A. Rehabilitative Services Admission Policies. In a nursing home which does not accept residents in need of specialized rehabilitative services, the minimal acceptable restorative service shall be the restorative nursing care plan designed to maintain function or improve the residentís ability to carry out activities of daily living as set forth in Regulation .18G, of this chapter.
B. Arrangements for Services.
(1) If a nursing homeís admission policies include the admission of residents requiring rehabilitative services, the nursing home shall provide, or arrange for under written agreement, specialized rehabilitative services by qualified personnel, such as a physical therapist, speech-language pathologist and audiologist, and occupational therapist.
(2) Initiation of services to meet the rehabilitative needs of the resident shall occur within 48 hours, excluding Saturday, Sunday, and State and federal holidays, of the physicianís order for the specialized service.
(3) The resident may not be accepted for admission if at least one service to meet the rehabilitative needs of the resident cannot be initiated within the 48-hour period, excluding Saturday, Sunday, and State and federal holidays.
C. Policies and Procedures.
(1) Written administrative and resident care policies and procedures shall be developed for rehabilitative services by appropriate rehabilitation team members and representatives of the medical, administrative, and nursing staff.
(2) Policies shall provide for the coordination of rehabilitative services and the rehabilitative aspects of nursing.
(3) The nursing home shall make its administrative and resident care policies available for review by residents and the residentís representative.
D. Written Plan of Care. Rehabilitative services shall be provided under a written plan of care, initiated by the attending physician, and developed in consultation with appropriate rehabilitation team members and the nursing service.
E. Physicianís Orders.
(1) Specialized rehabilitative services shall be provided only on written orders of the attending physician.
(2) Orders shall include modalities to be used, frequency, and anticipated goals and shall be made a part of the resident care plan.
(3) The physician shall review with the resident or the family or residentís representative the goals and the treatment program. The frequency of communications between the physician and the rehabilitation team members shall depend on changes in the resident and the residentís medical status.
F. Progress Notes.
(1) Within 2 weeks of referral to specialized rehabilitative services, the rehabilitation team members shall provide the attending physician with a written report of the evaluation, including goals and progress of the resident.
(2) Progress notes related to rehabilitative services shall be written at least every 2 weeks.
G. Reevaluation of Residentís Progress.
(1) The physician and the rehabilitation team members shall reevaluate the residentís progress as necessary, but at least every 30 days.
(2) The physician may document on the record that the reevaluation may be less frequent but in no case may the reevaluation exceed 60 days.
H. Residentís Record.
(1) The physicianís orders, the initial evaluations, the plan of rehabilitative care, goals, services rendered, evaluations of progress, and other pertinent information shall be:
(a) Recorded in the residentís medical record; and
(b) Dated and signed by the:
(i) Physician ordering the service; and
(ii) Those disciplines who provided the service.
(2) The record and progress notes concerning the resident shall reflect at all times the most recent and current status of the resident, including current short-term and long-term goals.
I. Proof of Licensure. The facility shall maintain a file which includes proof of current licensure of all the rehabilitative services' personnel.
J. Job Descriptions. Current job descriptions for all rehabilitative services personnel shall be readily available in the facility.