The Office of the Long-Term Care Patient Representative (OLTCPR) advocates for residents in skilled nursing and intermediate care facilities who lack the capacity to make medical decisions and have no legal surrogate. The Program supports the implementation of Health and Safety Code (HSC) section 1418.8 in approximately 1,192 skilled nursing and intermediate care facilities across California.
OLTCPR was created to strengthen protections for residents without decision-making capacity. Under HSC 1418.8, facilities must hold an IDT review before proceeding with certain medical interventions requiring informed consent, including but not limited to administering antipsychotic medications, modifying physician orders for life-sustaining treatment (POLST), do-not-resuscitate (DNR) orders, or transferring a resident to hospice care. The IDT must include the attending physician, registered nurse, other appropriate facility staff, and a patient representative.
A patient representative is a family member, friend, or other authorized individual who helps ensure that the resident’s known healthcare preferences, if known, or their best interests are considered during the IDT review process. If no suitable person is available, the facility must contact OLTCPR to assign a public patient representative (PPR). Facilities are responsible for notifying residents and patient representatives of IDT reviews, ensuring compliance with legal requirements, and submitting required data to the California Department of Aging.