2003 LEGISLATIVE COMPENDIUM Long-Term Care

[ Advance Directives | Nursing Home Reports | Other Long-Term Care Legislation ]

ADVANCE DIRECTIVES

Texas' existing advance directives legislation has been in effect since 1999, and experience has exposed a few minor problems with the specific language in the statute. In response to concerns expressed by physicians and hospitals, the diverse stakeholder group that developed the original statute was reconvened last year to negotiate some possible language revisions. Senate Bill 1320 by Sen. Jane Nelson (R-Flower Mound) and Rep. Jaime Capelo (D-Corpus Christi) is the product of that process and includes the following provisions:

Allows staff in nursing homes and other outpatient settings to honor physician do not resuscitate (DNR) orders,

Clarifies that the statutory protections apply to decisions about children,

Allows hospitals to discontinue care without having to repeat ethical reviews for patients readmitted within six months in unchanged or worsened condition,

Requires some specific patient notification language about patient rights,

Requires the Texas Health Care Information Council to maintain a Web page listing providers and referral groups that have volunteered to help patients find appropriate transfers, and

Provides that applicable federal law applies to cases of child abuse and neglect.

The negotiated bill also included language clarifying that life-prolonging measures are not required in cases where death is imminent anyway, but that language was removed before the bill was passed. In response to pressure from advocacy organizations, the bill also was amended to prohibit a parent or guardian from executing an out-of-hospital DNR order for a child unless the child has a terminal or irreversible fatal illness.

NURSING HOME REPORTS

SB 1074 by Sen. Royce West (D-Dallas) requires that all reports of abuse or neglect made by nursing home staff must be made both to the Department of Human Services (DHS) and to local law enforcement agencies. It further requires that DHS coordinate investigations with law enforcement agencies and expands the list of complaints that must be investigated within 24 hours. TMA expressed concerns that the current procedures for DHS investigations are effective, that the required dual reporting was unnecessary, and that unnecessary law enforcement investigations would disrupt patient care. Law enforcement agencies argued that they should always be informed of alleged crimes. The bill language was revised to require law enforcement agencies to defer to DHS investigations unless specific crimes are alleged, offering some protection from unnecessary disruption of the facility.

OTHER LONG-TERM CARE LEGISLATION

House Bill 3486 by Rep. Dianne Delisi (R-Temple) allows a nursing home pharmacist to return sealed and unused medications to stock for reuse.

HB 776 by Rep. Eliot Naishtat (D-Austin) and SB 1549 by Senator Nelson require nursing homes to provide annually to all nursing staff one hour of training in caring for people with dementia.

SB 313 by Sen. Chris Harris (R-Arlington) establishes that civil damages awarded against a nonprofit nursing institution may not be recovered from a tax-exempt endowment or fund that is used to fund care.

SB 421 by Sen. John Carona (R-Dallas) allows assisted living facilities to obtain professional liability insurance through the Texas Medical Liability Insurance Underwriting Association.

SB 826 by Sen. John Whitmire (D-Houston) requires that deaths in an institution where the physician is unable to certify the cause of death and requests an inquest must be reported to the attorney general. 

SB 923 by Sen. Judith Zaffirini (D-Laredo) prohibits nursing homes from hiring anyone with certain criminal convictions and requires criminal history checks within 24 hours employment.

SB 1012 by Sen. Royce West (D-Dallas) allows electronic monitoring devices in assisted living facilities.

SB 1073 by Senator West prohibits facilities serving the elderly or persons with disabilities from hiring anyone with certain criminal convictions.

Relevant bills not passed or vetoed were:

HB 1694 by Rep. Norma Chavez (D-El Paso) would have required gerontology training as part of physician licensing requirements. TMA opposes any state-mandated curricula for CME. The bill died in the House.

SB 827 by Senator Whitmire would have imposed criminal penalties on anyone who had custody care or control of an elderly person and failed to provide him or her with food, medical care, or shelter. The bill language would have prohibited hospitals from honoring advance directives, so the governor vetoed it at the hospitals' request.

Long-term care TMA staff contacts:

-Donna Kinney, manager, Regulatory Analysis and Advocacy, (512) 370-1422
-C.J. Francisco, JD, senior counsel, Office of the General Counsel, (512) 370-1339
-Yvonne Barton, associate director, Legislative Affairs Department, (512) 370-1359

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