapter 453, as a physical therapist. (71) [(67)] Physician--A person who holds a doctor of medicine or doctor of osteopathy degree and is currently licensed and practicing medicine under the laws of the state of Texas, Oklahoma, New Mexico, Arkansas, or Louisiana. (72) [(68)] Physician assistant--A person who is licensed under the Physician Assistant Licensing Act, Occupations Code, Chapter 204, as a physician assistant. (73) [(69)] Physician-delegated task--A task performed in accordance with the Occupations Code, Chapter 157, including orders signed by a physician that specify the delegated task, the individual to whom the task is delegated, and the client's name. (74) [(70)] Place of business--An office of a home and community support services agency that maintains client records or directs home health, hospice, or personal assistance services. This term includes a parent agency, a branch office, and an alternate delivery site. The term does not include an administrative support site. (75) [(71)] Plan of care--The written orders of a practitioner for a client who requires skilled services. (76) [(72)] Practitioner--A person who is currently licensed in a state in which the person practices as a physician, dentist, podiatrist, or a physician assistant, or a person who is a registered nurse registered with the Texas Board of Nursing [Nurse Examiners for the State of Texas] as an advanced practice nurse. (77)Preparedness--Actions taken in anticipation of a disaster. (78) [(73)] Presurvey conference--A conference held with DADS staff and the applicant or the applicant's representatives to review licensure standards and survey documents, and to provide consultation before the survey. (79) [(74)] Progress note--A dated and signed written notation by agency personnel summarizing facts about care and the client's response during a given period of time. (80) [(75)] Psychoactive treatment--The provision of a skilled nursing visit to a client with a psychiatric diagnosis under the direction of a physician that includes one or more of the following: (A)assessment of alterations in mental status or evidence of suicide ideation or tendencies; (B)teaching coping mechanisms or skills; (C)counseling activities; or Cont'd...
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