Texas State Laws Covering Nursing Home Abuse
According to §§19.401 – 19.421 of the Texas Administrative Code:
Residents have the right to:
- Be treated with respect, dignity and consideration
- Exercise their rights and civil liberties as a resident of Texas and citizen of the United States and observe their religious beliefs
- Confidentiality of personal and clinical records
- Be informed of their medical condition and participate in treatment planning
- Plan activities in the facility
- Choose their own attending physician and the source of pharmacy service
- Be free from mental, physical, or verbal abuse and chemical and physical restraints
- Associate and communicate in privacy, including visits with anyone of their choice in or outside of the facility, mail and telephone services, participation in resident council activities, access to their records and access to state inspection reports
- Be told of services provided by Medicaid or Medicare and informed of other items or services and their respective costs for which they may be charged
- Not be transferred or discharged without cause or notice
- Be treated without discrimination regardless of source of payment
- Make complaints and express grievances without fear of discrimination or reprisal
- Manage personal and financial affairs and make choices and independent decisions
- Issue advance directives, including directive to physician, medical power of attorney, and out-of-hospital do-not-resuscitate.
Quality of Life
According to §19.701 of the Texas Administrative Code:
A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life. If children are admitted to a facility, care must be provided to meet their unique medical and developmental needs.
(1) Dignity. The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of the resident’s individuality.
(2) Self-determination and participation. The resident has the right to:
(A) choose activities, schedules, and health care consistent with the resident’s interests, assessments, and plans of care;
(B) interact with members of the community both inside and outside of the facility; and
(C) make choices about aspects of the resident’s life in the facility that are significant to the resident.
(3) Participation in other activities. A resident has the right to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.
(4) Accommodation of needs. A resident has the right to:
(A) reside and receive services in the facility with reasonable accommodation of individual needs and preferences, except when the health or safety of the individual or other residents would be endangered; and
(B) receive notice before the resident’s room or roommate in the facility is changed.
(5) Accommodations for children. Pediatric residents should be matched with roommates of similar age and developmental levels.
Quality of Care
According to §19.901 of the Texas Administrative Code:
Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, as defined by and in accordance with the comprehensive assessment and plan of care. If children are admitted to the facility, care and services must be provided to meet their unique medical and developmental needs.
(1) Activities of daily living. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident’s abilities in activities of daily living do not diminish unless the circumstances of the individual’s clinical condition demonstrate that diminution is unavoidable. This includes the resident’s abilities to:
(i) bathe, dress, and groom;
(ii) transfer and ambulate;
(iv) eat; and
(v) use speech, language, or other functional communication systems;
(B) the resident is given the appropriate treatment and services to maintain or improve his abilities specified in paragraph (1) of this section;
(C) a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.
(2) Vision and hearing. To ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the resident:
(A) in making appointments; and
(B) by arranging for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices.
(3) Pressure sores. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident who enters the facility without pressure sores does not develop pressure sores unless his clinical condition demonstrates that they are unavoidable; and
(B) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.
(4) Urinary incontinence. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident who enters the facility without an indwelling catheter is not catheterized unless his clinical condition demonstrates that catheterization is necessary; and
(B) a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.
(5) Range of motion. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable; and
(B) a resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.
(6) Mental and psychosocial functioning. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident who displays mental or psychosocial adjustment difficulty receives appropriate treatment and services to correct the assessed problem; and
(B) a resident whose assessment does not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless his clinical condition demonstrates that such a pattern is unavoidable.
(7) Naso-gastric tube. Based on the comprehensive assessment of the resident, the facility must ensure that:
(A) a resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless his clinical condition demonstrates that use of a naso-gastric tube is unavoidable; and
(B) a resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers, and to restore, if possible, normal eating skills.
(8) Accidents. The facility must ensure that:
(A) the resident environment remains as free of accident hazards as possible; and
(B) each resident receives adequate supervision and assistive devices to prevent accidents.
(9) Nutrition. Based on the comprehensive assessment of the resident, the facility must ensure that a resident:
(A) maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless his clinical condition demonstrates that this is not possible; and
(B) receives a therapeutic diet when there is a nutritional problem.
(10) Hydration. The facility must ensure that the resident is provided with sufficient fluid intake to maintain proper hydration and health.
(11) Special needs. The facility must ensure that residents receive proper treatment and care for the following special services:
(B) parenteral or enteral fluids;
(C) colostomy, ureterostomy, or ileostomy care;
(D) tracheostomy care;
(E) tracheal suctioning;
(F) respiratory care;
(G) foot care; and
(12) Unnecessary drugs.
(A) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:
(i) in excessive dose (including duplicate drug therapy); or
(ii) for excessive duration; or
(iii) without adequate monitoring; or
(iv) without adequate indications for its use; or
(v) in the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(vi) any combination of the circumstances in clauses (i)-(v) of this subparagraph.
(B) Antipsychotic drugs. Based on the comprehensive assessment of the resident, the facility must ensure that:
(i) residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue use of these drugs.
(13) Medication errors. The facility must ensure that:
(A) it is free of medication error rates of 5.0% or greater; and
(B) residents are free of significant medication errors.
(14) Pediatric care.
(A) Licensed nursing care of children. A facility caring for children must have 24 hour a day on-site licensed nursing staff in numbers sufficient to provide safe care. For any facility with five or more children under 26 pounds, at least one nurse must be assigned solely to the care of those children.
(B) Fewer than five pediatric residents. Facilities with fewer than five pediatric residents must assure that the children’s rooms are in close proximity to the nurses’ station.
(C) Respiratory care of children.
(i) To facilitate the care of ventilator-dependent children or children with tracheostomies, a facility must group those children in rooms contiguous or in close proximity to each other. An exception to this rule is children who are able to be schooled off-site.
(ii) Facilities must assure that alarms on ventilators, apnea monitors, and any other such equipment uniquely identify the child or the child’s room.
(iii) A facility caring for children with tracheostomies requiring daily care (including ventilator-dependent children with tracheostomies) must have 24 hour a day on-site respiratory therapy staff in numbers sufficient to provide a safe ratio of respiratory therapist per these residents. For the purposes of this rule, respiratory therapy staff is defined as a registered respiratory therapist (RRT), a certified respiratory therapy technician (CRT), or a licensed nurse whose primary function is respiratory care.
(I) If the facility cares for nine or more children with tracheostomies requiring daily care (including ventilator-dependent children with tracheostomies), the facility must maintain a ratio of no less than one respiratory therapy staff per nine tracheostomy residents 24 hours a day.
(II) If the facility cares for six or more ventilator dependent children, the facility must:
(-a-) designate a respiratory therapy supervisor, either on staff or contracted who must be credentialed by the National Board for Respiratory Care (either CRT or RRT).
(-b-) provide and document that all respiratory therapy staff is trained in the care of children who are ventilator dependent. This training must be reviewed annually.
(-c-) assure that appropriate care, maintenance, and disinfection of all ventilator equipment and accessories occurs.