End-of-life services.

A facility that retains residents who require end-of-life care continues to be responsible for the care and services of all residents, must comply with the requirements of this section, and apply on basic care application form and indicate a change in services provided.

1. A facility may retain residents who require more than intermittent nursing care if the resident requires end-of-life care and chooses to remain in the
2. A facility providing end-of-life care must employ or contract with a registered nurse to supervise resident care to meet the needs of the residents at all times, either directly or indirectly. The facility must employ a licensed nurse to identify and respond to resident needs, care plan accordingly, provide oversight related to care, and review and document the resident’s individual needs and care
3. The facility, the resident in need of end-of-life care, or the resident’s designee may contract with a person or hospice agency to meet the needs of the
4. Individuals in need of end-of-life care who require skilled nursing care or are not capable of self-preservation may not be
5. The facility, in consultation with the resident or resident’s designee, shall develop and implement an interdisciplinary care plan that identifies how the resident’s needs are met and includes delineation of the roles of facility staff and others in the provision of care and services for the resident in need of end-of-life care and a list of medications the resident receives related to end-of-life care and who is authorized to administer the
6. Facility evacuation or E scores must be completed when there is a significant change in the resident’s capability for self evacuation when a resident is receiving end-of-life care. A significant change for the resident is defined as any change in the resident’s status or capabilities which results in a change in the E score for that resident. Facility staffing must be adjusted consistent with the E scores to maintain a slow evacuation capability. The fire evacuation needs of the resident receiving end-of-life care may be met by facility staff that wraps around hospice staff, family members, the resident’s designee, or
7. If a facility provides end-of-life care to residents, the facility shall ensure training and competency evaluation is completed for all nursing and personal care staff members specific to the care and services necessary to meet the needs of the terminally ill resident. The training and competency evaluation must be completed prior to caring for a resident in need of end-of- life care. The facility staff must be trained by a nurse. Training of the other individuals may be completed by any of the following:
   1. Facility personnel;
   2. Other experts;
   3. Nurse or nurse consultant; or
   4. Hospice agency

If the facility utilizes family, volunteers, or the resident’s designee to provide end-of life care, the facility shall ensure appropriate training for these individuals specific to the care and services provided by this person. The facility shall assure the competency of the individual for this task and address changes if the needs of the resident are not being met.

8. If the facility is unable, or becomes unable, to meet the needs of the resident requiring end-of-life care or the facility is unable to comply with these requirements, the facility shall promptly make arrangements to discharge or transfer the resident to a safe and appropriate location consistent with the level of care required to meet the resident’s