87R3355 JG-D
	By: Sanford	H.B. No. 2324

	A BILL TO BE ENTITLED
	AN ACT
	relating to a designated essential caregiver for residents of
	certain long-term care facilities during public health
	emergencies.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subtitle A, Title 4, Health and Safety Code, is
	amended by adding Chapter 226 to read as follows:
	CHAPTER 226. LONG-TERM CARE FACILITY ESSENTIAL CAREGIVER
	DESIGNATIONS AND REQUIREMENTS
	Sec. 226.001.  DEFINITIONS. In this chapter:
	(1)  "Essential caregiver" means an individual
	designated as a resident's essential caregiver in accordance with
	Section 226.003.
	(2)  "Executive commissioner" means the executive
	commissioner of the Health and Human Services Commission.
	(3)  "Long-term care facility" means:
	(A)  a facility licensed or regulated under
	Chapter 242, 247, or 252; and
	(B)  a state supported living center as defined by
	Section 531.002.
	(4)  "Public health emergency" means an immediate
	threat from a communicable disease as defined by Section 81.003
	that:
	(A)  poses a high risk of death or serious
	long-term disability to a large number of people in the general
	population; and
	(B)  creates a substantial risk of public exposure
	because of the disease's high level of contagion or the method by
	which the disease is transmitted.
	(5)  "Resident" means an individual, including a
	patient or client, who resides in a long-term care facility.
	Sec. 226.002.  PURPOSE. The purpose of this chapter is to
	require long-term care facilities to develop and implement policies
	and procedures for residents to designate an essential caregiver
	and to ensure that during a public health emergency the facility
	provides an essential caregiver with meaningful access to the
	resident to:
	(1)  detect resident concerns and advocate on behalf of
	the resident;
	(2)  observe and communicate to facility staff and
	health care providers important details and changes related to the
	resident's condition or behavior;
	(3)  assist the resident in managing complex or
	critical information;
	(4)  provide emotional support and ensure the
	resident's personal values and care preferences are considered by
	facility staff and health care providers;
	(5)  alleviate caregiving tasks of facility staff and
	health care providers;
	(6)  preserve and promote the resident's quality of
	life; and
	(7)  promote and help maintain a sense of continuity,
	identity, and autonomy for the resident.
	Sec. 226.003.  POLICIES AND PROCEDURES FOR DESIGNATION AND
	USE OF ESSENTIAL CAREGIVER. (a) The executive commissioner by rule
	shall require each long-term care facility to develop and implement
	policies and procedures allowing each resident to designate an
	essential caregiver to whom the facility will provide, in
	accordance with and in the manner described by this chapter,
	meaningful access to the resident during a public health emergency.
	(b)  The policies and procedures must:
	(1)  require long-term care facility staff and health
	care providers to consult each resident to determine the most
	appropriate individual to designate as the resident's essential
	caregiver;
	(2)  establish criteria for individuals to be
	designated as a resident's essential caregiver, provided the
	criteria allow the resident to designate a family member, a friend,
	an outside caregiver, or a volunteer who has provided regular care
	and support to the resident;
	(3)  if demonstrated by one or more individuals' past
	involvement with the resident or necessitated by the resident's
	particular needs, allow a resident to designate more than one
	essential caregiver;
	(4)  authorize a resident's essential caregiver to
	regularly assist facility staff and health care providers in
	providing care and emotional support to the resident, including
	during a public health emergency;
	(5)  except as otherwise provided by Section 226.004
	due to the imposition of quarantine restrictions, require facility
	staff to work cooperatively with each resident and essential
	caregiver to develop a visitation schedule that ensures:
	(A)  the caregiver has meaningful access to the
	resident during a public health emergency;
	(B)  the caregiver is allowed access to the
	resident to provide caregiving services:
	(i)  for the greater of three hours each day
	or the hours necessary for the caregiver to complete the services;
	and
	(ii)  in a manner, including during evening
	and weekend visits, that accommodates the caregiver's work,
	child-care obligations, or other schedule; and
	(C)  the number of caregivers admitted to the
	facility at any given time is appropriate for maintaining the
	health, safety, and security of each resident, staff member, and
	health care provider; and
	(6)  ensure that each essential caregiver has access to
	information on the proper use of personal protective equipment
	during a public health emergency.
	Sec. 226.004.  REQUIREMENTS AND RESTRICTIONS FOR ESSENTIAL
	CAREGIVER ACCESS DURING PUBLIC HEALTH EMERGENCY. (a) A long-term
	care facility must designate a central point of entry during a
	public health emergency where each essential caregiver must enter
	and register. Before entering the facility, facility staff or
	health care providers must properly screen each caregiver for
	symptoms of a disease or disorder related to a public health
	emergency in the same manner the facility staff and health care
	providers are screened.
	(b)  An essential caregiver admitted to a long-term care
	facility during a public health emergency must wear all necessary
	personal protective equipment while inside the facility, including
	eye protection or a face mask as necessary, and must frequently
	sanitize the caregiver's hands. The facility shall provide an
	appropriate number of hand sanitizing or other stations located
	throughout the facility for caregivers to maintain proper hygiene
	while inside the facility.
	(c)  A long-term care facility shall establish procedures
	allowing an essential caregiver to walk outside with the resident
	in the area surrounding the facility if the caregiver and resident
	wear appropriate personal protective equipment. A caregiver may
	not take a resident beyond that area other than to an essential
	medical appointment with the authorization of facility staff or
	health care providers.
	(d)  An essential caregiver must:
	(1)  visit or provide care to a resident inside the
	resident's room or another area designated by facility staff or
	health care providers;
	(2)  while inside the facility maintain an appropriate
	social distance from each individual other than the caregiver's
	resident, including facility staff, health care providers, and
	other residents; and
	(3)  immediately notify facility staff or health care
	providers if, within 14 days following the caregiver's most recent
	visit, the caregiver develops a fever or experiences symptoms of a
	disease or disorder related to a public health emergency.
	(e)  Except for a compassionate care visit authorized by a
	long-term care facility, an essential caregiver may not visit a
	resident who is under quarantine restrictions imposed by the
	facility due to the resident testing positive for, being exposed
	to, or experiencing symptoms of a disease or disorder related to a
	public health emergency.
	Sec. 226.005.  RESTRICTION OR REVOCATION OF ESSENTIAL
	CAREGIVER DESIGNATION. (a) A long-term care facility may restrict
	an essential caregiver's access to the facility or revoke a
	caregiver's designation for a violation of Section 226.004.
	(b)  Before restricting an essential caregiver's access or
	revoking a caregiver's designation, a long-term care facility must
	provide the caregiver with an opportunity to discuss the
	restriction or revocation with facility staff, health care
	providers, and the resident in an attempt to correct the violation.
	SECTION 2.  As soon as practicable after the effective date
	of this Act, the executive commissioner of the Health and Human
	Services Commission shall adopt rules as necessary to implement
	Chapter 226, Health and Safety Code, as added by this Act.
	SECTION 3.  This Act takes effect September 1, 2021.