481—65.25 (135C) Residents’ rights in general. Each facility shall ensure that policies and procedures are written and implemented which include at least provisions in subrules 65.25(1) to 65.25(21). These shall govern all services provided to staff, residents, their families or legal representatives. The policies and procedures shall be available to the public and shall be reviewed annually. (II)
	 65.25(1) Grievances. Written policies and procedures shall include a method for submitting grievances and recommendations by residents or their legal representatives and for ensuring a response and disposition by the facility. The written procedure shall ensure protection of the resident from any form of reprisal or intimidation and shall include:
	  a.   	 An employee or an alternate designated to be responsible for handling grievances and recommendations; (II)
	  b.   	 Methods to investigate and assess the validity of a grievance or recommendation; (II) and
	  c.   	 Methods to resolve grievances and take action. (II)
	 65.25(2) Informed of rights. Policies and procedures shall include a provision that residents be fully informed of their rights and responsibilities as residents and of all rules governing resident conduct and responsibilities. This information must be provided upon admission, or when the facility adopts or amends residents’ rights policies. It shall be posted in locations accessible to all residents. (II)
	  a.   	 The facility shall make known to residents what they may expect from the facility and its staff, and what is expected from residents. The facility shall communicate these expectations during a period not more than two weeks before or later than five days after admission. The communication shall be in writing in a separate handout or brochure describing the facility. It shall be interpreted verbally, as part of a preadmission interview, resident counseling, or in individual or group orientation sessions after admission. (II)
	  b.   	 Residents’ rights and responsibilities shall be presented in language understandable to residents. If the facility serves residents who do not speak English or are deaf, steps shall be taken to translate the information into a foreign or sign language. Blind residents shall be provided either Braille or a recording. Residents shall be encouraged to ask questions about their rights and responsibilities. Their questions shall be answered. (II)
	  c.   	 A statement shall be signed by the resident and legal guardian, if applicable, to indicate the resident understands these rights and responsibilities. The statement shall be maintained in the record. The statement shall be signed no later than five days after admission. A copy of the signed statement shall be given to the resident or legal guardian. (II)
	  d.   	 All residents, next of kin, or legal guardian shall be advised within 30 days of changes made in the statement of residents’ rights and responsibilities. Appropriate means shall be used to inform non-English-speaking, deaf or blind residents of changes. (II)
	 65.25(3) Resident abuse prohibited. Each resident shall receive kind and considerate care at all times and shall be free from physical, sexual, mental and verbal abuse, exploitation, and physical injury. (I, II)
	 65.25(4) Claim of abuse. Upon a claim of dependent adult abuse of a resident being reported, the administrator of the facility shall separate the victim and accused abuser immediately and maintain the separation until the abuse investigation is completed. (I, II)
	 65.25(5) Report of abuse. Pursuant to Iowa Code chapter 235B, a mandatory reporter of dependent adult abuse is any person who, in the course of employment, examines, attends, counsels, or treats a dependent adult and reasonably believes the dependent adult has suffered abuse. This includes a member of the staff or employee of a health care facility. (II, III)
If a staff member or employee is required to report pursuant to this subrule, the staff member or employee shall immediately notify the person in charge of the facility or the person’s designated agent, and the person in charge or the designated agent shall make the report to the department of human services. (II, III)
	 65.25(6) Informed of health condition. Each resident or legal guardian shall be fully informed by a physician of the health and medical condition of the resident unless a physician documents reasons not to in the resident’s record. (II)
	 65.25(7) Research. The resident or legal guardian shall decide whether a resident participates in experimental research. Participation shall occur only when the resident or guardian is fully informed and signs a consent form. (II, III)
Any clinical investigation involving residents must be sponsored by an institution with a human subjects review board functioning in accordance with the requirement of Public Law 93-348, as implemented by Part 46 of Title 45 of the Code of Federal Regulations, as amended December 1, 1981 (45 CFR 46). (III)
	 65.25(8) Resident work. Services performed by the resident for the facility shall be in accordance with the IPP. (II)
	  a.   	 Residents shall not be used to provide a source of labor for the facility against the resident’s will. Physician’s approval is required for all work programs and must be renewed yearly. (II, III)
	  b.   	 If the individual program plan requires activities for therapeutic or training reasons, the plan for these activities must be professionally developed and implemented. Therapeutic or training goals must be clearly stated and measurable and the plan shall be time limited and reviewed at least quarterly. (II, III)
	  c.   	 A resident engaged in work programs in the ICF/PMI shall be paid wages commensurate with wage and hour regulations for comparable work and productivity. (II)
	  d.   	 The resident shall have the right to employment options commensurate with training and skills. (II)
	  e.   	 Residents performing work shall not be used to replace paid employees to fulfill staff requirements. (II)
	 65.25(9) Encouragement to exercise rights. Residents shall be encouraged and assisted throughout their period of stay to exercise resident and citizen rights. Residents may voice grievances and recommend changes in policies and services to administrative staff or to an outside representative of their choice free from interference, coercion, discrimination, or reprisal. (II)
	 65.25(10) Posting names. The facility shall post the name, telephone number, and address of the:
	  a.   	 Long-term care resident’s advocate/ombudsman; (II)
	  b.   	 Survey agency; (II)
	  c.   	 Local law enforcement agency; (II)
	  d.   	 Care review committee members; (II)
	  e.   	 Administrator; (II)
	  f.   	 Members of the board of directors; (II)
	  g.   	 Corporate headquarters; (II) and the
	  h.   	 Iowa Protection and Advocacy Services, Inc.	(II)
The text of Iowa Code section 135C.46 shall also be available to provide residents another course of redress. These items shall be posted in an area where residents and visitors can read them. (II)
	 65.25(11) Dignity preserved. Residents shall be treated with consideration, respect, and full recognition of their dignity and individuality, including privacy in treatment and in care of personal needs. (II)
	  a.   	 Staff shall display respect for residents when speaking with, caring for, or talking about them as constant affirmation of the individuality and dignity of human beings. (II)
	  b.   	 Schedules of daily activities shall allow maximum flexibility for residents to exercise choice about what they will do and when they will do it. Residents’ individual preferences regarding such things as menus, clothing, religious activities, friendships, activity programs, entertainment, sleeping, eating, and times to retire at night and arise in the morning shall be elicited and considered by the facility. The facility shall make every effort to match nonsmokers with other nonsmokers. (II)
	  c.   	 Residents shall not have their personal lives regulated beyond reasonable adherence to meal schedules, bedtime hours, and other written policies which may be necessary for the orderly management of the facility and as required by these rules; however, residents shall be encouraged to participate in recreational programs. (II)
	  d.   	 Residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door shall shield the resident from passersby. People not involved in the care of a resident shall not be present without the resident’s consent during examination or treatment. (II)
	  e.   	 Privacy for each person shall be maintained when residents are being taken to the toilet or being bathed and while they are being helped with other types of personal hygiene, except as needed for resident safety or assistance. (II)
	  f.   	 Staff shall knock and be acknowledged before entering a resident’s room unless the resident is not capable of response. This does not apply under emergency conditions. (II)
	 65.25(12) Communications. Each resident may communicate, associate, and meet privately with persons of the resident’s choice, unless to do so would infringe upon the rights of other residents. Each resident may send and receive personal mail unopened unless prohibited in the IPP which has explicit approval of the resident or legal guardian. Telephones consistent with ANSI standards 42 CFR 405.1134(c) (10-1-86) shall be available and accessible for residents to make and receive calls with privacy. Residents who need help shall be assisted in using the telephone. (II)
Arrangements shall be made to provide assistance to residents who require help in reading or sending mail. (II)
	 65.25(13) Visiting policies and procedures. Subject to reasonable scheduling restrictions, visiting policies and procedures shall permit residents to receive visits from anyone they wish. Visiting hours shall be posted. (II)
	  a.   	 Reasonable, regular visiting hours shall not be less than 12 hours per day and shall take into consideration the special circumstances of each visitor. A particular visitor(s) may be restricted by the facility for one of the following reasons:
	 (1) 	 The resident refuses to see the visitor(s). (II)
	 (2) 	 The visit would not be in accordance with the IPP. (II)
	 (3) 	 The visitor’s behavior is unreasonably disruptive to the functioning of the facility. (II)
Reasons for denial of visitation shall be documented in resident records. (II)
	  b.   	 Decisions to restrict a visitor shall be reevaluated at least quarterly by the QMHP or at the resident’s request. (II)
	  c.   	 Space shall be provided for residents to receive visitors in comfort and privacy. (II)
	 65.25(14) Resident activities. Each resident may participate in activities of social, religious, and community groups as desired unless contraindicated for reasons documented by the attending physician or qualified mental health professional, as appropriate, in the resident’s record. (II)
Residents who wish to meet with or participate in activities of social, religious or community groups in or outside the facility shall be informed, encouraged, and assisted to do so. (II)
Residents shall be permitted to leave the facility and environs at reasonable times unless there are justifiable reasons established in writing by the attending physician, QMHP, or facility administrator for refusing permission. (II)
	 65.25(15) Resident property. Each resident may retain and use personal clothing and possessions as space permits and provided use is not otherwise prohibited in these rules. (II)
	  a.   	 Residents shall be permitted to keep reasonable amounts of personal clothing and possessions for their use while in the facility. The personal property shall be kept in a secure location which is convenient to the resident. (II)
	  b.   	 Residents shall be advised, prior to or at the time of admission, of the kinds and amounts of clothing and possessions permitted for personal use, and whether the facility will accept responsibility for maintaining these items, e.g., cleaning and laundry. (II)
	  c.   	 Any personal clothing or possession retained by the facility for the resident shall be identified and recorded on admission and the record placed on the resident’s chart. The facility shall be responsible for secure storage of items. They shall be returned to the resident promptly upon request or upon discharge from the facility. (II)
	 65.25(16) Sharing rooms. Residents, including spouses staying in the same facility, shall be permitted to share a room, if available, if requested by both parties, unless reasons to the contrary are in the IPP. Reasons for denial shall be documented in the resident’s record. (II)
	 65.25(17) Choice of physician and pharmacy. Each resident shall be permitted free choice of a physician and a pharmacy. The facility may require the pharmacy selected to use a drug distribution system compatible with the system currently used by the facility. (II)