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PUB 325: Your Right to Make Decisions About Medical Treatment

By Sevana Care · Checked against cdss.ca.gov and Title 22 on

When it is due
"Upon admission" [3].Section 87469(a) gives no number of days beyond that [3]. Health and Safety Code (HSC) § 1569.156(a)(3) also says to provide written information "upon admission" about the right to make decisions concerning medical care [4].
Who fills it out
Nobody.PUB 325 is a brochure with no fields or signature lines [1]. The facility gives it to each resident and to each resident's representative or responsible person, together with a copy of Sections 87469(b), (c) and (d) [3].
Where it is kept
Section 87469 does not say the home keeps a copy of the brochure or a record that it was given [3].CDSS's list of records an RCFE keeps (LIC 311F, 4/05) does not name PUB 325 [5]. Section 87469(b) does say residents may have an advance directive, a request to forego resuscitative measures or a Do-Not-Resuscitate form "in their facility file" [3].
How long to keep
Neither § 87469 nor § 87506 gives a period for PUB 325 [3][6].

On admission, Title 22 § 87469(a) requires an RCFE to give each resident, and each resident's representative or responsible person, written information on the right to make decisions about medical care. That information "shall include, but not be limited to" PUB 325 and a copy of Sections 87469(b), (c) and (d) [3]. PUB 325 is the California Department of Social Services (CDSS) brochure "Your Right To Make Decisions About Medical Treatment", a two-page leaflet [1][2]. The brochure says it "explains your right to make healthcare decisions and how you can plan now for your medical care if you are unable to speak for yourself in the future" [1]. HSC § 1569.156(a)(4) also requires written information about the facility's own policies on these rights [4]. The rule names the brochure as "PUB 325, (3/12)." The CDSS list and the brochure say (12/16) [3][2][1].

Who fills it out

Nobody fills it out. The brochure has no fields to complete and no signature lines [1]. The facility provides it. Section 87469(a): "Upon admission, a facility shall provide each resident, and representative or responsible person of each resident, with written information about the right to make decisions concerning medical care" [3].

The brochure never names an RCFE. It speaks to any patient, and it says "A federal law requires us to give you this information" [1]. The home's duty comes from § 87469(a) and HSC § 1569.156 [3][4].

When it is due

Upon admission. Section 87469(a) opens with those words [3], and the statute says the same: an RCFE shall "Provide written information, upon admission, about the right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right, under state law, to formulate advance directives" [4]. Neither text gives a number of days [3][4].

Which edition. The rule names "PUB 325, (3/12)" [3]. The CDSS list shows "PUB 325 (12/16)," and the brochure's panel reads "PUB 325 (12/16)" [2][1]. None of the sources here says why the dates differ or which edition a home should give.

Updates. Neither the brochure nor § 87469 says when to give it again [1][3].

Where it is kept

Section 87469 does not say the home keeps a copy of the brochure, or a record that it was given [3]. Neither CDSS's list of records an RCFE keeps (LIC 311F, 4/05) [5] nor § 87506(b), the list of what each resident's record contains [6], names PUB 325.

Section 87469(b) is about the resident's own papers: "Residents shall be permitted to have a Request to Forego Resuscitative Measures, an Advance Health Care Directive and/or a Do-Not-Resuscitate (DNR) Form in their facility file" [3]. Title 22 § 87101(a)(5) defines an Advance Health Care Directive as "a written instruction that relates to the provision of health care when the individual is incapacitated" [7].

How long to keep it. Neither § 87469 nor § 87506 gives a period for PUB 325 [3][6]. Section 87506(e) sets a minimum of three years after service to the resident ends for "Original records or photographic reproductions" [6].

What the record must show

Section 87469 does not say what the home records about giving the brochure [3].

What §§ 87469(b), (c) and (d) say [3]:

  • (b) Residents may have a Request to Forego Resuscitative Measures, an Advance Health Care Directive or a DNR form in their facility file.
  • (c) If a resident who has one of these on file has a medical emergency, the rule allows four responses:
    • immediately telephone 9-1-1, present the document to the responding emergency personnel and identify the resident
    • immediately give it to a physician, registered nurse or licensed vocational nurse who is present and assumes responsibility
    • for a terminally ill resident receiving hospice services, notify the hospice agency in the cases (c)(3) describes
    • a home that employs health care providers other than home health or hospice agencies "may comply with" HSC § 1569.74
  • (d) After that, staff notify the resident's hospice agency and Health Care Surrogate Decision Maker, if applicable.

What the brochure covers. It is organized by questions a resident might ask. Its questions include [1]:

  • Who decides about my treatment?
  • How do I know what I want?
  • Can other people help with my decisions?
  • What if I become too sick to make my own healthcare decisions?
  • Who can make an advance directive?
  • Who can I name as my agent?
  • What if I change my mind?
  • Will I still be treated if I don't make an advance directive?
  • How can I get more information about making an advance directive?

Questions

Does an RCFE have to give out PUB 325?

Yes. Section 87469(a) says the written information "shall include, but not be limited to" the brochure named "PUB 325, (3/12)" [3]. HSC § 1569.156(a)(4) also requires written information about the facility's own policies on these rights [4]. The CDSS list carries PUB 325 (12/16) [2].

Does the resident sign for it?

Neither the brochure nor § 87469 mentions a signature or an acknowledgment [1][3].

Is PUB 325 an advance directive?

No. It describes advance directives and has nothing to fill in [1]. It says a person can have a lawyer write one "or you can complete an advance directive by filling in the blanks on a form" [1].

Can a home require a resident to have an advance directive?

HSC § 1569.156(a)(1) says an RCFE shall "Not condition the provision of care or otherwise discriminate based on whether or not an individual has executed an advance directive, consistent with applicable laws and regulations" [4]. The brochure asks "Will I still be treated if I don't make an advance directive?" and answers "Absolutely" [1].

How Sevana Care keeps this record

Where does an advance directive go? Each resident's documents have one place for the advance directive, POLST or DNR, and its description mentions a PUB 325 information acknowledgment. That place also counts in the check for missing documents. The acknowledgment wording is ours: neither the brochure nor § 87469 mentions a signature or an acknowledgment [1][3]. We don't generate the PUB 325. Look for Advance Directive / POLST in a resident's documents in the sample home.

More in Admission and the resident file

  • LIC 602A: The medical assessment a licensed medical professional signs before admission
  • LIC 603A: The appraisal you complete before a resident moves in
  • LIC 9172: The checklist of what a new resident can do for themselves
  • LIC 625: A CDSS form you may use for the plan of action when a resident's need is not being met
  • LIC 627C: The signed consent for emergency medical or dental care

Sources

  1. CDSS, PUB 325 (12/16), Your Right To Make Decisions About Medical Treatment (PDF)
  2. CDSS, Forms and Publications (M-P)
  3. California Code of Regulations, Title 22, § 87469, Advance Directives and Requests Regarding Resuscitative Measures (Westlaw)
  4. Health and Safety Code § 1569.156 (leginfo.legislature.ca.gov)
  5. CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)
  6. California Code of Regulations, Title 22, § 87506, Resident Records (Westlaw)
  7. California Code of Regulations, Title 22, § 87101, Definitions (Westlaw)
  8. California Code of Regulations, Title 22, § 87468, Personal Rights of Residents (Westlaw)
  9. California Code of Regulations, Title 22, § 87507, Admission Agreements (Westlaw)