N.H. Code Admin. R. He-P 804.03 – Definitions

(a) “Abuse” means any one of the following:
1. (1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a resident;
2. (2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a resident; or
3. (3) “Sexual abuse” means contact or interaction of a sexual nature involving a resident without his or her informed consent.
(b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.
(c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.
(d) “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.
(e) “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 804.
(f) “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.
(g) “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.
(h) “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.
(i) “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA-J:34-37.
(j) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ALR-RC pursuant to RSA 151:2, I(e).
(k) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 804, or other federal or state requirements.
(l) “Assessment” means an evaluation of the resident to determine the care and services that are needed.
(m) “Assisted living residence–residential care (ALR-RC)” means a long term care residence providing personal care at the residential care level pursuant to RSA 151:9, VII(a)(1).
(n) “Care assessment for residential services (CARES) tool” means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I.
(o) “Care plan” means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.
(p) “Change of ownership” means the transfer of the controlling interest of an established ALR-RC to any individual, agency, partnership, corporation, government entity, association or other legal entity.
(q) “Chemical restraints” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.
(r) “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.
(s) “Commissioner” means the commissioner of the New Hampshire department of health and human services, or his or her designee.
(t) “Core services” means those minimal services to be provided to any resident by the licensee that are included in the basic rate.
(u) “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.
(v) “Days” means calendar days unless otherwise specified in the rule.
(w) “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.
(x) “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.
(y) “Direct care” means hands-on care and services provided to a resident, including but not limited to medical, nursing, psychological, or rehabilitatitive treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.
(z) “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.
(aa) “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.
(ab) “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.
(ac) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away or otherwise leaves a caregiving facility or environment unsupervised or unnoticed, without the knowledge of the licensee’s personnel.
(ad) “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.
(ae) “Employee” means anyone employed by the ALR-RC and for whom the ALR-RC has direct supervisory authority.
(af) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 804.
(ag) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.
(ah) “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.
(ai) “Facility” means “facility” as defined in RSA 151:19, II.
(aj) “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident’s health care and other personal needs.
(ak) “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s or occupants control.
(al) “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents, who have resided at the licensed premises for more than 30 days.
(am) “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.
(an) “Infectious waste” means those items specified by Env-Sw 103.28.
(ao) “Informed consent” means the decision by a resident, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.
(ap) “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.
(aq) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 804 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 804.
(ar) “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of disease.
(as) “License” means the document issued by the department or licensee of an ALR-RC which authorizes operation in accordance with RSA 151 and He-P 804, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number.
(at) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the ALR-RC is licensed.
(au) “Licensed practitioner” means a:
1. (1) Medical doctor;
2. (2) Physician’s assistant;
3. (3) Advanced practice registered nurse (APRN);
4. (4) Doctor of osteopathy;
5. (5) Doctor of naturopathic medicine; or
6. (6) Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.
(av) “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.
(aw) “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151.
(ax) “Licensing classification” means the specific category of services authorized by a license.
(ay) “Life safety code” means the standards, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.
(az) “Mechanical restraint” means locked or secured ALR-RCs or units within an ALR-RC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ALR-RC or unit within.
(ba) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.
(bb) “Mobile” means capable of moving from place to place, with or without assistive devices, without the assistance of others.
(bc) “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.
(bd) “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.
(be) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.
(bf) “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a resident.
(bg) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.
(bh) “Over-the-counter medications” means non-prescription medications.
(bi) “Patient rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.
(bj) “Personal care” means personal care services that are non-medical, hands-on services provided to a resident including, but not limited to, assistance with ADL’s.
(bk) “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.
(bl) “Personnel” means individual(s), either paid or volunteer, who provide direct or indirect care or services, or both, to a resident(s).
(bm) “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.
(bn) “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.
(bo) “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:
1. (1) A lancing or finger stick device to get a blood specimen;
2. (2) A test strip or reagents to apply a specimen to for testing; or
3. (3) A meter or monitor to calculate and show the results, including:
  1. a. Blood glucose meters, also called “glucometers”;
  2. b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or
  3. c. A Cholesterol meter.
(bp) “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of patient care.
(bq) “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with licensed practitioner’s orders.
(br) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.
(bs) “Protective care” means the provision of resident monitoring services, including but not limited to:
1. (1) Knowledge of resident whereabouts; and
2. (2) Minimizing the likelihood of accident or injury.
(bt) “Qualified personnel” means personnel that have been trained to and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.
(bu) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.
(bv) “Renovation” means the replacement in type or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.
(bw) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintain such materials, elements, equipment, or fixtures in good or sound condition.
(bx) “Reportable incident” means an occurrence of any of the following while the resident is either in the ALR-RC or in the care of ALR-RC personnel:
1. (1) The unanticipated death of the resident;
2. (2) An injury to a resident, that is potentially due to abuse or neglect; or
3. (3) The elopement or unexplained absence of a resident from the ALR-RC.
(by) “Resident” means any person admitted to or in any way receiving care, services, or both from a facility licensed in accordance with RSA 151 and He-P 804.
(bz) “Residential board and care occupancy,” means “residential board and care occupancy” as defined in NFPA 101 of the state fire code, namely “ an occupancy used for lodging and boarding of 4 or more residents not related by blood or marriage to the owners or operators for the purpose of providing personal care services.”
(ca) “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 804, and as required by other federal or state laws.
(cb) “Respite care” means the admission of a person from his or her primary residence to an ALR-RC, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care.
(cc) “Self administration of medication with assistance” means the resident takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.
(cd) “Self administration of medication without assistance” means the resident takes his or her own medication(s) without the assistance of personnel, including prompting.
(ce) “Self-directed medication administration” means a resident, who has a physical limitation that prohibits him or her from self administration of medication, with or without assistance, directs personnel to physically assist in the medication process which does not include assisting with injections or filling insulin syringes.
(cf) “Self evacuate” means the resident can initiate and complete movement from any location in the ALR-RC to an exit without assistance from personnel other than verbal or physical prompting.
(cg) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.
(ch) “Significant change”. means a decline or improvement in a resident’s status that:
1. (1) Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;
2. (2) Impacts more than one area of the resident’s health status; and
3. (3) Requires interdisciplinary review or revision of the care plan.
(ci) “State monitoring” means the placement of individuals by the department at an ALR-RC to monitor the operation and conditions of the facility.
(cj) “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.
(ck) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.
(cl) “Unexplained absence” means an incident involving a resident leaving the premises of the ALR-RC without the knowledge of the ALR-RC personnel in a manner that is contrary to their normal routine.
(cm) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

Source. #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. #9121, eff 4-3-08, EXPIRED: 4-3-16 New. #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17 New. #12414, eff 11-3-17; ss by #13339, eff 1-29-22