Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 553 - LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
Subchapter E - STANDARDS FOR LICENSURE
Section 553.267 - Rights
Universal Citation: 26 TX Admin Code ยง 553.267
Current through Reg. 49, No. 38; September 20, 2024
(a) Residents' Bill of Rights.
(1) A facility must:
(A) provide a copy of the Residents' Bill of
Rights to each resident; and
(B)
post the Residents' Bill of Rights, as provided by HHSC, in a prominent place
in the facility and written in the primary language of each resident.
(2) A resident has all the rights,
benefits, responsibilities, and privileges granted by the constitution and laws
of this state and the United States, except where lawfully restricted. The
resident has the right to be free of interference, coercion, discrimination,
and reprisal in exercising these civil rights.
(3) Each resident in the facility has the
right to:
(A) be free from physical and mental
abuse, including corporal punishment or physical and chemical restraints that
are administered for the purpose of discipline or convenience and not required
to treat the resident's medical symptoms;
(i)
A provider may use physical or chemical restraints only if the use is
authorized in writing by a physician or if the use is necessary in an emergency
to protect the resident or others from injury.
(ii) A physician's written authorization for
the use of restraints must specify the circumstances under which the restraints
may be used and the duration for which the restraints may be used.
(iii) Except in an emergency, restraints may
only be administered by qualified medical personnel.
(B) participate in activities of social,
religious, or community groups unless the participation interferes with the
rights of others.
(C) practice the
religion of the resident's choice.
(D) if intellectually disabled, with a
court-appointed guardian of the person, participate in a behavior modification
program involving use of restraints, consistent with subparagraph (A) of this
paragraph, or adverse stimuli only with the informed consent of the
guardian.
(E) be treated with
respect, consideration, and recognition of his or her dignity and
individuality, without regard to race, religion, national origin, sex, age,
disability, marital status, or source of payment. This means that the resident:
(i) has the right to make his or her own
choices regarding personal affairs, care, benefits, and services;
(ii) has the right to be free from abuse,
neglect, and exploitation; and
(iii) if protective measures are required,
has the right to designate a guardian or representative to ensure the right to
quality stewardship of his or her affairs.
(F) a safe and decent living
environment.
(G) not be prohibited
from communicating in his or her native language with other residents or
employees for the purpose of acquiring or providing any type of treatment,
care, or services.
(H) complain
about the resident's care or treatment. The complaint may be made anonymously
or communicated by a person designated by the resident. The provider must
promptly respond to resolve the complaint. The provider must not discriminate
or take other punitive action against a resident who makes a
complaint.
(I) receive and send
unopened mail, and the provider must ensure that the resident's mail is sent
and delivered promptly.
(J)
unrestricted communication, including personal visitation with any person of
the resident's choice, including family members and representatives of advocacy
groups and community service organizations, at any reasonable hour.
(K) make contacts with the community and to
achieve the highest level of independence, autonomy, and interaction with the
community of which the resident is capable.
(L) manage his or her financial affairs.
(i) The resident may authorize in writing
another person to manage his or her money.
(ii) The resident may choose the manner in
which his or her money is managed, including a money management program, a
representative payee program, a financial power of attorney, a trust, or a
similar method, and the resident may choose the least restrictive of these
methods.
(iii) The resident must be
given, upon request of the resident or the resident's representative, but at
least quarterly, an accounting of financial transactions made on his or her
behalf by the facility should the facility accept his or her written delegation
of this responsibility to the facility in conformance with state law.
(M) access the resident's records,
which are confidential and may not be released without the resident's consent,
except:
(i) to another provider, if the
resident transfers residence; or
(ii) if the release is required by another
law.
(N) choose and
retain a personal physician and to be fully informed in advance about treatment
or care that may affect the resident's well-being.
(O) participate in developing his or her
individual service plan that describes the resident's medical, nursing, and
psychological needs and how the needs will be met.
(P) be given the opportunity to refuse
medical treatment or services after the resident:
(i) is advised by the person providing
services of the possible consequences of refusing treatment or services;
and
(ii) acknowledges that he or
she understands the consequences of refusing treatment or services.
(Q) unaccompanied access to a
telephone at a reasonable hour or in case of an emergency or personal
crisis.
(R) privacy, while
attending to personal needs and a private place for receiving visitors or
associating with other residents, unless providing privacy would infringe on
the rights of other residents.
(i) This right
applies to medical treatment, written communications, telephone conversations,
meeting with family, and access to resident councils.
(ii) If a resident is married and the spouse
is receiving similar services, the couple may share a room.
(S) retain and use personal
possessions, including clothing and furnishings, as space permits, and may be
limited for the health and safety of other residents.
(T) determine his or her dress, hair style,
or other personal effects according to individual preference, except the
resident has the responsibility to maintain personal hygiene.
(U) retain and use personal property in his
or her immediate living quarters and to have an individual locked area
(cabinet, closet, drawer, footlocker, etc.) in which to keep personal
property.
(V) refuse to perform
services for the facility, except as contracted for by the resident and
operator.
(W) be informed by the
provider no later than the 30th day after admission:
(i) whether the resident is entitled to
benefits under Medicare or Medicaid; and
(ii) which items and services are covered by
these benefits, including items or services for which the resident may not be
charged.
(X) not be
transferred or discharged unless:
(i) the
transfer is for the resident's welfare, and the resident's needs cannot be met
by the facility;
(ii) the
resident's health is improved sufficiently so that services are no longer
needed;
(iii) the resident's health
and safety or the health and safety of another resident would be endangered if
the transfer or discharge was not made;
(iv) the provider ceases to operate or to
participate in the program that reimburses for the resident's treatment or
care; or
(v) the resident fails,
after reasonable and appropriate notice, to pay for services.
(Y) not be transferred or
discharged, except in an emergency, until the 30th day after the date the
facility provides written notice to the resident, the resident's legal
representative, or a member of the resident's family, stating:
(i) that the facility intends to transfer or
discharge the resident;
(ii) the
reason for the transfer or discharge;
(iii) the effective date of the transfer or
discharge;
(iv) if the resident is
to be transferred, the location to which the resident will be transferred;
and
(v) any appeal rights available
to the resident.
(Z)
leave the facility temporarily or permanently, subject to contractual or
financial obligations.
(AA) have
access to the State Ombudsman and a certified ombudsman.
(BB) execute an advance directive, under
Texas Health and Safety Code, Chapter 166, or designate a guardian in advance
of need to make decisions regarding the resident's health care should the
resident become incapacitated.
(b) Providers' Bill of Rights.
(1) A facility must post a Providers' Bill of
Rights in a prominent place in the facility.
(2) The Providers' Bill of Rights must
provide that a provider of assisted living services has the right to:
(A) be shown consideration and respect that
recognizes the dignity and individuality of the provider and the
facility;
(B) terminate a
resident's contract for just cause after a written 30-day notice;
(C) terminate a contract immediately, after
notice to HHSC, if the provider finds that a resident creates a serious or
immediate threat to the health, safety, or welfare of other residents of the
facility, except during evening hours and on weekends or holidays, notice to
HHSC must be made to 1-800-458-9858;
(D) present grievances, file complaints, or
provide information to state agencies or other persons without threat of
reprisal or retaliation;
(E) refuse
to perform services for the resident or the resident's family other than those
contracted for by the resident and the provider;
(F) contract with the community to achieve
the highest level of independence, autonomy, interaction, and services to
residents;
(G) access patient
information concerning a client referred to the facility, which must remain
confidential as provided by law;
(H) refuse a person referred to the facility
if the referral is inappropriate;
(I) maintain an environment free of weapons
and drugs; and
(J) be made aware of
a resident's problems, including self-abuse, violent behavior, alcoholism, or
drug abuse.
(c) Access to residents. The facility must allow an employee of HHSC or an employee of a local authority into the facility as necessary to provide services to a resident.
(d) Authorized electronic monitoring (AEM).
(1) A facility must permit
a resident, or the resident's guardian or legal representative, to monitor the
resident's room through the use of electronic monitoring devices.
(2) A facility may not refuse to admit an
individual and may not discharge a resident because of a request to conduct
authorized electronic monitoring.
(3) HHSC Information Regarding Authorized
Electronic Monitoring form must be signed by or on behalf of all new residents
upon admission. The form must be completed and signed by or on behalf of all
current residents. A copy of the form must be maintained in the active portion
of the resident's clinical record.
(4) A
resident, or the resident's guardian or legal representative, who wishes to
conduct AEM must request AEM by giving a completed, signed, and dated HHSC
Request for Authorized Electronic Monitoring form to the manager or designee. A
copy of the form must be maintained in the active portion of the resident's
clinical record.
(A) If a resident has the
capacity to request AEM and has not been judicially declared to lack the
required capacity, only the resident may request AEM, notwithstanding the terms
of any durable power of attorney or similar instrument.
(B) If a resident has been judicially
declared to lack the capacity required to request AEM, only the guardian of the
resident may request AEM.
(C) If a
resident does not have the capacity to request AEM and has not been judicially
declared to lack the required capacity, only the legal representative of the
resident may request AEM.
(i) A resident's
physician makes the determination regarding the capacity to request AEM.
Documentation of the determination must be made in the resident's clinical
record.
(ii) When a resident's
physician determines the resident lacks the capacity to request AEM, a person
from the following list, in order of priority, may act as the resident's legal
representative for the limited purpose of requesting AEM:
(I) a person named in the resident's medical
power of attorney or other advance directive;
(II) the resident's spouse;
(III) an adult child of the resident who has
the waiver and consent of all other qualified adult children of the resident to
act as the sole decision-maker;
(IV) a majority of the resident's reasonably
available adult children;
(V) the
resident's parents; or
(VI) the
individual clearly identified to act for the resident by the resident before
the resident became incapacitated or the resident's nearest living
relative.
(5) A resident, or the resident's guardian or
legal representative, who wishes to conduct AEM must also obtain the consent of
other residents in the room, using the HHSC Consent to Authorized Electronic
Monitoring form. When complete, the form must be given to the manager or
designee. A copy of the form must be maintained in the active portion of the
resident's clinical record. AEM cannot be conducted without the consent of
other residents in the room.
(A) Consent to
AEM may be given only by:
(i) the other
resident or residents in the room;
(ii) the guardian of the other resident, if
the resident has been judicially declared to lack the required capacity;
or
(iii) the legal representative
of the other resident, determined by following the same procedure established
under paragraph (4)(C) of this subsection.
(B) Another resident in the room may
condition consent on:
(i) pointing the camera
away from the consenting resident, when the proposed electronic monitoring is a
video surveillance camera; and
(ii)
limiting or prohibiting the use of an audio electronic monitoring
device.
(C) AEM must be
conducted in accordance with any limitation placed on the monitoring as a
condition of the consent given by or on behalf of another resident in the room.
The resident's roommate, or the roommate's guardian or legal representative,
assumes responsibility for assuring AEM is conducted according to the
designated limitations.
(D) If AEM
is being conducted in a resident's room, and another resident is moved into the
room who has not yet consented to AEM, the monitoring must cease until the new
resident, or the resident's guardian or legal representative,
consents.
(6) When the
completed HHSC Request for Authorized Electronic Monitoring form and the HHSC
Consent to Authorized Electronic Monitoring form, if applicable, have been
given to the manager or designee, AEM may begin.
(A) Anyone conducting AEM must post and
maintain a conspicuous notice at the entrance to the resident's room. The
notice must state that the room is being monitored by an electronic monitoring
device.
(B) The resident, or the
resident's guardian or legal representative, must pay for all costs associated
with conducting AEM, including installation in compliance with life safety and
electrical codes, maintenance, removal of the equipment, posting and removal of
the notice, or repair following removal of the equipment and notice, other than
the cost of electricity.
(C) The
facility must meet residents' requests to have a video camera obstructed to
protect their dignity.
(D) The
facility must make reasonable physical accommodation for AEM, which includes
providing:
(i) a reasonably secure place to
mount the video surveillance camera or other electronic monitoring device;
and
(ii) access to power sources
for the video surveillance camera or other electronic monitoring
device.
(7) All
facilities, regardless of whether AEM is being conducted, must post an 8
1/2-inch by 11-inch notice at the main facility entrance. The notice must be
entitled "Electronic Monitoring" and must state, in large, easy-to-read type,
"The rooms of some residents may be monitored electronically by or on behalf of
the residents. Monitoring may not be open and obvious in all cases."
(8) A facility may:
(A) require an electronic monitoring device
to be installed in a manner that is safe for residents, employees, or visitors
who may be moving about the room, and meets all local and state
regulations;
(B) require AEM to be
conducted in plain view; and
(C)
place a resident in a different room to accommodate a request for
AEM.
(9) A facility may
not discharge a resident because covert electronic monitoring is being
conducted by or on behalf of a resident. If a facility discovers a covert
electronic monitoring device and it is no longer covert as defined in §
553.3 of this chapter (relating to Definitions), the resident must meet all the
requirements for AEM before monitoring is allowed to continue.
(10) All instances of abuse or neglect must
be reported to HHSC, as required by § 553.273 of this subchapter (relating
to Abuse, Neglect, or Exploitation Reportable to HHSC by Facilities). For
purposes of the duty to report abuse or neglect, the following apply.
(A) A person who is conducting electronic
monitoring on behalf of a resident is considered to have viewed or listened to
a recording made by the electronic monitoring device on or before the 14th day
after the date the recording is made.
(B) If a resident, who has capacity to
determine that the resident has been abused or neglected and who is conducting
electronic monitoring, gives a recording made by the electronic monitoring
device to a person and directs the person to view or listen to the recording to
determine whether abuse or neglect has occurred, the person to whom the
resident gives the recording is considered to have viewed or listened to the
recording on or before the seventh day after the date the person receives the
recording.
(C) A person is required
to report abuse based on the person's viewing of or listening to a recording
only if the incident of abuse is acquired on the recording. A person is
required to report neglect based on the person's viewing of or listening to a
recording only if it is clear from viewing or listening to the recording that
neglect has occurred.
(D) If abuse
or neglect of the resident is reported to the facility and the facility
requests a copy of any relevant recording made by an electronic monitoring
device, the person who possesses the recording must provide the facility with a
copy at the facility's expense. The cost of the copy must not exceed the
community standard. If the contents of the recording are transferred from the
original technological format, a qualified professional must do the
transfer.
(E) A person who sends
more than one recording to HHSC must identify each recording on which the
person believes an incident of abuse or evidence of neglect may be found. Tapes
or recordings should identify the place on the recording that an incident of
abuse or evidence of neglect may be found.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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