These residents have a clinical diagnosis of Human Immunodeficiency Virus (HIV) infection and related conditions which require 24 hour a day skilled nuring care.
Facility Responsibilities The facility shall
1. Aggressively meet the medical needs of a predominantly young population who have a terminal illness.
2. Provide comprehensive skilled nursing care and related services for residents who require constant nursing intervention and monitoring. The staff shall have specialized training and skills in the care of persons with HIV.
3. Develop policy to govern the comprehensive skilled nursing care and related medical or other services provided. This includes a physician, registered nurse, and any other staff responsible for the execution of such policies.
4. Have an established plan to insure that the health care of every resident is under the supervision of a licensed physician interested and experienced in the primary care of persons with HIV.
5. Make provision to have a licensed physician available to make frequent visits and to furnish necessary medical care in cases of an emergency.
6. Make provisions to have 24 hour access to services in an acute care hospital.
7. Maintain clinical records on all residents and maintain the confidentiality of such records to the highest extent possible.
8. Provide 24 hour nursing service sufficient to meet the complex nursing needs with registered nurse coverage 24 hours per day, seven days per week as the plan of care indicates.
9. Provide appropriate methods and procedures for dispensing and administering medications and
10. Provide policy, procedure, and ongoing education for enhanced universal precautions, be responsible for keeping policy update on current trends for universal precautions related to infectious diseases as outlined by the Center for Disease Control (CDC), and develop specific policies (Practices and Precautions) for preventing transmission of infection in the work-place including employee health issues.
11. Provide social services sufficient to meet the mental, psychosocial, behavioral, and emotional needs of the resident. These services shall be provided by a social worker with at least a master level degree from an accredited school of social work and who is licensed as applicable by the State of Louisiana, who shall provide a minimum of two (2) hours per week of services per resident.
12. Provide dietary services to meet the complex and comprehensive nutritional needs of the resident.
These services shall be provided by registered dietician who shall provide at least one hour per week per resident, but in no case less than 4 hours per month.
13. Provide a dynamic activity program congruent with the needs and ages of the resident which includes an exercise program when indicated to promote and maintain the residents tolerance level to daily activity levels.
14. Provide and/or arrange transportation services to meet the medical needs of the resident.
15. Provide for the resident the opportunity to participate in the coordination and facilitation in the service delivery and personal treatment plan.
16. Provide care plan meetings and updates as often as necessary as necessary by the residents changing condition.
17. Provide for appropriate consultation and services to meet the needs of the resident including but not limited to: oncology, infectious diseases, hematology, neurology, dermatology, gastro-enterology, thoracic, gynecology, pediatrics, mental health and/or any other specialized services as indicated.
18. Develop respiratory therapy protocols. The respiratory therapist shall work with other medical staff to assure compliance. These services shall be provided as often as necessary by a respiratory therapist either contractually or full-time employment for no less than 8 hours per month.
19. Provide physical therapy and other rehabilitative services as necessary to meet the special needs of the resident with sensory perception deficit (touch, hearing, sight, etc.).
20. Provide and/or arrange through community resources for legal and/or pastoral services as needed
by the resident.
21. Provide a component of care related to personality changes and communication problems brought on as the illness progresses.
22. Provide for access to volunteers and community resources.
23. Provide for access to "significant others" to participate in the emotional support and personal care services.
24. Provide a minimum daily average of 4.0 actual nursing hours per resident.
Determination of Skilled Nursing Services for AIDS
An individual shall be determined to meet the requirements for SN-ID HIV classification of care in a Long Term Care facility when the following criteria, based on current needs are met. These criteria are meant to be objective, self-explanatory, and universally applicable.
Payment or reimbursement is not made just because of a diagnosis of AIDS or being HIV+. The payment is intended to be reimbursement for the additional expenses of administering IV therapy and the additional RN hours required to provide this type of therapy in the nursing facility.
Examples of Services
Examples of SN-ID Services for which residents with a clinical diagnosis of HIV and a condition which is given 24 hours a day Skilled Nursing may include but are not limited to
1. Enhanced level of universal precautions based on resident needs (blood and body fluid precautions)
2. Continuous ongoing education regarding disease process, infection control, medication, side effects, etc.
These services are in conjunction with the following:
1. Intermittent or continuous IV therapy, respiratory therapy, nutritional therapy, or other intervention.
2. Administration of highly toxic pharmaceutical and experimental drugs which include monitoring of side effects.
3. Continuous changes in treatment plan for symptom control.
4. Daily medical/nursing assessment for residents changing condition.
5. Continuous monitoring for
A. Tolerance level
B. Skin integrity
C. Bleeding
D. Persistent diarrhea
E. Pain intensity
F. Mental status
G. Nutritional status
H. Tuberculosis (monthly sputum for AFB).
The following related conditions may also require SNF ID LOC for HIV:
1. Opportunist Infections
A. Pneumocystis carnii pneumonia (PCP)
B. Mycobacterium avium-intracellular complex (MAC)
C. Cytomegalovirus
D. Cyptocpccus neoformans
E. Strongylcides stercoralis
2. Non-opportunistic Infections
A. Mycobacterium tuberculosis
B. Pyogenic bacteria (staphylococcus, Strepto-coccus, etc.)
C. Histoplasmosis
3. Malignancies - Kaposi's Sarcoma
4. Opportunistic Gastrointestinal Infections
A. Cyptosporidium
B. Isospora Belli
C. Malabsorption Syndrome with progressive malnutrition
5. Neurological Complications
A. progressive multi-focal leukoencephalopathy
B. Brain Abscesses
C. Acute encephalitis
D. Vascular accident
E. Toxoplasmosis
F. Retinopathy
SKILLED ID NURSING CARE FOR METHICILLIN-RESISTANT