(a) The delegation of resident rights may occur in three cases:
  (1) when a competent individual chooses to allow another to act for him, such as with a Durable Power of Attorney;
  (2) when the resident has been adjudicated to be incompetent by a court of law and a guardian has been appointed; or
  (3) when the physician has determined that, for medical reasons, the resident is incapable of understanding and exercising such rights. The Health and Safety Code, Chapter 313, Consent to Medical Treatment, provides guidance under certain circumstances when a resident is comatose, incapacitated, or otherwise mentally or physically incapable of communication.
(b) In order to assure preservation of rights, the physician and the facility must document specific information concerning the incapability of the resident to understand and exercise his rights.
(c) Facility documentation must cover:
  (1) the relationship of the resident to the person assuming his rights and responsibilities;
  (2) the authority allowing the responsible person to act for the resident;
  (3) resident assessments, care plans, and progress notes that address the resident's inability to exercise his rights and responsibilities; and
  (4) assurance that the resident who is mentally capable of understanding and exercising his rights, but physically incapable of doing so, receives interventions which facilitate the exercise of his rights.
(d) Physician documentation must cover:
  (1) resident's comatose state, incapacity, or other mental or physical inability to communicate;
  (2) proposed medical treatment or decision;
  (3) periodic assurance that there has been no essential change in the resident's mental function; and
  (4) reevaluation whenever a significant change in resident status occurs or for orders that impact on resident rights (such as "No CPR").

Source Note: The provisions of this §554.420 adopted to be effective May 1, 1995, 20 TexReg 2393; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871