The following words and terms, when used in this chapter, have
the following meanings unless the context clearly indicates otherwise.
(1) Business day--Any day except a Saturday, Sunday,
or legal holiday listed in Texas Government Code, §662.021.
(2) Certified ombudsman--A staff ombudsman or a volunteer
ombudsman.
(3) CFR--Code of Federal Regulations.
(4) Complainant--A person who makes a complaint.
(5) Complaint--A statement of dissatisfaction or concern
made by or on behalf of a resident, that relates to action, inaction,
or a decision by any of the following entities or persons, that may
adversely affect the health, safety, welfare, or rights of the resident:
(A) a long-term care (LTC) facility or LTC facility
staff;
(B) a governmental entity, including a health and human
services agency; or
(C) any other person who provides care or makes decisions
related to a resident.
(6) DAHS facility--A day activity and health services
facility. A facility licensed in accordance with Texas Human Resources
Code, Chapter 103.
(7) Day--A calendar day.
(8) Federal fiscal year--A 12-month period of time
from October 1 through September 30.
(9) Governmental entity--An entity that is:
(A) a state agency;
(B) a district, authority, county, municipality, regional
planning commission, or other political subdivision of the state;
or
(C) an institution of higher education, as defined
in Texas Education Code, §61.003.
(10) Grievance--A statement of dissatisfaction or concern
regarding a representative of the Office of the State Long-Term Care
Ombudsman (Office) or the State Ombudsman and the performance of their
functions, responsibilities, and duties described in 45 CFR §1324.13,
45 CFR §1324.19, and this chapter.
(11) Grievant--A person who makes a grievance.
(12) HCSSA--Home and community support services agency.
An entity licensed in accordance with Texas Health and Safety Code
Chapter 142.
(13) HHSC--The Texas Health and Human Services Commission
or its designee.
(14) Host agency--A governmental entity or nonprofit
organization that contracts with HHSC to ensure that the local ombudsman
entity implements the State Long-Term Care Ombudsman Program (Ombudsman
Program) in an ombudsman service area.
(15) Incident report--A document created by an LTC
facility about an abnormal event involving a resident, including an
accident or injury.
(16) Immediate family member--A member of the same
household or a relative with whom there is a close personal or significant
financial relationship.
(17) Informed consent--Consent from a resident or legally
authorized representative after the State Ombudsman or a representative
of the Office explains the options for ombudsman action and possible
outcomes of such options in a manner and language in which the resident
or legally authorized representative understands, as determined by
the State Ombudsman or a representative of the Office. Informed consent
may be communicated in writing, orally, visually, or through the use
of auxiliary aids and services.
(18) Individual conflict of interest--A situation in
which a person is involved in multiple interests, financial or otherwise,
that could affect the effectiveness and credibility of the Ombudsman
Program and includes a person:
(A) having direct involvement in the licensing, surveying,
or certification of an LTC facility, a HCSSA, a DAHS facility, a nursing
facility administrator, or a nurse aide;
(B) having ownership or investment interest (represented
by equity, debt, or other financial relationship) in an LTC facility,
a HCSSA, a DAHS facility, or an association of LTC facilities, HCSSAs,
or DAHS facilities;
(C) managing or being employed in an LTC facility,
a HCSSA, a DAHS facility, or an association of LTC facilities, HCSSAs,
or DAHS facilities;
(D) being employed by an LTC facility within the 12
months before performing functions of the Ombudsman Program;
(E) accepting gifts, gratuities, or other consideration
from an LTC facility or from a resident of such an LTC facility or
the resident's family;
(F) accepting money or any other consideration from
anyone other than the local ombudsman entity or host agency for performing
functions of the Ombudsman Program;
(G) receiving or having the right to receive, directly
or indirectly, remuneration (in cash or in kind) under a compensation
arrangement with an owner or operator of an LTC facility, a HCSSA,
or a DAHS facility;
(H) being involved in PASRR screenings for LTC facility
placements other than responding to a complaint made to the Ombudsman
Program;
(I) determining eligibility regarding Medicaid or other
public benefits for residents;
(J) being employed by a managed care organization that
provides services to residents;
(K) serving as a representative of the Office for an
LTC facility in the ombudsman service area and in which a relative
of the representative resides or works;
(L) acting as a decision-maker or legally authorized
representative for a resident in the ombudsman service area;
(M) having management responsibility for, or operating
under the supervision of, a person with management responsibility
for adult protective services as described in Texas Human Resources
Code, Chapter 48;
(N) being a resident;
(O) being a member of a board or council that represents
the interests of an LTC facility; or
(P) having an immediate family member who meets any
of the descriptions in subparagraphs (A) - (O) of this paragraph.
(19) Legally authorized representative--A person authorized
by law to act on behalf of another person with regard to a matter
described in this chapter, including:
(A) a parent, guardian, or managing conservator of
a minor;
(B) the guardian of an adult;
(C) an agent to whom authority to make health care
decisions is delegated under a medical power of attorney or durable
power of attorney in accordance with state law; or
(D) the representative of a deceased person.
(20) Local ombudsman entity--One of the following:
(A) an identifiable unit of a host agency that:
(i) consists of representatives of the Office who are
employees, independent contractors, or volunteers of the host agency;
and
(ii) implements the Ombudsman Program in an ombudsman
service area; or
(B) an identifiable unit of a governmental entity or
nonprofit organization that:
(i) consists of representatives of the Office who are
employees, independent contractors, or volunteers of the governmental
entity or nonprofit organization; and
(ii) contracts with a host agency to implement the
Ombudsman Program in an ombudsman service area.
(21) LTC facility--Long-term care facility. A nursing
facility licensed or required to be licensed in accordance with Texas
Health and Safety Code, Chapter 242, and or an assisted living facility
licensed or required to be licensed in accordance with Texas Health
and Safety Code, Chapter 247.
(22) Managing local ombudsman--A person who:
(A) is certified as a staff ombudsman to serve as a
managing local ombudsman in accordance with §88.102 of this chapter
(relating to Certification of an Ombudsman); and
(B) works with a host agency and the Office to oversee
the implementation of the Ombudsman Program in an ombudsman service
area.
(23) Office--The Office of the State Long-Term Care
Ombudsman. An organizational unit within HHSC that:
(A) is headed by the State Ombudsman;
(B) consists of representatives of the Office who are
employees of HHSC; and
(C) oversees the statewide implementation of the Ombudsman
Program.
(24) Older Americans Act--A federal law (Title 42,
United States Code, §3011 et seq.) that establishes and funds
a comprehensive service system for persons 60 years of age or older
and certain caregivers and family members of persons 60 years of age
or older.
(25) Ombudsman database--The statewide reporting system
required by §712(c) of the Older Americans Act that is a web-based
application in which Ombudsman Program data is entered, stored, maintained,
and analyzed.
(26) Ombudsman intern--A person who is being trained
to be a volunteer ombudsman in accordance with the Ombudsman Certification
Training Manual but has not been certified as a volunteer ombudsman.
Cont'd... |
