The nursing home regulation covers the procedures and principles that state-run and private nursing homes are required to comply with, as established by the Ministry of Family, Labour and Social Services. The establishment of nursing homes dates back to the 11th century.
However, the first nursing home opened in our country after the establishment of the Republic began its operations in 1955. The Private Nursing Home Regulation, on the other hand, was created in 2008 in terms of the comprehensive operation of nursing homes. Shortly after its creation, it was published in the Official Gazette on 07.08.2008 and gained official status.
Private Nursing Home Regulation
The Private Nursing Home Regulation has undergone four different amendments over the years since 2008. This regulation is composed of six different sections. In total, there are 42 different procedural and substantive articles. The main purpose of the nursing home regulation is to set out provisions regarding the establishment procedures, staff composition, staff status, service standards of the nursing home, operating conditions, inspections, fees, transfer status, or closure of nursing homes that have been opened or are planned to be opened by real or private legal entities.
All provisions included in this regulation are implemented by the General Director of the Social Services and Child Protection Agency. If it is determined during inspections that any provision of the regulation has not been fulfilled, various sanctions may be imposed on nursing homes. These sanctions may take the form of administrative fines, temporary suspension of services, or legally closing the nursing home.
Regulation on Private Nursing Homes and Nursing Home Elderly Care Centers
The nursing home regulation was published in the Official Gazette on 07.08.2008.
Official Gazette Date: 07.08.2008
Official Gazette Number: 26960
Nursing Home Regulation – Section One
Purpose, Scope, Legal Basis, and Definitions
ARTICLE 1 – (1) The purpose of this Regulation is to determine the procedures and principles regarding the establishment procedures, service standards, staff status, operating conditions, fees, supervision, transfer, and closure of nursing homes and nursing home elderly care centers to be opened by real persons and private law legal entities.
Scope
ARTICLE 2 – (1) This nursing home regulation covers nursing homes and nursing home elderly care centers opened by real persons or private law legal entities.
Legal Basis
ARTICLE 3 – (1) This nursing home regulation has been prepared on the basis of subparagraph (g) of the first paragraph of Article 9 and Articles 34 and 35 of the Social Services and Child Protection Agency Law No. 2828 dated 24/5/1983.
Definitions
ARTICLE 4 – (1) In this Regulation:
a) General Directorate: The General Directorate of the Social Services and Child Protection Agency,
b) Nursing home: A social service institution with a minimum capacity of twenty, established by real persons or private law legal entities, providing twenty-four-hour residential services in order to protect and care for healthy elderly individuals in a peaceful environment and to meet their social, physical, and moral needs,
c) Nursing home and elderly care center: A social service institution with a minimum capacity of twenty, providing twenty-four-hour residential services to healthy elderly individuals and elderly individuals requiring special care in different sections of the same building,
ç) Provincial Directorate: The Provincial Directorate of Social Services,
d) District Directorate: The District Directorate of Social Services,
e) Institution: The nursing home and/or elderly care center,
f) Professional staff: The social worker, psychologist, (Amended phrase: OG-26/9/2008-27009) physician, physiotherapist, dietitian, and nurse working in the institutions,
g) Private law legal entities: Associations, foundations, and companies established in accordance with the provisions of private law,
ğ) Social service: The institutional unit composed of professional staff for the purpose of carrying out professional activities and programs to be implemented in a coordinated and effective manner,
h) Elderly person: A person who is at least fifty-five years old, who needs social, physical, and moral support, whose mental and psychological health is sound, and who requires institutional care;
1) Elderly person requiring special care: An elderly person who needs the support of others in cases such as age-related dementia, Alzheimer’s disease, severe paralysis, being bedridden, or other conditions requiring special care; who is identified by a physician’s report stating that there is no objection to staying in a nursing home or elderly care center, obtained from the psychiatry clinics of health institutions, provided that even if their mental and psychological health is not sound, they do not pose any adverse situation to other elderly individuals receiving services in nursing homes and elderly care services (Amended phrase: OG-26/9/2008-27009); who does not have a contagious disease or a disease requiring continuous medical care, or if they have a contagious disease, who is identified by a physician’s report stating that there is no objection to being cared for in collective living areas, obtained from the relevant departments of health institutions (Amended phrase: OG-26/9/2008-27009).
2) Healthy elderly: An elderly person whose mental and psychological health is sound, who can independently perform personal self-care, and who does not have a contagious disease or alcohol or drug addiction.
ı) (Amended: OG-2/6/2010-27599) Elderly care worker: A worker who has at least a fourth-level or equivalent certificate in the field of patient and elderly care in accordance with modular education programs from Health Vocational High Schools, Vocational High Schools, and higher education institutions’ departments related to aging, or who has completed short-term and progressive education programs and equivalent courses in the field of elderly and patient care in accordance with the Regulation on Non-Formal Education Institutions of the Ministry of National Education published in the Official Gazette dated 21/5/2010 and numbered 27587,
i) Elderly care center: A social service institution with a minimum capacity of twenty, providing twenty-four-hour residential services, which is opened within nursing homes or directly for this purpose in order to ensure the care and protection of elderly persons requiring special care,
j) Elderly care plan: A written plan prepared separately for each elderly person in elderly care centers, taking into account the characteristics and needs of the elderly person, approved by the responsible manager, and describing in detail the content and frequency of the services to be provided to the elderly person,
k) (Repealed: OG-2/6/2010-27599)
Shall mean.
Nursing Home Regulation – Section Two: Establishment and Procedures
Application to establish an institution
ARTICLE 5 – (1) Real persons or private law legal entities wishing to establish an institution shall apply to the Provincial/District Directorate with a petition.
(2) The petition shall state the name and address of the institution, as well as the identity and full address of the founder.
Conditions required of the founder
ARTICLE 6 – (1) The following conditions shall be required of persons who will establish an institution or take over an established institution:
a) To be at least a graduate of primary education or primary school,
b) To be a citizen of the Republic of Türkiye,
c) To have legal capacity to exercise civil rights,
ç) Except for negligent offenses and sentences converted to alternative sanctions instead of short-term imprisonment, or deferred judgments other than the offenses listed below; not having been convicted, even if pardoned, of crimes against the security of the State, simple or aggravated embezzlement, extortion, bribery, theft, fraud, forgery, breach of trust, fraudulent bankruptcy, or other disgraceful or dishonorable crimes, or crimes of smuggling, bid rigging in public tenders and procurements, or disclosure of State secrets,
d) The condition that the institution has not been closed due to activities contrary to the relevant regulations while being a founder of any social service institution shall be required.
(2) Private law legal entities may appoint a representative for establishment or transfer procedures.
(3) The conditions required for real persons shall also be sought for the representative.
(4) (Amended: OG-4/4/2012-28254) For legal entities structured as commercial companies, a declaration of the trade name indicating that the company announcement is within the scope of the institution’s establishment activities, the name of the trade registry office where it is registered and the trade registry number (if the trade registry gazette showing the company’s establishment status and latest management was published before 1/10/2003, the original or an institution-approved copy of the trade registry gazette), a declaration of the affiliated tax office name and tax identification number, the original or institution-approved copy of the notarized signature circulars, and a provincial directorate-approved document and decision copy showing that the company representative is among the shareholders shall be required.
(5) (Amended: OG-31/7/2009-27305) For legal entities structured as foundations, associations, unions, or chambers, a provincial directorate-approved document and decision copy showing that the representative designated by the legal entity is a member of the board of directors, and a document showing that the establishment of the institution is included in the foundation deed or association charter shall be required.
Documents required for opening permit
ARTICLE 7 – (Amended: OG-31/7/2009-27305)
(1) The founder must prepare a file containing the documents listed below and submit it to the Provincial Directorate in two copies. If the application is made to the district directorate, the documents shall be prepared in three copies.
a) For the founder and the responsible manager:
1) Declaration of Turkish Identity Number,
2) The original or an administration-approved copy of the document showing educational status,
3) A written declaration stating that there is no criminal record,
4) A written declaration stating that there is no condition preventing the continuous performance of duties,
5) An employment contract to be concluded between the responsible manager and the founder shall be required.
b) For the institution building:
1) Building occupancy permit or a structural report to be obtained from the relevant departments of universities,
2) A copy of the title deed of the building or the lease agreement,
3) A report to be obtained from the fire department regarding fire safety,
4) If the institution has a special care unit or if the institution provides services directly as a care home, a suitability report to be obtained from the provincial health directorate shall be required.
Procedures to be carried out for opening permit
ARTICLE 8 – (1) The following procedures shall be carried out for the opening permit.
a) By the Provincial or District Directorate;
1) The physical conditions of the institution,
2) Its furnishings,
3) Its capacity to be determined by taking into account the width of the bedrooms and the adequacy of other sections of the institution,
4) Necessary procedures regarding the opening permit report shall be carried out by professional staff assigned at the Provincial/District Directorate concerning the general suitability for service.
b) (Amended: OG-31/7/2009-27305) If the application is made to the provincial directorate; provided that all prepared documents comply with the determined principles, the opening of the institution for service shall take place upon the proposal of the provincial directorate and the approval of the governorship. One of the files whose documents are approved by the provincial directorate shall remain at the provincial directorate. The second shall be delivered to the founder against signature after the opening permit document is issued. A copy of the opening approval shall be sent to the General Directorate for information.
c) If the application is made to the district directorate, the same procedure shall be followed, and one set of the prepared files and a copy of the opening approval shall be sent to the district directorate.
ç) It is mandatory to conclude employment contracts between the founder and all personnel employed in the institutions. The institution for which the opening permit document has been issued and whose personnel has been completed shall commence service.
d) The opening permit document must be displayed in a visible place within the institution.
e) The employer and workplace name and the type of work performed by each institution granted an opening permit shall be notified by the Provincial Directorate within one month to the regional labor directorate to which that place is affiliated.
Admission of elderly persons to the institution
ARTICLE 9 – (1) Elderly persons shall be admitted to the institution for which opening approval has been obtained from the governorship and an opening permit document has been issued, and the institution shall commence service.
(2) The activities of places providing unauthorized services under the name of nursing homes and/or nursing home elderly care centers without obtaining opening approval from the governorship and without an opening permit document shall be suspended, and the provisions of Article 32 shall be applied.
Personnel work permit
ARTICLE 10 – (1) Personnel work permits shall be granted within the framework of the following principles.
(a) The founder and the responsible manager of an institution that has been granted an opening permit shall, within at most one month from the date of receiving the opening permit, prepare the documents specified in subparagraph (a) of the first paragraph of Article 7 in two copies for each personnel to be employed in the institution and submit them to the Provincial/District Directorate.
(b) (Amended: OG-31/7/2009-27305) The Provincial Directorate evaluates these documents of the personnel in terms of compliance with the conditions specified in the third section of the nursing home regulation and approves them within one month.
(c) If the recruited personnel does not commence duty, this situation shall be notified by the employer to the Provincial Directorate and the regional labor directorate.
(ç) The first copy of the personnel documents and work approval shall be kept at the Provincial/District Directorate, and the second copy shall be kept at the institution. Personnel not approved by the Provincial Directorates may not work. The same procedure shall apply to newly recruited personnel.
(d) Personnel shall be required to carry a photo identification card approved by the Provincial/District Directorates during working hours at the institution.
(e) In the event that the responsible manager takes leave for various reasons, the most senior professional staff member present at the institution who has the qualifications specified in the second paragraph of Article 13 shall be appointed as an acting manager for a maximum period of one month. The Provincial Directorate shall be informed about the identity of the staff member on leave and the acting manager. In case of a change of the responsible manager, the approval of the Provincial Director shall be required.
(f) It is mandatory to employ a responsible manager, social worker, (Amended phrase: OG-26/9/2008-27009) physician, nurse, elderly care worker, and cook in institutions.
(g) In cases where elderly persons whose mental and psychological health is not sound are admitted to elderly care centers, it is mandatory to employ a psychiatry specialist physician (Amended phrase: OG-26/9/2008-27009) on a full-time or part-time basis by concluding a service contract.
(ğ) (Amended: OG-6/7/2011-27986) In nursing homes and/or elderly care centers, healthcare personnel holding the titles of physiotherapist, dietitian, and technician may be employed on a full-time or part-time basis. However, their duties and responsibilities are limited to their own professional legislation.
Procedures to be carried out for transfer and relocation
ARTICLE 11 – (1) The following procedures shall be carried out for transfer and relocation.
a) (Amended: OG-2/6/2010-27599) In the transfer of the institution, the parties shall apply to the Provincial/District Directorate within thirty days from the date of transfer with a transfer deed to be obtained from a notary. In addition to the transfer deed, the persons who will take over the institution shall be required to prepare, in three copies, the documents specified in subparagraph (a) of the first paragraph of Article 7 and subparagraph (2) of paragraph (b).
b) In the relocation of the institution to another address, the founder shall apply to the Provincial/District Directorate with a petition containing the address of the new building. As a result of the on-site inspection to be carried out by the Provincial/District Directorate, a status report regarding the building and a temporary permit document shall be prepared. If the temporary permit document is issued by the district directorate and the building is also found appropriate by the provincial directorate, the founder shall be requested to prepare, in three copies, the documents specified in subparagraph (b) of the first paragraph of Article 7. The relocation process of an institution that does not obtain the opening permit document within three months shall be cancelled. Photographic documents showing the furnishing of the institution shall be submitted to the Provincial Directorate in three copies within one month following the relocation.
c) The documents prepared in three files for transfer and relocation shall be submitted by the Provincial Directorate for the approval of the governorship. After approval, the opening permit document shall be issued. One of the files and a copy of the approval shall be sent to the General Directorate.
ç) (Amended: OG-2/6/2010-27599) The existing permits of real persons and private law legal entities that carry out transfer or relocation, or take over or accept relocation without notifying the Provincial Directorate shall be revoked.
(2) With regard to the establishment of institutions, transfer, relocation, and employment of personnel, matters not specified in this nursing home regulation shall be handled in accordance with general provisions.
Branch opening procedures
ARTICLE 12 – (1) For branch opening permits, the same procedures as those for opening a new institution shall be applied. A separate responsible manager and personnel shall be employed for each branch.
Nursing Home Regulation – Section Three
Qualifications, Duties, Powers, and Responsibilities of Personnel
Responsible manager
ARTICLE 13 – (1) The responsible manager is primarily responsible for ensuring that all administrative, financial, and technical affairs of the institution are carried out in accordance with their purpose, and for providing the best possible care and protection of the elderly, as well as meeting their physical, social, and moral needs.
(2) (Amended: OG-31/7/2009-27305) Persons to be appointed as responsible managers must be graduates of at least four-year higher education programs. Founders who meet this qualification may also serve as the responsible manager of the institution.
(3) One person may not serve as the responsible manager of more than one institution and may not work in another job during working hours.
(4) The responsible manager is responsible for carrying out the administrative, financial, and technical affairs of the institution in accordance with the relevant legislation, and their duties and powers are specified below.
a) To take measures to ensure the care and protection of the elderly and to meet all their needs, to assign duties among staff, and to supervise them,
b) To ensure the completion of standard forms sent by the General Directorate, to follow up on them, to ensure that numerical data are submitted to the relevant authorities, and to conduct all correspondence related to the elderly within the framework of the institution’s internal service directive,
c) To ensure that personnel files are maintained and that all procedures and correspondence are carried out in accordance with the relevant legislation and the institution’s internal service directive,
ç) To organize, approve, and ensure the implementation of the center’s working programs and hours,
d) To ensure communication between the Provincial/District Directorate and the institution.
Social worker
ARTICLE 14 – (1) A social worker is personnel who has received at least four years of education in departments of universities providing education in the field of social services.
(2) The duties and powers of the social worker are specified below.
a) To provide information about the institution to elderly persons applying for admission and their relatives, to ensure the preparation of documents required for application, to conduct social assessments and prepare social assessment reports, to place applications in order, file them, to conduct and follow up internal and external correspondence of the institution on matters within the professional field,
b) To ensure the adaptation of elderly persons admitted to the institution, to identify the problems of elderly persons experiencing adaptation difficulties, and to take part in efforts aimed at resolving such problems,
c) To monitor the psycho-social status of the elderly, to assist in resolving their problems by using individual, group, and community work methods, and to prepare necessary reports,
ç) To regulate the social relations of the elderly with their immediate environment, to assist in their development, and to conduct professional work with their relatives when necessary,
d) To organize social and cultural activities and to ensure the participation of the elderly in these activities,
e) To work together with other professional staff in promoting the institution to the environment and society,
f) To ensure that the standard forms requested by the Provincial Directorate are prepared in full and on time and submitted to the Provincial Directorate,
g) To take part in in-service training programs to be prepared by the institution on matters within the professional field, to prepare in-service training programs on professional subjects when deemed necessary, and to ensure that information is provided to the Provincial Directorate.
(3) The social worker carries out the duties listed above within the social service unit to be established in the institution, in cooperation with other professional staff and as part of a team effort.
(4) In nursing homes with a capacity of up to fifty and in elderly care centers with a capacity of up to thirty, one social worker shall be employed on a full-time or part-time basis. If the responsible manager is a social worker, an additional social worker may not be required. Where the capacity is fifty or more in nursing homes and thirty or more in elderly care centers, it is mandatory to employ one social worker on a full-time or part-time basis for every fifty and/or thirty elderly persons. A social worker may work part-time at another nursing home and/or elderly care center, provided that the days and hours do not overlap.
Psychologist
ARTICLE 15 – (1) A psychologist is personnel who has received at least four years of education in departments of universities providing education in the field of psychology.
(2) The duties and powers of the psychologist are specified below.
a) To conduct psychological assessments of elderly persons to be admitted to the center when necessary, to identify their problems and attempt to resolve these problems by establishing professional relationships with the elderly person and their close environment, to prepare relevant professional reports, and when necessary, to liaise with hospitals, psychiatry clinics, and similar institutions to carry out case follow-up,
b) To conduct psychological assessments of elderly persons admitted to the institution, to monitor them during the adaptation process, and to assist them in resolving their problems when necessary by establishing relationships with their relatives,
c) To enable elderly persons to engage in various activities according to their abilities and interests, to contribute to activities that help them make use of their free time, and to ensure their participation in organized social and cultural activities,
ç) To prepare elderly persons who will leave the institution at their own request or at the request of their relatives for their new life,
d) To take part in cooperation with official and voluntary organizations for the purpose of promoting the institution to the environment and society, and in the planning and programming of voluntary activities,
e) To take part in in-service training programs to be prepared within the institution on matters related to the service area.
(3) The psychologist carries out the duties listed above within the social service unit, in cooperation with other professional staff.
(4) In institutions with a capacity of up to fifty, one psychologist may be employed on a full-time or part-time basis. If the responsible manager is a psychologist, an additional psychologist may not be required in institutions with a capacity of up to fifty. A psychologist may work part-time at another nursing home and/or elderly care center, provided that the days and hours do not overlap.
Physician (Amended phrase: OG-26/9/2008-27009)
ARTICLE 16 – (1) The duties and powers of the (Amended phrase: OG-26/9/2008-27009) physician are specified below.
a) To conduct medical evaluations of the elderly cared for in the institution, to establish contact with the elderly person’s (Amended phrase: OG-26/9/2008-27009) physician who has been diagnosed and whose treatment has been planned by health institutions/organizations, and to carry out follow-up in line with recommendations,
b) To conduct regular health checks of the elderly and ensure that a health file is prepared for each elderly person,
c) To notify the relevant institutions in cases of contagious diseases and to ensure that protective, preventive, and therapeutic measures are taken,
ç) To ensure and monitor compliance of the institution and its personnel with hygiene rules,
d) To make proposals to the institution’s administration for the provision of medicines, medical consumables, and other tools and equipment needed during service delivery, to keep existing items ready for service at all times, and to ensure the preparation and monitoring of necessary medical records,
e) In the absence of a dietitian at the institution, to guide studies related to the dietary programs and nutrition of the elderly,
f) To prepare and conduct in-service training programs on medical subjects for institution personnel.
(2) The (Amended phrase: OG-26/9/2008-27009) physician works in cooperation with the responsible manager and other healthcare personnel in the delivery of health services.
(3) (Amended paragraph: OG-6/7/2011-27986) It is mandatory to employ one physician on a full-time or part-time basis in every institution. If the responsible manager is a physician, an additional physician may not be required in institutions with a capacity of up to fifty. If the institution’s capacity exceeds fifty, one physician shall be employed for every fifty elderly persons on specified days and hours of the week. The working hours of this physician may not be less than two hours per day and ten hours per week. In Elderly Care Centers, a psychiatry specialist physician shall also be employed on a full-time or part-time basis.
Nurse/Health Officer (Amended Title: OG-6/7/2011-27986)
ARTICLE 17 – (1) The duties and powers of the nurse are specified below.
a) To prepare elderly persons for medical examinations, to administer treatments, to monitor temperature, pulse, respiration, and blood pressure, to ensure that necessary measures are taken to support the daily living activities of the elderly, and to carry out checks,
b) To provide first aid required by the profession in emergency situations and to inform the (Amended phrase: OG-26/9/2008-27009) physician,
c) To take and ensure the taking of necessary measures in cases of contagious diseases,
ç) To prepare the medication tracking log to be created for the elderly together with the (Amended phrase: OG-26/9/2008-27009) physician and keep it ready for inspections,
d) To accompany elderly persons referred to healthcare institutions when necessary and to take required actions upon discharge,
e) To carry out work to ensure compliance with the institution’s general hygiene conditions and to manage matters related to the infirmary and isolation room,
f) To be responsible for the cleanliness, laundry, body hygiene, and order of the elderly persons’ beds, clothing, and personal care,
g) To oversee meal distribution in the unit for which they are responsible and to assist elderly persons during meals, helping those who have difficulty eating,
(4) In nursing homes with a capacity of up to fifty and elderly care centers with a capacity of up to thirty, one social worker shall be employed on a full-time or part-time basis. If the responsible manager is a social worker, an additional social worker may not be required. In cases where the capacity is fifty or more in nursing homes and thirty or more in elderly care centers, it is mandatory to employ one social worker, full-time or part-time, for every fifty and/or thirty elderly persons. A part-time social worker may work in another nursing home and/or elderly care center provided that working days and hours do not overlap.
Psychologist
ARTICLE 15 – (1) A psychologist is personnel who has completed at least four years of education in departments providing psychology education at universities.
(2) The duties and responsibilities of the psychologist are listed below.
a) To conduct psychological assessments of elderly persons to be admitted to the center when necessary, identify their problems, attempt to resolve these problems by establishing professional relationships with the elderly and their close relatives, prepare relevant professional reports, and when necessary, contact hospitals, psychiatric clinics, and similar institutions to carry out case follow-up,
b) To conduct psychological assessments of elderly persons admitted to the institution, monitor them during the adaptation phase, and assist in resolving their problems by establishing relationships with their relatives when necessary,
c) To ensure that elderly persons are engaged in various activities according to their abilities and interests, contribute to activities that help them utilize their leisure time, and ensure their participation in organized social and cultural activities,
ç) To prepare elderly persons who will leave the institution at their own request or that of their relatives for their new life,
d) To take part in cooperation with official and voluntary organizations and in planning and programming voluntary activities in order to promote the institution to the community and society,
e) To take part in in-service training programs to be prepared within the institution on matters related to the service field.
(3) The psychologist carries out the duties listed above within the social service unit in cooperation with other professional staff.
(4) In institutions with a capacity of up to fifty, one psychologist may be employed on a full-time or part-time basis. If the responsible manager is a psychologist, an additional psychologist may not be required in institutions with a capacity of up to fifty. A part-time psychologist may work in another nursing home and/or elderly care center provided that working days and hours do not overlap.
(Amended phrase: OG-26/9/2008-27009) Physician
ARTICLE 16 – (1) (Amended phrase: OG-26/9/2008-27009) The duties and responsibilities of the physician are listed below.
a) To conduct medical evaluations of elderly persons receiving care at the institution, establish contact with the physician of elderly persons whose diagnosis and treatment plan have been determined by health institutions/organizations, and follow up in line with recommendations,
b) To conduct regular health check-ups of elderly persons and ensure that a health file is prepared for each elderly individual,
c) To notify relevant institutions in case of contagious diseases and ensure that protective, preventive, and therapeutic measures are taken,
ç) To ensure and monitor compliance of the institution and its personnel with hygiene rules,
d) To make proposals to the institution management for the provision of medicines, medical consumables, and other tools and equipment needed during service, ensure that existing supplies are kept ready for use at all times, and ensure the preparation and monitoring of necessary medical records,
e) In the absence of a dietitian at the institution, to guide studies related to diet programs and nutrition of elderly persons,
f) To prepare and conduct in-service training programs on medical matters for institution personnel.
(2) (Amended phrase: OG-26/9/2008-27009) Physician works in cooperation with the responsible manager and other health personnel in the provision of health services.
(3) (Amended paragraph: OG-6/7/2011-27986) It is mandatory to employ one physician on a full-time or part-time basis in each institution. If the responsible manager is a physician, an additional physician may not be required in institutions with a capacity of up to fifty. If the institution’s capacity exceeds fifty, one physician shall be employed for every fifty elderly persons on specified days and hours of the week. The working hours of this physician may not be less than two hours per day and ten hours per week. In Elderly Care Centers, a psychiatrist specialist physician shall also be employed on a full-time or part-time basis.
Nurse/Health Officer (Amended Title: OG-6/7/2011-27986)
ARTICLE 17 – (1) The duties and responsibilities of the nurse are listed below.
a) To prepare elderly persons for examination, administer treatments, monitor temperature, pulse, respiration, and blood pressure, ensure that necessary measures are taken to support daily living activities of elderly persons, and carry out controls,
b) To provide first aid required by the profession in emergency situations and inform the physician,
c) To take and ensure the implementation of necessary measures in cases of contagious diseases,
ç) To prepare the medication follow-up register for elderly persons together with the physician and keep it ready during inspections,
d) To accompany elderly persons referred to health institutions when necessary and take required actions in case of discharge,
e) To carry out activities to ensure compliance with general hygiene conditions of the institution and manage tasks related to the infirmary and isolation room,
f) To be responsible for the cleanliness and order of elderly persons’ beds, laundry, and personal hygiene,
g) To be involved in meal distribution in the section they are responsible for and assist elderly persons while eating, especially those who have difficulty eating,
ğ) In institutions without a dietitian, to ensure the implementation of nutrition and diet programs deemed appropriate by the physician or dietitian, ensure that the kitchen and food service areas comply with hygiene conditions, supervise kitchen staff’s compliance with necessary cleaning rules, and take part in ensuring annual carrier examinations of elderly persons and staff.
(2) The nurse performs duties in cooperation with other service staff within the health unit.
(3) (Amended paragraph: OG-6/7/2011-27986) It is essential that at least one nurse/health officer be employed on a full-time basis in each nursing home/elderly care center. For every capacity of thirty or more, one nurse/health officer or a health personnel with a technician title working full-time under the responsibility of this personnel shall be employed.
Elderly Care Assistant
ARTICLE 18 – (1) The duties and responsibilities of the elderly care assistant are listed below.
a) To perform all services related to the physical care of elderly persons and assist with nutrition when necessary,
b) To assist in organizing and maintaining order in the elderly person’s room/section and belongings,
c) To assist in meeting the social and physical needs of elderly persons,
ç) To report important incidents encountered during the time spent with elderly persons and elderly persons who become ill to the unit supervisor,
d) To carry out other duties and services in line with plans and programs prepared for elderly persons within the institution.
(2) Elderly care assistants are responsible to the responsible manager, social service, and health unit.
(3) (Amended paragraph: OG-6/7/2011-27986) It is mandatory to employ one care assistant in eight-hour shifts in institutions. In nursing homes, if the capacity exceeds forty, one care assistant shall be employed for every fifteen elderly persons for daytime shifts; in special care units and Elderly Care Centers, if the capacity exceeds twenty-four, one elderly care assistant shall be employed for every ten elderly persons. The working system of care assistants is specified in detail in the institution’s internal service directive.
(4) Institutions providing affiliated services under this nursing home regulation may employ elderly care assistants through outsourced services if deemed necessary and if their qualifications are appropriate.
(5) Elderly care assistants may not be employed in cleaning and other tasks of the institution.
Cook
ARTICLE 19 – (1) The cook is responsible for preparing and serving meals in accordance with health conditions.
(2) In each institution with a capacity of up to fifty, at least one cook shall be employed; in each institution with a capacity exceeding fifty, an additional assistant cook shall be employed.
(3) The cook must hold a certificate or qualification document. If the institution purchases meals, personnel related to service shall be assigned.
Other Personnel
ARTICLE 20 – (1) It is mandatory to employ a sufficient number of personnel for cleaning services.
(2) Depending on needs, personnel such as office staff, technicians, drivers, watchmen, and security personnel may be employed in the institution.
(3) The working conditions and principles of these personnel, who perform and bear responsibility for all kinds of work related to their fields, are determined by the responsible manager of the institution.
Nursing Home Regulation – Section Four
Physical Features and Institutional Units
Location of the Building
ARTICLE 21 – (1) (Amended paragraph: OG-6/7/2011-27986) The institution shall be opened for service in a building that is independent in terms of entrance, exit, and operation. Throughout the building, only services for elderly persons shall be provided. Care shall be taken to ensure that the building is located in or near the city center and has a garden with sufficient space where elderly persons can walk and rest.
(2) The location of the building must be suitable and safe in terms of traffic for the arrival and departure of elderly persons.
(3) (Amended: OG-2/6/2010-27599) In nursing homes, elevators are mandatory in buildings with ground floor + 2 floors; in nursing homes with special care units and in elderly care centers, elevators are mandatory in buildings with ground floor + 1 floor and above. In ground floor + 1 floor nursing homes, if the special care unit is located on the entrance floor of the building, an elevator is not required.
(4) (Additional paragraph: OG-6/7/2011-27986) Institutions may not be opened in buildings adjacent to places where flammable or explosive substances are sold or manufactured.
Fire Protection and Heating
ARTICLE 22 – (1) The institution shall have a sufficient number of fire extinguishing tools and equipment, and necessary precautions against fire shall be taken.
(2) It is mandatory to prepare a civil defense plan in the institution.
(3) Within two months after the issuance of the operating permit, a civil defense plan to be implemented in case of fire, sabotage, and earthquake shall be prepared and submitted to the Provincial Directorate.
(4) The building shall be heated by a safe central heating system.
Institutional Units and Their Features
ARTICLE 23 – (1) In each institution, in accordance with the physical conditions and facilities of the building, there shall be an administration room, social service unit, physical therapy unit, infirmary, bedrooms, sitting rooms and corners, dining hall, kitchen, bathroom, toilet, laundry room, and other necessary sections. These sections must be of a size sufficient to meet the determined capacity. At the entrance, there shall be an information desk, a telephone booth, and an alarm panel, and elevators shall be available in multi-storey buildings.
a) A room shall be arranged for the responsible manager, furnished with appropriate equipment, wide enough to accommodate at least ten people, and containing special cabinets for storing administrative documents.
b) Social service;
1) In each institution, a suitable space within the administrative section, easily accessible to elderly persons and their relatives, shall be designated as the social service unit where social service staff can carry out professional activities.
2) Since the social service unit is the section where professional activities are carried out and confidential information about elderly persons is kept, it shall be arranged appropriately.
c) Bedrooms;
1) Bedrooms may be arranged as single, double, triple, or quadruple rooms. Excluding bathrooms and toilets, single rooms shall be 9–12 m², double rooms 16–18 m², triple rooms 20–24 m², quadruple rooms 30–34 m², and the floor-to-ceiling height shall be at least 2.60 meters.
2) Rooms shall be furnished in a way that allows elderly persons to watch the outside through the windows. Beds may not be placed adjacent to each other, and furniture may not be arranged in a way that restricts the free movement of elderly persons within the room. Each room shall be equipped with a staff call bell system.
3) Each elderly person shall be provided with one bed, one bedside cabinet, one wardrobe, one armchair, and one chair, and each room shall contain a table or coffee table.
4) (Amended sentence: OG-2/6/2010-27599) Except for centers opened before the entry into force of this nursing home regulation, it is mandatory for single-occupancy bedrooms to have a washbasin, shower, and toilet. In bedrooms with two or more beds, care shall be taken to arrange shower, washbasin, and toilet sections provided that physical conditions are sufficient. On floors where there are rooms without showers, washbasins, and toilets, one shower, one washbasin, and one toilet section shall be arranged separately for men and women.
5) The capacity of nursing homes shall be determined based on the size of the bedrooms. However, care shall be taken to ensure capacity compatibility between bedrooms and other sections, and that these sections are of sufficient size to meet the determined capacity.
ç) Sitting rooms and corners;
1) Sitting rooms shall be arranged so that elderly persons can chat, watch television, and play age-appropriate games. A separate sitting room shall be designated for elderly persons who smoke.
2) If the physical conditions of the building are suitable, sitting corners with a view shall be arranged in corridors.
d) Dining hall;
1) The dining hall shall contain tables and chairs that are easy to clean. Adequate ventilation shall be provided.
2) There may be a single dining hall in the institution, or separate dining halls may be arranged on different floors.
e) Kitchen;
1) The kitchen shall be located in a bright area and be suitable for being kept continuously clean and orderly.
2) Kitchen walls and floors shall be covered with materials that are easy to clean. Equipment and utensils used for cooking and serving food shall be made of steel, and shelves and cabinets shall be available for their storage. Separate sinks shall be available for washing vegetables and dishes, and adequate ventilation shall be ensured.
3) In addition, small kitchens may be arranged where elderly persons can prepare tea, coffee, and meals and wash dishes whenever they wish.
f) Laundry room;
1) A section shall be arranged where laundry is washed, dried, and ironed.
2) In addition, areas may be arranged with sinks and household-type washing machines where elderly persons can wash their laundry when they wish, and with facilities for hanging laundry.
g) Bathrooms and showers;
1) In the institution, a sufficient number of showers and bathrooms shall be available in addition to the showers in bedrooms.
2) In bathrooms, measures shall be taken to prevent elderly persons from slipping; horizontal and vertical grab bars to assist sitting and standing shall be fixed in appropriate places, and a call bell shall be available.
ğ) Toilets and washbasins;
1) In the institution, a sufficient number of squat and seated toilets shall be available separately for male and female elderly persons. Measures shall be taken in toilets to prevent slipping, and horizontal and vertical grab bars shall be fixed in appropriate places.
2) Toilet door locks must be capable of being opened from both the inside and the outside.
3) Toilets shall contain a sufficient number of washbasins and mirrors at standard height.
4) Appropriate sinks shall be provided to enable elderly persons to wash their feet.
5) Flush mechanisms must be positioned at a height reachable by elderly persons.
h) Other sections;
1) A special section shall be arranged in the institution where all health-related services are provided and where equipment and tools are located. Necessary medicines, first aid, and treatment materials shall be kept in this section.
2) In addition, a section shall be arranged where elderly persons can fulfill their religious duties, as well as areas such as a library, workshop, and sports areas where they can spend their leisure time.
3) The entrance, corridors, and stairways of the institution shall be adequately illuminated; stairways shall have horizontal handrails along the walls in addition to banisters. Elevator cabins must contain grab bars and seating.
4) All sections of the institution shall be regularly treated against pests at appropriate intervals in a manner that does not harm elderly persons or food.
5) In nursing homes, there shall be a garden where elderly persons can go out, walk, sit, get fresh air, and spend their free time, providing at least three square meters of space per elderly person.
Special Care Unit
ARTICLE 24 – (1) The special care unit is the place where the care and protection of elderly persons having the characteristics specified in subparagraph (1) of paragraph (h) of the first clause of Article 4 are provided.
(2) Elderly persons who do not have sound mental and psychological health but who will benefit from nursing home/elderly care center services must be cared for in different sections of the institution or in separate buildings. If care services are provided within the same center to elderly persons with different characteristics, separate sections shall be created in accordance with these characteristics, and measures shall be taken to prevent uncontrolled passage between these sections. All necessary safety measures shall be taken to prevent elderly individuals from harming each other or themselves due to disabilities or health problems.
(3) The institution may provide services directly as an elderly care center for special care elderly persons, or it may provide services as both a nursing home and an elderly care center in separate units within the same building for nursing home elderly persons and special care elderly persons.
(4) The special care unit shall;
a) Have room doors with a minimum width of 80 cm to allow passage of wheelchairs and walkers,
b) Have rooms arranged in a way that allows movement of wheelchairs and walkers,
c) Have a mattress protector placed between the bed and the sheet,
ç) Have a staff call bell system installed at the head of each bed,
d) Ensure continuous availability of hot water in the central system of the institution,
e) Have floor surfaces covered with materials suitable for frequent and easy cleaning, and walls covered with wipeable materials,
f) Take necessary measures for ventilation and install insect-preventive screens on windows,
g) Ensure that elderly beds have features that prevent pressure sores
is required.
Services to be provided in the special care unit
ARTICLE 25 – (1) In these units, it is required to feed the elderly, assist them with bathing, perform daily and immediate personal hygiene, assist with toileting needs, clean and change those using diapers, change clothing and bed linens daily and when necessary, clean beds, transport elderly persons to and from other sections within the institution, assist with exercises, perform wound care, administer medications regularly, monitor blood pressure and injections, and assign accompanying staff for those referred to health institutions or hospitalized.
(2) Diets shall be prepared by a dietitian in accordance with the physician’s recommendations.
(3) For elderly persons who have sound mental and psychological health, do not require continuous medical care, but are severely paralyzed, disabled, bedridden, or require special care due to conditions such as dementia or Alzheimer’s, special care units may be established within nursing homes, or the institution may provide services solely for this purpose.
Nursing Home Regulation – Section Five
Services and Operation
Procedure to be followed for admitting elderly persons to the institution
ARTICLE 26 – (1) (Amended: OG-31/7/2009-27305) The requirement for admission to the institution is that the elderly person be fifty-five years of age or older. However, admission of persons under fifty-five years of age in mandatory cases shall be carried out upon the proposal of the responsible manager and the approval of the provincial directorate, based on the result of a social assessment report.
(2) For the admission of elderly persons to the institution;
a) Petition,
b) (Amended: OG-31/7/2009-27305) Declaration of Republic of Türkiye Identification Number,
c) A health report obtained solely from the relevant departments of private or public health institutions indicating that the elderly person does not have a contagious disease, or if a contagious disease exists, that it is not a contagious disease that prevents staying in collective living areas according to an infectious diseases and clinical microbiology specialist; proving that the elderly person has sound mental and psychological health or has the characteristics specified in subparagraph (1) of paragraph (h) of the first clause of Article 4; that the elderly person is not addicted to drugs or alcohol; and stating that the elderly person is suitable to benefit from nursing home or elderly care center services. If the elderly person has another chronic disease requiring medical follow-up, this shall also be specified in the physician’s report obtained from the specialist of the relevant department or clinic.
(3) No discrimination shall be made among elderly persons to be admitted to the institution on the basis of race, color, gender, language, nationality, religion, political opinion, philosophical belief, or education, and past convictions shall not be taken into consideration.
(4) Elderly persons whose documents are completed and arranged and who are evaluated according to the social assessment report shall be admitted to the institution, placed on a waiting list, or rejected.
Determination of fees
ARTICLE 27 – (1) The monthly care fee of the institution shall be determined by a commission consisting of the Provincial Director, representatives from the Metropolitan Municipality/Municipality, Treasury, Provincial Directorate of Industry and Trade, and a representative selected from among the founders of institutions within the province, under the chairmanship of the Governor or a Deputy Governor appointed by the Governor. Fees exceeding the determined amount may not be charged.
(2) The commission shall convene in the first week of December each year to determine the monthly care fees for the following year.
(3) The fee shall be determined by taking into account increases in the cost of living index and wholesale price indices, socio-economic conditions, personnel, nutrition, rent, heating, maintenance, other current expenses, and depreciation, with the addition of a profit margin.
(4) The commission shall determine the monthly care fees within the province as minimum and maximum limits.
(5) The determined fee shall be submitted for approval to the governorship. Upon approval, it shall enter into force as of January. A copy of the approved fee shall be sent to the General Directorate.
(6) The monthly care fee includes accommodation, nutrition, medication follow-up, injections, wound care, blood pressure measurement, simple medical interventions, diaper, and cleaning service expenses. No additional fee may be charged from the elderly person or their relatives for these services.
(7) Each institution is obliged to provide free care to elderly persons at a rate of at least 5% of its capacity. Elderly persons to be cared for free of charge shall be determined by the Provincial Directorate.
Collection of fees
ARTICLE 28 – (1) Upon admission of the elderly person to the institution, a deposit equal to one month’s care fee shall be collected. The monthly care fee shall be collected after the service is provided, and a receipt shall be issued. Receipts must be presented during inspections.
(2) If the elderly person leaves the institution of their own free will, the collected deposit shall not be refunded. The deposit shall be offset against the monthly care fee.
(3) In the event of the elderly person’s death, the care fee corresponding to the number of days cared for and any outstanding debt shall be deducted, and the remaining amount shall be refunded.
(4) If, over time, the deposit amount becomes lower than the nursing home fee, no additional fee may be requested from the elderly person or their relatives.
(5) In elderly care centers, no additional fee may be charged on top of the monthly care fee for elderly persons whose mental and psychological health is not sound.
(6) (Added: OG-31/7/2009-27305) No letter of commitment regarding the length of stay shall be requested from elderly persons admitted to the institution, and no contract shall be executed.
Temporary and Day Care
ARTICLE 29 – (1) Within the capacities specified in the opening approval of the institutions, elderly persons may be admitted for temporary inpatient or day care, limited to the number of vacant beds, with the approval of the Provincial/District Directorate. With regard to such care;
a) The documents regarding the admission conditions of elderly persons to nursing homes and centers shall be prepared,
b) They shall comply with the existing rules of the institution during their stay,
c) They shall benefit from the daily services provided to the residents of the institution, and for each elderly person admitted for day care, a bed shall be allocated within the capacity,
ç) Those staying as inpatients for a temporary period shall pay the fee of the room in which they stay, while those receiving day care shall pay 50% of the monthly base care fee determined annually on a provincial basis, calculated on a daily basis,
d) If there is no service vehicle belonging to the institution, transportation of those receiving day care shall be provided by the elderly person or their relatives
is required.
Matters Related to Nutrition
ARTICLE 30 – (1) Elderly persons shall be provided with breakfast in the morning and lunch and dinner according to a food ration to be prepared or procured by a dietitian, based on their age and health conditions.
(2) In addition, snacks shall be provided twice a day, in the morning and in the evening.
(3) (Amended phrase: OG-26/9/2008-27009) Special diet meals shall be prepared for elderly persons for whom a special diet is recommended by a physician.
Inspection
ARTICLE 31 – (1) The institution shall be inspected at least twice a year by professional staff authorized by the Provincial/District Directorate to carry out establishment opening procedures. When necessary, it may also be inspected by inspection staff of the General Directorate.
(2) During inspections, institution officials are obliged to present all kinds of documents and to provide the necessary facilitation.
(3) One copy of the inspection report shall be kept at the Provincial Directorate, and one copy shall be sent to the General Directorate.
(4) Deficiencies identified during inspections shall be recorded in the inspection logbook, and a period of one month shall be granted for their устранment. If they are not remedied within this period, the institution shall be warned in writing and an additional period deemed appropriate shall be granted. Within the granted period, the institution is obliged to correct the specified deficiencies.
(5) In cases where it is determined or reported that elderly care is provided in places that do not comply with the definition and characteristics of an institution used under this nursing home regulation, the professional staff of the General Directorate and the Provincial/District Directorate are authorized to examine the identified deficiencies on site and to take the necessary measures.
Closure of the Institution
ARTICLE 32 – (1) The institution;
a) Admitting elderly persons to the institution in violation of Article 9,
b) Failure to remedy the deficiencies identified during inspections within the granted periods,
c) Neglect, abuse, or application of violence against the elderly under care in terms of health and hygiene, and from economic, social, and psychological aspects,
ç) Acting contrary to general moral rules,
d) Charging fees higher than the determined amount and insisting on demanding excessive fees,
e) Providing care for elderly persons above the determined capacity and insisting on doing so,
f) Engaging in activities outside the stated purpose,
g) Receiving a report or determining that activities are carried out without an opening permit
In such cases, following the proposal of the Provincial Directorate and the approval of the governorship (Repealed phrase: OG-21/8/2010-27679) (…), a decision shall be taken to close the institution.
(2) Legal action shall be taken against the founders and responsible persons of closed institutions for acts constituting a crime in accordance with Article 27 of the Social Services and Child Protection Agency Law No. 2828 dated 24/5/1983 and the relevant legislation.
Closure of the Institution by the Founder
ARTICLE 33 – (1) Founders are obliged to notify the Provincial Directorate, the staff, and the elderly in writing of their intention to close the institution at least three months in advance.
(2) Founders who close the institution without notifying the Provincial Directorate may not open a new institution or become partners.
Procedures to Be Carried Out During the Closure of the Institution
ARTICLE 34 – (1) In order to prevent grievances of the elderly in an institution for which a closure procedure has been initiated, the founder shall take the necessary measures.
(2) Provincial/District Directorates are responsible for informing the elderly or their relatives about existing private or other institutions in that province or district.
(3) As of the date the institution is closed, if the elderly person has any debt, it shall be collected from the deposit paid in advance, and the remaining amount shall be refunded.
(4) The founder is obliged to submit all documents related to the institution to the Provincial Directorate within fifteen days.
(5) Closed institutions shall be promptly reported to the General Directorate by the Provincial Directorate.
Nursing Home Regulation – Section Six
Miscellaneous and Final Provisions
Documents to Be Sent to Provincial Directorates
ARTICLE 35 – (1) During the first week of each month, institutions shall prepare two copies of the staff list, the list of elderly persons residing in the institution, a copy of the monthly payroll, employee hiring notifications, four-month social security premium declarations, and copies of payment receipts showing that monthly social security premiums have been paid, as well as the quarterly list of elderly persons and staff and, if there are any changes, the documents related to such staff. One copy shall remain at the institution, and the other shall be sent to the Provincial/District Directorate for inspection. Procedures shall be carried out in accordance with Article 32 against institutions that fail to submit the requested documents despite warnings.
Names of Institutions
ARTICLE 36 – (1) Institutions may not use names and titles used by the state or other institutions, nor names and titles contrary to social values, nor words and expressions in foreign languages. The terms “nursing home” and “elderly care center” must be used in the names of institutions.
Use of Institution Buildings
ARTICLE 37 – (1) Founders and staff may not use the sections allocated to elderly persons in the institutions as residences.
(2) The institution building may not be used for purposes other than its opening purpose.
Books and Files Required to Be Kept in Institutions
ARTICLE 38 – (1) Institutions are required to keep the books and files listed below.
a) Incoming and outgoing correspondence register,
b) Required accounting records,
c) Personnel personnel and health files,
ç) Registry book of elderly persons,
d) Inspection logbook certified by the Provincial Directorate,
e) Elderly files containing general information and health records of elderly persons,
f) Elderly medication tracking log.
(2) The use of letterhead paper or an official stamp is mandatory in the institution’s correspondence.
Health Checks of Staff and Elderly Persons
ARTICLE 39 – (1) It is mandatory that necessary medical examinations and check-ups of staff working in institutions and elderly persons are carried out periodically; that staff undergo chest radiography at least once a year and porter examinations; that elderly persons whose mental and psychological health is not sound receive psychiatric follow-up, medical control and, if necessary, treatment at least once a month by a psychiatrist under a service contract or at a health institution; that their medications are regulated; and that the results of medical controls are kept in the files of staff and elderly persons and presented during inspections.
Repealed Nursing Home Regulation
ARTICLE 40 – (1) The Regulation on Private Nursing Homes and Elderly Care Homes published in the Official Gazette dated 3/9/1997 and numbered 23099 has been repealed.
On-Call (Duty) Services
ADDITIONAL ARTICLE 1 – (Added: OG-6/7/2011-27986)
(1) On national holidays and public holidays and during working hours outside 08:00–18:00, a healthcare personnel member shall be assigned as the on-call officer. Provided that the institution’s services are not disrupted, professional staff may be assigned as on-call officers.
Transitional Provisions
TEMPORARY ARTICLE 1 – (1) Institutions that were operating by obtaining an opening permit from the General Directorate of Social Services and Child Protection before this Nursing Home Regulation entered into force shall, within one year following the entry into force of this Regulation, carry out the necessary arrangements specified in this Regulation—except for the conditions set out in subparagraph (1) of paragraph (c) of the first paragraph of Article 23 and the minimum capacity limitation stated in subparagraphs (b), (c), and (i) of the first paragraph of Article 4—and shall notify the Provincial Directorate of the works carried out by submitting a report. The permits previously granted to those that fail to make these arrangements shall be revoked.
(2) (Additional paragraph: OG-2/6/2010-27599) Provided that their acquired rights are preserved, elderly care staff who were employed in institutions before this Regulation entered into force shall, within 6 months from the effective date of this paragraph, be ensured to obtain a certificate in accordance with subparagraph (ı) of the first paragraph of Article 4, and the situation shall be reported to the Provincial Directorate.
(3) (Additional paragraph: OG-2/6/2010-27599) Institutions that were operating before this Regulation entered into force shall be exempt from the provision of the third paragraph of Article 21, unless they are relocated to another building.
Entry into Force
ARTICLE 41 – (1) This Nursing Home Regulation, for which the opinions of the Ministry of Finance and the Court of Accounts have been obtained, shall enter into force on the date of its publication.
Execution
ARTICLE 42 – (1) The provisions of this Regulation shall be executed by the General Director of the Social Services and Child Protection Institution.
| Official Gazette in Which the Nursing Home Regulation Was Published | ||
| Date | Number | |
| 7/8/2008 | 26960 | |
| Official Gazettes in Which the Amending Regulations Were Published | ||
| Date | Number | |
| 1. | 26/9/2008 | 27009 |
| 2. | 31/7/2009 | 27305 |
| 3. | 2/6/2010 | 27599 |
| 4. | 21/8/2010 | 27679 |
| 5. | 6/7/2011 | 27986 |
| 6. | 4/4/2012 | 28254 |