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NURSING HOSPITAL 60 BEDS
WITH NURSING COLLEGE
[CODE NO.4107]
Health care is gaining increasing importance in recent years. The concept of health care is emerging from providing treatment to the disease to the improvement of overall health status and also maintenance of good health.
India, a signatory to the “Alma Alta” declaration of 1978, is committed to the goal of “HEALTH FOR ALL” by the year 2000 A.D. In order to achieve the targets and thereby improving the health status of people in the country, tremendous efforts are required to be made not only by government but also by people. It is in this perspective development of health care assumes significant importance. New Challenges and new opportunities for investing in health care i.e. in hospitals and nursing homes etc. have arisen.
The expectation was that with adequate investments in health infrastructure and appropriate mix of Public health strategies, the country would be well-placed to meet this laudable goal. However, even in the target year, we can at best claim partial success in meeting the goal of a healthy population.
• Life expectancy in the country is still at 62 years as against the target of 64 years.
• Infant mortality rate is still hovers at 71 per 1000 live births against the target of below 60 per 1000
• People dyeing as a result of communicable diseases are 470 per 100000.
• Doctors per 1000 population : 0.41
• Hospital Beds per 1000 population in the country : 0.7
In the very beginning, there were government owned hospitals where one had to pay no money for treatment. Then, a private ward facility was started in the hospitals. The patient had to pay rent for a private room while medicines and doctors were available free of cost. The private ward helped the patient to avoid the untidiness of a general ward and noise etc. The patients, who were in a position to afford the room rent, were admitted to private rooms. The poor’s, however, got admission in rushed general wards.
Increasing negligence by the doctors of these hospitals and the overcrowding in them gave private hospitals to have a good business. No. of private hospitals began to come in light with all facilities for E.C.G.S, X-Rays, Laboratories, 24-hours emergency and admission facilities for ill persons, seriously injured in pregnant ladies. The medium class and high class families started preferring these private hospitals and nursing homes as one’s life is considered to be much costly and expenses for treatment can be neglected.
A medical college in meant to impart education of medical field to students to qualify them as doctors in different specialized disciplines so as to treat patients suffering from various ailments doctors with their dedicated spirit serve the nation at large by providing medication and treatment for eradication of diseases which exchanger health and add suffering to humanity. Normally a medical college is associated with a hospital.
Hospitals provide the facilities of O.P.D. and admission for seriously ill seriously injured, seriously burnt and pregnant ladies, causalities etc.
Presently, every city or town in india has no. of private hospitals furnished with latest medical facilities available and with more qualified surgeons, physicians and specialist doctors. Even sometimes, they are furnished with more modern machines than those available in the nearby Government Hospital. These hospitals can be seen well crowded as they provide very good service at a smile. As they are run by privates very good medical care is provided by them.
A private hospital is a place where one may get treatment from ordinary fever to a major surgery operation. As a matter of fact, no limitation has been made for the facilities available in a hospital. However, generally all private hospitals are provided with latest facilities and ultra modern machines. In a hospital, surgeons, physicians, E.N.T., specialists, children specialist, Eye-surgeon, psychologists and sex-specialist are essential.
WHAT LICENSE REQUIRED TO OPEN A NURSING HOME
AND THEIR PROCEDURE
Health care is the basic requirement and right of every citizen of the country. Nursing homes form the platform for this healthcare delivery, aided by doctors, nurses as well as other medical staff.
Necessary Licenses required opening a nursing home in India
Registration in accordance with the clinical establishment act (Registration and Regulation) Act, 2017
This act was enacted by the central government and is being adopted by states of India. It needs a one-time registration for a premise towards being operated as a nursing home. The registration is required to be done through the respective state government that has implemented this act. For registration, nursing homes should fulfill the minimum requirement under the category in which it falls. Each state has described the procedure of registration of the nursing homes that fall within their territory.
Registration of nursing home
Each state has its own Nursing Home Registration Act. The Act provides a minimum requirement for the building, employees, equipment and certain guidelines to be fulfilled by the nursing home.
The licenses that are required to start a nursing home in India are:
Permits
• Land and construction
A nursing home could be set up only on a Non-Agriculture land that could be used. The numerous approval, as well as permissions required from the local authority and the government should be obtained before starting any nursing home.
• Electricity and water
A nursing home needs approximately 100 liters of water per bed each day but it varies from different nursing homes. The permission from the concerned municipal authority is required to be obtained for making available the facilities of water as well as electricity.
• Sewage
Well planned sanitary measures for disposal of waste as well as drainage system which includes tanks, pipelines, etc. and the permission from the local authorities should be obtained.
• Biomedical Waste
The nursing homes must have an incinerator for disposal of bio-disposal waste, for instance, body parts or tissues. A nursing home is not able to afford such cost and it needs minimum space and additional machinery installations which are expensive for a nursing home set up. The permission from the Municipal Corporation shall be required for such removal of waste and it should not be injurious towards the individuals living at a neighboring location.
• Fire and Health License
Approval of the Fire Department is required for a nursing home as well as a health certificate from the local authority after the installation of all the beds and equipment within the nursing home. A NOC from the Fire department shall also be required for nursing home and it would be the responsibility of the nursing home management to prove that the nursing home shall not cause any damage or loss of life and requires being received from the local municipal council.
• Regulations relating to Employment of Staff
Employment of employees (Doctors, Nurses, Pharmacists) only after proper credentialing
Prevention of sexual harassment of women employee at the workplace
Responsibility of employer for the safety of workforces
Rules governing the employment of staff
Immunization / other measures for the protection of staff from Occupational Health hazards.
• Sign Boards
Rules for the size, contents as well as the correct place for signboards (IMC Regulations 2002)
• Information that requires is displayed at the nursing home are;
Certificate of registration of nursing home with the municipal authorities
IMC/SMC registration certificate (IMC Regulations, 2002)
Charges for consultation as well as other procedures/services (IMC Regulations 2002)
Clinic timings, closed days
• FSSAI license for operating a kitchen
This comes under the Food Safety and Standards Authority of India under the Ministry of Health and Family Welfare, Government of India. The license is necessary if the nursing home runs an in house kitchen for the patients as well as attendants.
• Permit to store LPG cylinder
If the nursing home stores a large quantity of LPG cylinder for usage in nursing home’s kitchen or any other purpose, it must take a permit from the Controller of Explosives under the Petroleum act, 1934.
• Pharmacy registration for medical shop
This comes under the Office of the Drug Controller. There are different licenses for medical shops attached to nursing homes (IP) and standalone medical shops. There are minimum requirements for the registration like the minimum size of the shop (250 – 300 ft) as well as requirements of Air conditioner and Refrigerator. This license is valid for a period of 5 years.
• Trademark registration
Indian Trademarks Act 1999 is not a mandatory activity and is essential only if the nursing home wants to trademark its logo or name
• Vehicle registration for ambulances
The ambulance bought by the nursing home must be registered under RTO, Transport Department, and state government.
• Arms licenses under arms act 1959
If arms are possessed by a nursing home or its employees (for example by security guards), a license for the same should be available.
• Waste disposal
Provisions are required to be made for the appropriate disposal of biomedical waste in order to avoid pollution. The compulsory permissions should be received from the State Pollution Board and arrangements made for eco-friendly removal of biomedical waste as directed through the board.
Planning the nursing home Infrastructure
One must take care of these things;
Qualifications of Doctors as well as their registration numbers
Working hours for Nurses as well as their shift timings
Medical equipment as well as instruments purchased
Computers as well as other hardware devices set up
Engineers as well as staffs required for maintenance, plumbing, medical gas pipelines, air conditioning, etc. set
The other important license required is:
• Licenses and regulations relating to Building Permit obtained from the Municipality)
• No objection certificate obtained from the Chief Fire Officer
• License under Bio-Medical Management and Handling Rules, 1998 (You are required to check whether the external agency is accredited towards disposing all biomedical wastes of the nursing home, a copy of their license shall be available with the nursing home, also one must check whether an MOU amid the agency and the nursing home is available.
• No objection certificate under the Pollution Control Act.
• Radiation Protection Certificate regarding all X-rays as well as CT Scanners from BARC.
• Excise permit towards storing spirit
• License to operate lifts under the Lifts and Escalators Act. (if applicable)
• Narcotics and Psychotropic substances Act, 1985
• Vehicle Registration Certificates (For all nursing home vehicles.)
• Atomic energy regulatory body approvals (For the structural facility of the radiology department, TLD badges, etc)
• Boilers Act, 1923(If applicable)
• Medical termination of pregnancy Act, 1971
• License for the Blood Bank (To be displayed in the Blood Bank)
• Transplantation of Human Organs Act 1994(If applicable)
• PNDT Act, 1996 (PNDT stands for Prenatal diagnostics test. To be displayed in the Radiology department that this is followed.)
• Dentist Regulations, 1976
• Drugs & Cosmetics Act, 1940
• Electricity Act, 1998
• ESI Act, 1948 (For contract employees)
• Environment Protection Act, 1986
• Fatal Accidents Act 1855
• Guardians and Wards Act, 1890
• Indian Lunacy Act, 1912 (Applicable only if a Psychiatry department is there in the nursing home).
• Indian Nursing Council Act 1947 (which has provisioned that whether the nurses are registered with NCI).
• Also, you are required to check whether pharmacists are registered with Pharmacy Council of India.
• Insecticides Act, 1968
• Lepers Act Maternity Benefit Act, 1961
• Indian Medical Council Act and the Code of Medical Ethics, 1956
• Minimum wages act, 1948 (For contract employees)
• National Building Code Persons with Disability Act, 1995
• Pharmacy Act, 1948
• Protection of Human Rights Act, 1993
• Registration of Births and Deaths Act, 1969
• SC and ST Act, 1989
• Urban Land Act, 1976
• Right to Information Act 2005
• Registration for transplantation of human organ Act, 1994 (in case the nursing home varies out human organ transplantation or organ harvesting, it shall be registered under this Act)
• License for provision of Psychiatric services (if the nursing home is providing a certain type of services like de-addiction, treatment of psychiatric disorders, child/adolescent psychiatric clinic, etc, then they must register with their state government).
• Excise permit to store spirit (in order to store spirit beyond a certain quantity, the nursing home must obtain a permit from state excise department)
Provisions for OPDs, Indoor, operation theatres, ICUs, Labour room etc. should be provided depending upon the type of facilities being offered. Nursing Homes should have their own Laboratory and Diagnostic (X-ray, Ultrasound etc.) facilities which should be established as per the norms indicated against such facilities or should have working arrangements with Laboratories, Blood Bank and other diagnostic centers. In case of Hospital or Nursing homes having 100 or more beds, it should have provision for emergency laboratory tests and mobile X-ray machine for emergency X- ray.
