Authority: IC 16-28-1-7

Affected: IC 16-28-5-1

Sec. 38. (a) Based on the comprehensive assessment of a resident and the care plan, the facility must ensure the following:

1. (1) The resident's abilities in activities of daily living (ADL) do not diminish unless circumstances of the resident's clinical condition demonstrate that diminution was unavoidable. Conditions demonstrating unavoidable diminution in ADLs include the following:

   1. (A) The natural progression of the resident's disease.
   2. (B) Deterioration of the resident's physical condition associated with the onset of a physical or mental disability while receiving care to restore or maintain functional abilities.

2. (2) A resident is given the appropriate treatment and services to maintain or improve his or her abilities, including, but not limited to, the following:

   1. (A) Bathing, dressing, and grooming.
   2. (B) Transfer and ambulation.
   3. (C) Toileting.
   4. (D) Eating.
   5. (E) Speech, language, or other functional communication systems.

3. (3) A resident who is unable to carry out ADL receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Each resident shall show evidence of good personal hygiene, including, but not limited to, the following:

   1. (A) Care of the skin.
   2. (B) Shampoo and grooming of the hair.
   3. (C) Oral hygiene and care of the lips to prevent dryness and cracking.
   4. (D) Shaving and beard trimming.
   5. (E) Cleaning and cutting of the fingernails and toenails.

(b) Consistent with the care plan and the resident's right to refuse care, the following services shall be provided:

1. (1) Each resident shall be given or assisted in oral care, at least daily, to promote clean and healthy gums and teeth. Dentures, when present, shall be properly cared for and cleaned at least daily.
2. (2) Each resident shall be bathed or assisted to bathe as frequently as is necessary, but at least twice weekly.
3. (3) Each resident shall have at least one (1) shampoo every week and more often if needed or requested as part of the resident's normal bathing schedule.
4. (4) Each resident shall be dressed in clean garments.
5. (5) Residents who are not bedfast shall be encouraged to be dressed each day.
6. (6) A resident who is bedfast or chair-fast shall have his or her body position changed in accordance with the resident's need as stated in the care plan. Proper body alignment shall be maintained in accordance with the capabilities of each resident.

(c) The resident shall be encouraged or assisted to be as independent as possible, including having self-help and ambulation devices readily available to meet the current needs of the resident with the devices in good repair.

(d) Each resident shall have personal care items such as combs and brushes, cleaned as appropriate.

(e) Each resident may retain personal care items if in the original container labeled by the manufacturer.

(f) The resident has the right to refuse care and treatment to restore or maintain functional abilities after efforts by the facility to counsel and/or offer alternatives to the resident. Refusal of such care and treatment should be documented in the clinical records.

(g) For purposes of IC 16-28-5-1, a breach of:

1. (1) subsection (a), (b), (c), or (f) is a deficiency; and
2. (2) subsection (d) or (e) is a noncompliance.

(Indiana Department of Health; 410 IAC 16.2-3.1-38; filed Jan 10, 1997, 4:00 p.m.: 20 IR 1555, eff Apr 1, 1997; readopted filed Jul 11, 2001, 2:23 p.m.: 24 IR 4234; readopted filed May 22, 2007, 1:44 p.m.: 20070613-IR-410070141RFA; readopted filed Sep 11, 2013, 3:19 p.m.: 20131009-IR-410130346RFA; readopted filed Nov 13, 2019, 3:14 p.m.: 20191211-IR-410190391RFA; readopted filed Nov 14, 2025, 11:18 a.m.: 20251210-IR-410240588RFA)