New Jersey Administrative Code › Title 8 - HEALTH › Chapter 39 - STANDARDS FOR LICENSURE OF LONG-TERM CARE FACILITIES › Subchapter 9 - MANDATORY ADMINISTRATION › Section 8:39-9.6 - Mandatory policies and procedures for advance directives

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The facility shall
				develop and implement procedures to ensure that there is a routine inquiry made of
				each adult resident, upon admission to the facility and at other appropriate times,
				concerning the existence and location of an advance directive. If the resident is
				incapable of responding to this inquiry, the facility shall have procedures to
				request the information from the resident's family or in the absence of a family
				member, another individual with personal knowledge of the resident. The procedures
				shall assure that the resident or family's response to this inquiry is documented in
				the medical record. Such procedures shall also define the role of facility
				admissions, nursing, social service and other staff as well as the responsibilities
				of the attending physician or advanced practice nurse.
(b) The facility shall develop and implement
				procedures to promptly request and take reasonable steps to obtain a copy of
				currently executed advance directives from all residents. These shall be entered
				when received into the medical record of the resident.
(c) A resident shall be transferred to another
				health care facility only for a valid medical reason, in order to comply with other
				applicable laws or Department rules, to comply with clearly expressed and documented
				resident choice, or in conformance with the New Jersey Advance Directives for Health
				Care Act, 26:2H-53 et seq., in the instance of
				private, religiously affiliated health care institutions who establish policies
				defining circumstances in which it will decline to participate in the implementation
				of advance directives. Such institutions shall provide notice to residents or their
				families or health care representatives prior to or upon admission of their
				policies. A timely and respectful transfer of the individual to another institution
				which will implement the resident's advance directive shall be effected. The
				facility's inability to care for the resident shall be considered a valid medical
				reason. The sending facility shall receive approval from a physician or advanced
				practice nurse and the receiving health care facility before transferring the
				resident.
(d) The facility shall, in
				consultation with the attending physician or advanced practice nurse, take all
				reasonable steps to effect the appropriate, respectful and timely transfer of
				residents with advance directives to the care of an alternative health care
				professional in those instances where a health care professional declines as a
				matter of professional conscience to participate in withholding or withdrawing
				life-sustaining treatment. In those instances where the health care professional is
				the resident's physician or advanced practice nurse, the facility shall take
				reasonable steps, in cooperation with the physician or advanced practice nurse, to
				effect the transfer of the resident to another physician's or advanced practice
				nurse's care in a responsible and timely manner. Such transfer shall assure that the
				resident's advance directive is implemented in accordance with their wishes within
				the facility, except in cases governed by (c) above.
(e) The facility shall have procedures to provide
				each adult resident upon admission, and where the resident is unable to respond, to
				the family or other representative of the resident, with a written statement of
				their rights under New Jersey law to make decisions concerning the right to refuse
				medical care and the right to formulate an advance directive. Such statement shall
				be issued by the Commissioner. Appropriate written information and materials on
				advance directives and the institution's written policies and procedures concerning
				implementation of such rights shall also be provided. Such written information shall
				also be made available in any language which is spoken as a primary language, by
				more than 10 percent of the population served by the facility.
(f) The facility shall develop and implement
				procedures for referral of residents requesting assistance in executing an advance
				directive or additional information to either staff or community resource persons
				who can promptly advise and/or assist the resident.
(g) The facility shall develop and implement
				policies to address application of the facility's procedures for advance directives
				to residents who experience an urgent life-threatening situation.
(h) The facility shall develop and implement
				policies and procedures for the declaration of death of residents, in instances
				where applicable, in accordance with
				26:6-1 et seq. and the New Jersey
				Declaration of Death Act,
				26:6A-1 et seq. ( P.L. 1991, c.90).
				Such policies shall also be in conformance with rules promulgated by the New Jersey
				Board of Medical Examiners which address declaration of death based on neurological
				criteria (N.J.A.C. 13:35-6A ), including the qualifications of physicians or
				advanced practice nurses authorized to declare death based on neurological criteria
				and the acceptable medical criteria, tests, and procedures which may be used. The
				policies and procedures shall also accommodate a resident's religious beliefs with
				respect to declaration of death.
(i) The
				facility shall establish procedures for considering disputes among the resident,
				health care representative and the attending physician concerning the resident's
				decision-making capacity or the appropriate interpretation and application of the
				terms of an advance directive to the resident's course of treatment. The procedures
				may include consultation with an institutional ethics committee, a regional ethics
				committee or another type of affiliated ethics committee, or with any individual or
				individuals who are qualified by their background and/or experience to offer
				clinical and ethical judgments.
(j) The
				facility shall establish a process for residents, families, and staff to discuss and
				address questions and concerns relating to advance directives and decisions to
				accept or refuse medical treatment.
(k)
				The facility shall provide periodic community education programs, individually or in
				coordination with other area facilities or organizations, that provide information
				to consumers regarding advance directives and their rights under New Jersey law to
				execute advance directives.
(l) At least
				one education or training program each year shall be held and documented for all
				administrative and resident care staff regarding the rights and responsibilities of
				staff under the New Jersey Advance Directives for Health Care Act ( P.L. 1991,
				c.201) and the Federal Patient Self Determination Act (
				P.L.
				101-508 ), and internal facility policies and
				procedures to implement these laws.