Current through Reg. 50, No. 13; March 28, 2025
(a) A
facility may allow personal care staff to perform a health maintenance activity
(HMA) for a resident, without being delegated, only if:
(1) the activity is performed for a person
with a functional disability as defined in §
553.3 of this chapter (relating to
Definitions);
(2) a registered
nurse (RN) acting on behalf of the facility conducts and documents an
assessment in accordance with subsection (b) of this section, and determines,
based on the assessment, that the activity qualifies as an HMA not requiring
delegation; and
(3) the facility
ensures and documents that all the conditions and requirements of subsection
(c) of this section are met:
(A) the
resident, the resident's legally authorized representative, or other adult
chosen by the resident, as applicable, is willing and able to direct personal
care staff to perform the task without RN supervision; and
(B) the resident, the resident's legally
authorized representative, or other adult chosen by the resident, as
applicable, is willing and able and has agreed in writing, to participate in
directing the personal care staff's actions in carrying out the HMA;
(4) the activity addresses a
condition that is stable and predictable, as defined in §
553.3 of this chapter;
and
(5) the activity is performed
for a resident who could perform the task on his or her own but for a
functional disability that prevents it.
(b) The RN conducting an assessment for
purposes of subsection (a)(1) of this section must conduct it in accordance
with Board of Nursing rules at 22 TAC §
225.6(relating to RN Assessment of
the Client).
(1) The RN's assessment must
consider each element listed in 22 TAC §
225.6, and all relevant aspects of
the resident's environment, to develop an overall understanding of the
resident's health status.
(2) In
assessing each element required by paragraph (1) of this subsection, the RN may
consider strength in one element to compensate for or offset a weakness in
another element, as long as the RN determines that all required conditions in
subsection (c) of this section are met.
(3) The RN is not required to know the
identity of the personal care staff member who will perform the activity or his
or her specific qualifications. The RN is not required to determine the
competency of the personal care staff who will perform the activity.
(4) The RN must reassess a resident's status
in accordance with this subsection any time there is a change in the resident's
condition that may affect the resident's physical or cognitive abilities, or
the stability or predictability of the resident's condition and, at a minimum,
must reassess the resident's status:
(A) at
least once annually; or
(B) at
least once every six months if the resident has been diagnosed with Alzheimer's
disease or a related disorder or resides in an Alzheimer's disease certified
facility or unit.
(c) To meet the condition of subsection
(a)(2) of this section, the RN, in addition to conducting a resident assessment
meeting the requirements of subsections (a)(1) and (b) of this section, must
determine and document that all of the conditions listed in 22 TAC §
225.8(a)(2)
(relating to Health Maintenance Activities Not Requiring Delegation)
exist.
(d) If the RN determines
under subsection (a)(1) of this section that an activity does not qualify as an
HMA not requiring delegation, personal care staff may perform that activity for
the resident only if:
(1) the RN has
determined in accordance with 22 Texas Administrative Code (TAC) Chapter 225
(relating to RN Delegation to Personnel and Tasks Not Requiring Delegation in
Independent Living Environments for Clients with Stable and Predictable
Conditions) that:
(A) the activity can be
delegated to a personal care staff member; and
(B) the activity constitutes the medication
administration;
(2) the
RN has properly delegated the task to the personal care staff member in
accordance with 22 TAC Chapter 225 and §
553.261(a)(1)(A)(iii)
of this chapter (relating to Coordination of
Care); and
(3) the medication and
medication administration requirements of §
553.261(a) of
this chapter are otherwise met.
