| (a) Competent adults may issue advance directives in
accordance with applicable laws. An advance directive has the meaning
as defined in Texas Health and Safety Code, §166.002.
(b) A facility must maintain policies and procedures
implementing the following with respect to all adult residents:
(1) The facility must:
(A) maintain written policies regarding the implementation
of advance directives; and
(B) include a clear and precise statement of any procedure
the facility is unwilling or unable to provide or withhold in accordance
with an advance directive.
(2) The facility must:
(A) when a resident is admitted, provide the resident
or the appropriate person referenced in paragraph (8) of this subsection
with a copy of:
(i) the advance care planning educational material
provided by DADS;
(ii) the resident's rights under Texas law (whether
statutory or as recognized by the courts of the state) to make decisions
concerning medical care, including the right to accept or refuse medical
or surgical treatment and the right to formulate advance directives;
and
(iii) the facility's policies respecting the implementation
of these rights, including the written policies regarding the implementation
of advance directives;
(B) within 14 days after the resident is admitted,
orally review and discuss the information provided in accordance
with subparagraph (A) of this paragraph and the importance of planning
for end-of-life care with the resident or with the appropriate person
referenced in paragraph (8) of this subsection; and
(C) annually and when there is a significant positive
change or a significant deterioration in the resident's clinical condition,
provide, review, and discuss the written information regarding advance
directives listed in subparagraph (A) of this paragraph with the resident
or with the appropriate person referenced in paragraph (8) of this
subsection.
(3) The facility must document the oral discussion
and the provision of the written information in the resident's clinical
record. The facility must document in the resident's clinical record
whether or not the resident has executed an advance directive.
(4) The facility must not condition the provision of
care or otherwise discriminate against a resident based on whether
or not the resident has executed an advance directive.
(5) The facility must ensure compliance with the requirements
of Texas law, whether statutory or as recognized by the courts of
Texas, respecting advance directives.
(6) The facility must provide, individually or with
others, education for staff and the community on issues concerning
advance directives. For the community, this may include newsletters,
newspaper articles, local news reports, or commercials. For educating
staff, this may include in-service programs.
(7) The facility must provide the attending physician,
emergency medical technician, and hospital personnel with any information
relating to a resident's known existing advance directive and assist
with coordinating physicians' orders with the resident's known existing
advance directive.
(8) Except as provided in paragraph (9) of this subsection,
if a resident is in a comatose or otherwise incapacitated state, and
therefore is unable to receive information or articulate whether the
resident has executed an advance directive, the facility must provide,
review, and discuss written information regarding advance directives,
including advance care planning educational material provided by DADS
and facility policies regarding the implementation of advance directives,
in the following order of preference, to:
(A) the resident's legal guardian;
(B) a person responsible for the resident's health
care decisions;
(C) the resident's spouse;
(D) the resident's adult child;
(E) the resident's parents; or
(F) the person admitting the resident.
(9) If a resident is in a comatose or otherwise incapacitated
state, and therefore is unable to receive information or articulate
whether the resident has executed an advance directive, and if the
facility is unable, after diligent search, to locate a person listed
under paragraph (8) of this subsection, the facility is not required
to provide written information regarding advance directives. The
facility must document in the resident's clinical record its attempts
to make a diligent search.
(10) If a resident, who was incompetent or otherwise
incapacitated and was unable to receive information regarding advance
directives, including written policies regarding the implementation
of advance directives, later becomes able to receive the information,
the facility must provide, review, and discuss the written information
at the time the resident becomes able to receive the information.
(11) If the resident or a relative, surrogate, or other
concerned or related person presents the facility with a copy of the
resident's advance directive, the facility must comply with the advance
directive, including recognition of a Medical Power of Attorney,
to the extent allowed under state law. If no one comes forward with
a previously executed advance directive and the resident is incapacitated
or otherwise unable to receive information or articulate whether he
has executed an advance directive, the facility must document in the
resident's clinical record that the resident was not able to receive
information and was unable to communicate whether an advance directive
existed.
(c) Failure to provide the facility's written policies
as required in subsection (b)(2)(A)(iii) of this section when a resident
is admitted will result in an administrative penalty of $500.
(d) A facility that provides services to children must
ensure that:
(1) prior to admission to the facility, the primary
physician, who has been providing care to the child, has discussed
advance directives with the family or guardian and has provided documentation
of this discussion to the facility; and
(2) the decision made by the family or guardian regarding
advance directives is addressed in the comprehensive care plan (see
§19.802 of this title (relating to Comprehensive Care Plans)).
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| Source Note: The provisions of this §554.419 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective August 1, 2000, 25 TexReg 6779; amended to be effective April 1, 2007, 32 TexReg 1582; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
