(a) The RN, in consultation with the client if 16 or older, and when appropriate the client's responsible adult, must make an assessment to determine if the care:      
        (1) qualifies as an ADL or HMA not requiring delegation;       
        (2) can be delegated to an unlicensed person; or       
        (3) should not be delegated and only performed by a nurse.       
      (b) In making this determination, the RN shall consider each of the following elements of assessment to develop an overall picture of the client's health status:      
        (1) the ability of the client or client's responsible adult to participate in the health care decision and ability and willingness to participate in the management and direction of the task;       
        (2) the adequacy and reliability of support systems available to the client or client's responsible adult;       
        (3) the degree of the stability and predictability of the client's health status relative to which the task is performed;       
        (4) the knowledge base of the client or client's responsible adult about the client's health status;       
        (5) the ability of the client or client's responsible adult to communicate with an unlicensed person in traditional or non-traditional ways; and       
        (6) how frequently the client's status shall be reassessed.       
      (c) While each element must be assessed, strength in one factor may compensate/offset a weakness in another factor. The assessment under this section does not require the RN to know either the specific unlicensed person who will perform the tasks or the specific qualifications of the unlicensed person who will perform the tasks, thus the RN is not required to determine the competency of the unlicensed person.     
     Source Note:        The provisions of this §225.6 adopted to be effective February 19, 2003, 28 TexReg 1386; amended to be effective February 24, 2014, 39 TexReg 1154