As used in this subpart:

1. (1)

   1. (A) “Clinical support team” means nonuniversal workers of the entire facility that provide services to HomeStyle homes and any traditional nursing facility around which a HomeStyle home is constructed by providing support to self-directed or self-managed work teams through the development of goals and defining of roles, as well as providing services to residents.

   2. (B) The clinical support team includes but is not limited to the:

      1. (i) Administrator;
      2. (ii) Director of nursing;
      3. (iii) Assistant director of nursing; and
      4. (iv) MDS nurse;
2. (2) “Food safety” means a method of ensuring safe preparation and delivery of food for and to residents;

3. (3) “Family-style dining” means residential-style dining in which:

   1. (A) All food is placed in serving bowls, platters, and similar residential serving dishes on the table;
   2. (B) Residents and staff dine together; and
   3. (C) Residents are encouraged to serve themselves or serve themselves with help from staff;

4. (4) “HomeStyle or HomeStyle facilities” means small, free-standing, self-contained homes that:

   1. (A) Surround or are adjacent to a central administration unit, which may or may not be a traditional nursing facility;

   2. (B)

      1. (i) Provide up to twelve (12) private residents’ rooms that are shared only at the request of a resident to accommodate a:

         1. (a) (a) Spouse;
         2. (b) (b) Partner;
      2. (c) (c) Family member; or
      3. (d) (d) Friend.

      4. (ii) Additionally, a spouse that does not meet medical criteria for nursing facility placement may reside in the room assigned to a spouse who:

         1. (a) (a) Is admitted to the facility; and
         2. (b) (b) Meets medical criteria for admission.
      5. (iii) The facility may charge the spouse who does not meet medical criteria for room and board, as well as other services so long as the facility meets all requirements for cost reporting;

   3. (C) Has a full, accessible private bathroom for each resident room that contains at a minimum a:

      1. (i) Toilet;
      2. (ii) Sink; and
      3. (iii) Shower;
   4. (D) Has the appearance of a residential dwelling for both the exterior and the interior;

   5. (E)

      1. (i) Has residents’ rooms constructed around a central, communal, family-style open space that includes a:

         1. (a) (a) Hearth;
         2. (b) (b) Dining area; and
      2. (c) (c) Residential-style kitchen.

      3. (ii) The central communal area shall contain a living area where residents and staff may socialize, dine, and prepare food together that, at a minimum, provides:

         1. (a) (a) A living room seating area;
         2. (b) (b) A dining area large enough for a single table serving all residents in the home plus two staff members; and
      4. (c) (c) An open full kitchen.
      5. (iii) The communal area may include a gas fireplace with a fixed, “stay- cool” glass screen;

   6. (F)

      1. (i) Contains residential-style design approach, scale, details, and materials throughout the home that are similar to the typical residential designs and finishes in the immediate surrounding community and does not contain or utilize commercial and institutional elements and products such as nurse station, medication carts, hospital or office type florescent lighting, acoustical tile ceilings, institutional style railings and corner guards, room numbering, labeling, and signage that would not normally be found in a home setting.
      2. (ii) Where rules require specific institutional elements, every effort shall be made to provide the institutional elements in a manner consistent with what might be found in a new home in the community (e.g., residential wall sconces used for required nurse call lights);

   7. (G) Has outdoor space that:

      1. (i) Allows residents to ambulate, with or without assistive devices such as wheelchairs or walkers;
      2. (ii) Signals staff wirelessly when someone enters the outdoor space from the HomeStyle home;
      3. (iii) Is partially covered to protect from sun and elements under the covered area; and
      4. (iv) Provides for outdoor activities;

   8. (H)

      1. (i) Utilizes a wireless alert system or call system meeting the requirements in 20 CAR § 400-818(c).
      2. (ii) The system shall also include, for residents who have been care planned to be at risk for wandering or elopement, location bracelets that permit residents to signal for assistance and permits staff to locate residents.
      3. (iii) Wired call or alert systems and overhead paging are not permitted;

   9. (I)

      1. (i) Utilizes a wireless communication and notification system for staff.
      2. (ii) The system shall provide a means for notification of staff both in the home and in other homes or other areas of the facility by other staff;
   10. (J) Contains ample natural light in each habitable space provided through exterior windows and other means, with window areas, exclusive of skylights and clearstories, being a minimum of ten percent (10%) of the area of the room;
   11. (K) Has built-in safety features (e.g., magnetic locks on cabinets with chemicals or knives) to allow all areas of the house, including the kitchen and any staff office, to be accessible to the residents during the majority of the day and night;
   12. (L) Provides self-directed care for residents through the establishment of self-managed or self- directed work teams consisting of certified nursing assistants;

   13. (M)

       1. (i) Prepares and cooks at least eighty percent (80%) of resident meals in the HomeStyle home.

       2. (ii) Nothing in this part prohibits the consumption of foods:

          1. (a) (a) Prepared outside the HomeStyle home by family, acquaintances, or social organizations such as churches;
          2. (b) (b) Grown in or on the grounds of the HomeStyle home by residents or staff; or
       3. (c) (c) Prepared by local retail eating establishments that are licensed or inspected by the Department of Health;

   14. (N) Trains all staff involved in the operation of the project in the philosophy, operations, and skills required to implement and maintain:

       1. (i) Self-directed care;
       2. (ii) Self-directed or self-managed work teams;
       3. (iii) A noninstitutional approach to life and care in long-term care;
       4. (iv) Appropriate safety and emergency skills; and
       5. (v) Other elements required for successful operations and outcomes of the project;
   15. (O) Is designed to be fully independent and disabled accessible;
   16. (P) Has overhead lift tracks that run from the bed into the bathroom in each resident room;
   17. (Q) Has at least one (1) lift motor for each HomeStyle home;
   18. (R) Has separate slings for each resident in the facility who requires a lift;
   19. (S) Is not connected to, or shares, any area that would not typically be connected or shared between private homes in the surrounding community (such as a driveway); and
   20. (T) Has all residents’ room entrances visible from the central communal area;
5. (5) “Home or homes” means each discrete HomeStyle unit housing up to twelve (12) private residents’ rooms;
6. (6) “Person-directed 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, as opposed to an institutional medical model that is schedule and task driven;
7. (7) “Self-directed or self-managed work team” means the universal workers assigned to a specific HomeStyle home and who determine, plan and manage day-to-day activities in the house with little or no direct supervision; and

8. (8) “Universal or flexible worker” means a certified nursing assistant who:

   1. (A) Has received additional training in the areas of:

      1. (i) Dietary;
      2. (ii) Housekeeping;
      3. (iii) Activities; and
      4. (iv) Laundry; and
   2. (B) Is a member of the self-managed or self-directed work team.

Codification Notes: “MDS” means minimum data set.