Frequently Asked Questions

• Program Overview: Office of the Long-Term Care Patient Representative

  • 1. When was the Office Long-Term Care Patient Representative established?

    California Department of Aging’s Office of the Long-Term Care Patient Representative was established by Welfare and Institutions Code sections 9260 - 9295 and began providing public patient representatives on January 27, 2023.

  • 2. What does the Office of the Long-Term Care Patient Representative do?

    The Office of the Long-Term Care Patient Representative provides trained representatives called public patient representatives for residents of skilled nursing and intermediate care facilities who:

    • Need a medical intervention or treatment.
    • Lack capacity to provide informed consent.
    • Have no legal surrogate to act on their behalf.
    • Have no friend or relative who can represent them on an interdisciplinary team review.

  • 3. What is OPR and OLTCPR?

    • OPR: Office of Patient Representative.
    • OLTCPR: Office of the Long-Term Care Patient Representative.

    Note: OPR is often used as a shorter abbreviation for OLTCPR.

  • 4. Does this program replace a facility’s Bioethics Committee?

    The program does not replace the Epple committees or bioethics review process. Rather, the program provides public patient representatives (PPRs) should the resident meet the criteria to have one assigned as required by Health and Safety Code (HSC) § 1418.8.

    HSC § 1418.8 requires a facility to conduct an interdisciplinary team (IDT) review of a proposed or prescribed medical intervention that requires informed consent prior to its administration when -

    • The resident’s attending physician has determined that the resident lacks capacity to give the informed consent, and
    • The resident does not have a legal decision maker.

    This IDT review has also been referred to as an Epple Committee meeting, bioethics review process, or an unrepresented patient IDT. As of January 27, 2023, an IDT review convened pursuant to HSC § 1418.8 must include a patient representative in addition to the attending physician, a registered nurse responsible for the resident’s care, and any other appropriate staff. The patient representative may be a resident’s family member or friend who is not able to take full responsibility for making health care decisions for the resident but is willing and available to participate in the IDT review.

    If the resident does not have a family member or friend who is willing and available to serve as the patient representative, the facility must submit a request for a PPR to the California Patient Representative Information System. Upon receipt of the request, the Office of the Long-Term Care Patient Representative will assign a PPR to participate in the IDT review convened pursuant to HSC § 1418.8.

    The IDT review may be held in person or remotely, but all required IDT members must be present. Facilities must provide a number of notices related to IDT reviews. Facilities may not implement medical interventions authorized by an IDT prior to providing notice to the resident and the resident’s patient representative regarding the outcome of the IDT review. The notice must state that the resident has a right to judicial review, and the facility must allow sufficient time for the resident to seek judicial review prior to implementing a medical intervention.

    If the resident chooses to seek judicial review, the facility may not implement any medical interventions authorized by the IDT prior to the court making a final determination—except in emergencies.

• Eligibility and Scope of Services

  • 1. Does the Office of the Long-Term Care Patient Representative provide patient representatives for all interdisciplinary team reviews convened pursuant to Health and Safety Code § 1418.8?

    No. Before requesting a public patient representative (PPR), facilities must attempt to identify a friend or family member who can serve as the resident’s patient representative on the interdisciplinary team (IDT) review.

    • The facility must document its efforts to locate a friend or family member in the resident’s medical record.
    • If a friend or family member cannot be identified within 72 hours of the physician notifying the facility that an IDT review is needed, the facility must submit a request for a PPR in the California Patient Representative Information System.

  • 2. Does the Office of the Long-Term Care Patient Representative provide public patient representatives to acute care hospitals?

    No. Public patient representatives are only available for residents in skilled nursing facilities and intermediate care facilities. The Office of the Long-Term Care Patient Representative does not provide PPRs for acute care hospitals or other types of healthcare facilities.

  • 3. Are Public patient representatives available to people who are under age 65 and not able to make their own medical decisions?

    Yes. Public patient representatives are available to represent any resident in a skilled nursing or intermediate care facility who lacks the capacity to provide informed consent for their healthcare decisions, and does not have family, friends, or a legal decisionmaker who can represent them at an interdisciplinary team review.

• Public Patient Representatives: Roles and Responsibilities

  • 1. What is a public patient representative?

    A public patient representative is a trained representative from the Office of the Long-Term Care Patient Representative that participates in interdisciplinary team (IDT) reviews held pursuant to Health and Safety Code § 1418.8 for specified long-term care residents who may need medical treatment but lack the capacity to make health care decisions, have no legal surrogate authorized to make decisions on their behalf, and have no family or friend to serve as a patient representative on the IDT review.

  • 2. Do public patient representatives make health care decisions for residents?

    No. Pursuant to Health and Safety Code § 1418.8, an Interdisciplinary Team (IDT) must be convened to review proposed medical interventions that require informed consent, if a resident lacks capacity and has no legal surrogate.

    If the IDT’s members reach consensus—meaning they all agree with the proposed intervention(s), the facility can proceed with the intervention(s) after notifying the resident (by providing the Notice of Outcome) and allowing sufficient time for the resident to seek judicial review if the resident disagrees.

  • 3. Will public patient representatives provide other services for residents who have no family or legal surrogate?

    No. Public patient representatives (PPRs) have a narrowly defined role. PPRs only represent residents on interdisciplinary team reviews convened pursuant to Health and Safety Code §1418.8.

  • 4. What will the public patient representative do once assigned to represent a resident during a Health and Safety Code §1418.8 interdisciplinary team review?

    The public patient representative (PPR) will:

    • Ensure all criteria for holding an interdisciplinary team (IDT) are met.
    • Review required written notices from the facility to the resident.
    • Review physician's documentation of the resident's lack of capacity to provide informed consent, including the basis for the determination.
    • Review the facility’s documentation of its efforts to identify a surrogate decisionmaker—or alternatively—a family member or friend to serve as the patient representative.
    • Meet the resident to understand their needs and preferences.
    • Review the resident’s medical records to prepare for the IDT.
    • Review facility policies and procedures relevant to Health and Safety Code §1418.8 and All Facilities Letter 23-18.
    • Participate in the IDT meeting, considering treatment risks, benefits, and alternatives.
    • Represent the resident’s preferences (if known) and best interests.
    • Articulate the Resident’s Preferences or the best approximation of them. Except in emergencies, the proposed medical intervention shall not be administered unless all IDT members agree or reach a consensus.
    • Report any suspected abuse or neglect concerns.
    • Refer residents seeking judicial review to appropriate legal services.

  • 5. Are there any roles that fall outside of the public patient representative’s scope of responsibility?

    Yes. Public patient representatives do not:

    • Participate in routine care plan meetings that fall outside the scope of HSC § 1418.8.
    • Serve as surrogate decision makers for residents regarding financial, admission, or placement decisions, including transfers and discharges.
    • Represent residents who have a friend or relative able to serve as the resident’s patient representative during an HSC § 1418.8 interdisciplinary team (IDT) review.
    • Investigate elder or dependent adult abuse or neglect.
    • Participate in IDT reviews of medical interventions or treatments that would "directly and inexorably lead to death".
    • Provide legal representation for residents who wish to seek judicial review. In this case, the program will refer the resident to a local legal services program.
    • Provide services in settings that are not skilled nursing or intermediate care facilities licensed by the California Department of Public Health.
    • Provide case management.
    • Provide community resource referrals to residents/families.
    • Sign consents to treat, admission, transfer, discharge paperwork, POLST forms, or hospice forms.

  • 6. Are public patient representatives mandated reporters for elder abuse?

    Yes. Public patient representatives (PPRs) are mandated reporters and are required to follow the mandated reporter process.

    Note: PPRs do not investigate elder or dependent adult abuse and neglect concerns or resolve care issues. This would be the role of the Long-Term Care Ombudsman Program, California Department of Public Health, and/or other enforcement agencies, such as law enforcement, or the Division of Medi-Cal Fraud and Elder Abuse (DMFEA).

  • 7. Can public patient representatives sign the Physician Orders for Life Sustaining Treatment or hospice paperwork on behalf of the resident?

    No. Public patient representatives (PPRs) cannot sign any documents for a resident, including the Physician Orders for Life Sustaining Treatment (POLST) form and paperwork to admit an individual to hospice care. The interdisciplinary team (IDT) representative for the facility signs the POLST as the "legally recognized decisionmaker" and indicates their relationship as "IDT representative". The physician signs in the area designated for the physician signature.

    Additionally, PPRs are not responsible for completing a new POLST upon a resident’s admission. If a resident requires a new POLST, the IDT representative and physician must complete it, not the PPR.

  • 8. Can public patient representatives assist residents with fiduciary matters or sign admission paperwork?

    No. Public patient representatives (PPRs) are not able to assist patients with any fiduciary matters such as Medi-Cal applications or provide financial assistance, nor can PPRs sign paperwork to admit an individual to a facility, or transfer or discharge them from a facility.

  • 9. Can public patient representatives sign off on consent to treat paperwork on behalf of residents who do not have a responsible party?

    No. Public patient representatives are not able to sign off on consent to treat paperwork on behalf of residents.

  • 10. Can public patient representatives assist with locating family members?

    No. The Office of the Long-Term Care Patient Representative and public patient representatives are not able to assist with locating family members or finding additional family support.

    Per Health & Safety Code (HSC) § 1418.8, the facility is responsible for identifying or using due diligence to search for a legal decision maker. If a legal decision maker cannot be identified or located, the facility should take further steps to promptly identify, or use due diligence to search for, a patient representative to participate in the interdisciplinary team review. Facilities should include provisions for locating their residents’ family members in their internal policies and procedures.

    Due diligence includes, at minimum, interviewing the resident, reviewing the medical records of the resident, and consulting with the staff of the skilled nursing or intermediate care facility, as appropriate, and with family members and friends of the resident, if any have been identified. The facility shall make a reasonable effort to reach these identified individuals.

  • 11. What is the difference between a public patient representative and an ombudsman representative?

    An Ombudsman representative assist residents in long-term care facilities with everyday issues like health, safety, and personal preferences. They speak up for the resident based on what the resident wants, or if the resident can’t communicate, they follow the wishes of the resident’s representatives. For more information about the Ombudsman program, visit The California Department of Aging's Long-Term Care Ombudsman page.

    A public patient representative (PPR) is a trained representative who takes part in interdisciplinary team review pursuant Health and Safety Code § 1418.8 to review medical decisions for residents who cannot make healthcare choices on their own.

    PPRs are there when a resident does not have a legal decision maker, family, or friends to help make those decisions. They focus on making sure medical decisions are made in the best interest of the resident.

  • 12. If a family member is in touch with the facility but does not come to a meeting, is the facility required to request a public patient representative?

    Yes. If a family member or friend is not available to participate (in-person or by phone) or declines to act as the patient representative on an interdisciplinary team (IDT) review held pursuant to Health and Safety Code § 1418.8, then the facility must request a public patient representative, but prior to contacting the Office of the Long-Term Care Patient Representative, facilities must attempt to identify a friend or family member who can serve as the resident’s patient representative on the IDT review. The facility’s efforts to locate a friend or family member must be documented in the resident’s record. The facility should also document (1) that the facility: (a) told the family member/friend (including name and phone number) of the proposed medical intervention, (b) explained the IDT review process, and (c) requested the family member's participation in the IDT as the resident representative, and (2) that the family member/friend was not available or declined to take on the role.

  • 13. Does a family member need to be a legal conservator or have durable power of attorney to make decisions for a resident?

    No. A patient representative may be a family member or friend of the resident. They do not need to be a legal conservator or have durable power of attorney (DPOA) for healthcare to serve in this role.

    If a family member or friend is not available, the Office of the Long-Term Care Patient Representative may assign a public patient representative.

    Under Health and Safety Code § 1418.8, if a resident in a skilled nursing or intermediate care facility lacks the capacity to make healthcare decisions and does not have a legally recognized decision maker (such as a conservator or someone with DPOA for healthcare), the facility may use the interdisciplinary team process to make healthcare decisions in the resident’s best interest.

    However, if a family member is legally designated as a decision-maker (e.g., through conservatorship or DPOA), they would have the legal authority to make healthcare decisions for the resident.

  • 14. Can the Office of Long-Term Care Patient Representative tell facilities how to verify and approve private patient representatives?

    No. The Office of the Long-Term Care Patient Representative (OLTCPR) does not have authority to direct or advise facilities on how to vet private patient representatives.

    Under Welfare Institutions Code Chapter 3.6 (§ 9260-9295), OLTCPR is responsible for providing public patient representatives for residents of skilled nursing or intermediate care facilities to participate in interdisciplinary team reviews held pursuant to Health and Safety Code (HSC) § 1418.8. This applies when a family member, friend, or other authorized person is unavailable, unwilling, or unable to serve.

    Facilities are responsible for determining the appropriate vetting process for private patient representatives. They should consult their legal counsel or relevant regulatory agencies to ensure compliance with HSC § 1418.8(a)(2) and (a)(4).

• Requesting a Public Patient Representative

  • 1. How can facilities request a public patient representative for a resident?

    a. Register as a California Patient Representative Information (CAPRIS) user:
    Facility staff must first register as a CAPRIS user by completing Section A of the CAPRIS User Action Request Form.

    • Each facility is limited to three (3) CAPRIS users.
    • User registration requests may take 1-2 business days to process.

    b. Submit request for a public patient representative (PPR) in CAPRIS

    • Once registered, facility staff must submit PPR requests through CAPRIS.
    • PPR requests submitted outside of CAPRIS will not be accepted.

  • 2. What is the turnaround time for public patient representative assignment once a request has been submitted?

    The Office of the Long-Term Care Patient Representative makes every effort to respond to requests within 1-2 business days.

  • 3. Will each facility and resident have an assigned public patient representative?

    No. Public patient representatives (PPRs) are assigned to specific counties, but may cover other areas based on availability.

    Facilities must request a PPR for each interdisciplinary team meeting needed when a resident lacks the capacity to make healthcare decisions and does not have a legal decision-maker, family member, or friend available to serve.

    PPRs are assigned on a case-by-case basis, depending on availability at the time of the request.

  • 4. Can public patient representatives be available for interdisciplinary team reviews on weekends?

    No. public patient representatives are not available to participate in interdisciplinary team (IDT) reviews on weekends and holidays. IDT reviews must take place during the Office of the Long-Term Care Patient Representative’s business hours: 8:00am – 5:00pm.

  • 5. If the emergency intervention happens on a weekend, does the 24-hour notification begin at that time or will Monday be considered the 24-hour time frame?

    The 24-hour notification period begins at the time the emergency intervention is administered. The facility must provide the required oral and written Emergency Intervention Notice to the resident and the resident’s patient representative. The facility must submit a copy of the Emergency Intervention Notice to the Office of the Long-Term Care Patient Representative, even if an alternative patient representative is available. The facility must conduct an interdisciplinary review within one (1) week of administering the emergency intervention. (Health and Safety Code § 1418.8 (h).)

  • 6. Does a public patient representative need to be present at regular quarterly care plan meetings?

    No. Public patient representatives only participate when the facility’s interdisciplinary team (IDT) meets to review a new order requiring informed consent, there are changes in the resident’s condition requiring review of consent, or when the facility holds a follow-up IDT meeting to evaluate the use of the prescribed medical intervention.

  • 7. Does every member of the interdisciplinary team need to approve the physician’s order for treatment or medical intervention, or is a majority enough?

    Yes. Per Health and Safety Code § 1418.8, the interdisciplinary team must reach a consensus (unanimous agreement) prior to administering the proposed intervention or treatment.

• Interdisciplinary Team Reviews Held Pursuant to Health & Safety Code § 1418.8

  • 1. Is the requirement to convene an interdisciplinary team review new?

    No. Health and Safety Code § 1418.8, which is also called the Epple Bill, has required skilled nursing and intermediate care facilities to use interdisciplinary team reviews to make medical decisions for residents who lack capacity and have no legal surrogates since 1992.

  • 2. Have there been changes to Health and Safety Code § 1418.8?

    Yes. In 2021, California updated Health and Safety Code (HSC) § 1418.8, requiring changes in how skilled nursing facilities and intermediate care facilities handle certain medical decisions for residents. These updates focus on residents who lack capacity to give informed consent to prescribed medical interventions and do not have a legal decisionmaker.

    What used to be called Epple Committees or bioethics review meetings are now called interdisciplinary team (IDT) reviews.

    As the result of a court case called CANHR v. Smith (later called CANHR v. Angell), the following changes became effective on January 27, 2023:

    • All IDT reviews convened pursuant to HSC § 1418.8 must include a patient representative. As previously required, the IDT review also must include the attending physician, a registered nurse responsible for the resident’s care, and any other appropriate staff. The IDT review may be held in person or remotely, but all required IDT members must be present.
    • Facilities must provide a number of notices related to IDT reviews.
    • Facilities may not implement medical interventions authorized by an IDT prior to providing notice to the resident and the resident’s patient representative regarding the outcome of the IDT review. The notice must state that the resident has a right to judicial review, and the facility must allow sufficient time for the resident to seek judicial review prior to implementing a medical intervention.
    • If the resident chooses to seek judicial review, the facility may not implement any medical interventions authorized by the IDT prior to the court making a final determination—except in emergencies.

  • 3. What is the required timeline for convening an interdisciplinary team review under Health and Safety Code § 1418.8?

    For non-emergency medical interventions, there is no required timeline for convening the interdisciplinary team (IDT) reviews. However, the facility must provide both written and verbal notice to the resident and the resident’s patient representative at least five (5) days prior to the IDT meeting.

  • 4. How will medical emergencies be handled?

    • In the case of an emergency, after obtaining a physician’s order as necessary, a skilled nursing or intermediate care facility may administer a medical intervention that requires informed consent prior to the facility issuing the required notice or conducting an interdisciplinary team (IDT) review.
    • The emergency must be documented in the resident’s records.
    • Within 24 hours of the intervention, a notice explaining the medical intervention must be provided to the resident and to the resident’s patient representative. The notice must include the date, time, and location of the required post-intervention IDT review.
    • The facility must conduct an IDT review within one week of the emergency for an evaluation of the medical intervention.
    • The IDT must include a patient representative.

  • 5. What is the facility’s role in the Health and Safety Code § 1418.8 interdisciplinary team process?

    The facility will:

    • Provide all required notices—both written and verbal.
    • Facilitate the public patient representative’s in-person or remote meetings with the resident.
    • Facilitate the resident’s participation in the interdisciplinary team (IDT) review if the resident wishes to participate.
    • Make the resident’s medical and clinical records, as well as relevant facility policies and procedures, available to the public patient representative. In most cases, the facility will need to provide this information to the public patient representative electronically.
    • Convene the IDT meeting. This may be an in-person or remote meeting.
    • Submit required data to the Office of the Long-Term Care Patient Representative for all IDT reviews convened pursuant to HSC § 1418.8—including those where the resident is represented by a friend or relative rather than a public patient representative.

  • 6. What happens if the interdisciplinary team does not reach consensus?

    If the interdisciplinary team does not reach consensus and the facility wants to proceed with the intervention, the facility must petition to obtain a court order pursuant to section 3201 of the Probate Code to authorize the medical intervention.

  • 7. What happens if the resident does not consent to the intervention or treatment agreed upon by the interdisciplinary team review team?

    Residents have the right to judicial review to contest the physician and surgeon’s determinations, the use of an interdisciplinary team to review and administer medical treatment, or the decisions made by the interdisciplinary team. If judicial review is sought, the intervention shall not be administered until a final determination is made by a court, except in cases of emergency. Facilities must report instances when judicial review is sought by the resident to the Office of the Long-Term Care Patient Representative.

  • 8. If the hospital has approved do-not-resuscitate, comfort measures, and/or hospice, do these orders continue at the facility?

    Yes. Do-Not-Resuscitate, Comfort Measures, and Hospice orders made by the hospital should continue at the facility. However, the interdisciplinary team (IDT) will review the appropriateness of these orders during the IDT review. The facility should ensure the orders are documented correctly in the resident's record.

  • 9. Can the Physician Orders for Life-Sustaining Treatment be updated to reflect changes like Do-Not-Resuscitate or Comfort Measures?

    Yes. The Physician Orders for Life-Sustaining Treatment can be updated to reflect changes, such as Do-Not-Resuscitate or Comfort Measures, based on the decisions made during the interdisciplinary team (IDT) review. If the hospital's orders need to be updated, this should be done through the IDT process to ensure that all relevant medical staff and the patient representative are involved.

• Required Notices for Facilities

  • 1. What notices will facilities be required to provide?

    • Notice of Interdisciplinary Team Review of Proposed Medical Intervention or Treatment
      An initial notice containing required information must be provided to the resident and the resident’s patient representative at least five (5) days prior to the Health and Safety Code (HSC) § 1418.8 interdisciplinary team (IDT) review. See Notice of Interdisciplinary Team Review of Proposed Medical Intervention or Treatment

    • Notice of Outcome of Interdisciplinary Team Review of Proposed Medical Intervention or Treatment
      A follow-up notice must be provided to the resident and the resident’s patient representative after the IDT review has taken place. See Notice of Outcome of Interdisciplinary Team Review of Proposed Medical Intervention or Treatment.

    • Notice of Interdisciplinary Team Review of Emergency Medical Intervention or Treatment

      An emergency intervention notice must be provided to the resident and the resident’s patient representative within 24 hours of an emergency intervention. See Notice of Interdisciplinary Team Review of Emergency Medical Intervention or Treatment.

    • Notice of Failure to Conduct Timely Interdisciplinary Team Review Following an Emergency Medical Intervention
      If the facility fails to conduct an IDT review within one (1) week of an emergency medical intervention that falls under HSC § 1418.8, the facility must notify the Office of the Long-Term Care Patient Representative (OLTCPR) regarding the delay, the cause of the delay, and the number of days following the emergency medical intervention that the IDT review was convened. See Notice of Failure of Conduct Timely IDT Review Following an Emergency Medical Intervention.

    • Notification for Emergency Medical Intervention Resulting in Severe Emotional Distress or Physical/Chemical Restraints
      In cases where an emergency results in the application of a medical intervention to treat severe and sustained emotional distress or the application of physical or chemical restraints (involving residents who lack capacity and have no legal surrogate), the facility must notify the resident and the resident’s patient representative within 24 hours of the intervention. The facility also must notify the OLTCPR within 24 hours of the intervention—even if a friend or relative is available to serve as the patient representative and has been notified.

  • 2. Where can facilities find the required notices?

    Fillable PDF templates are available for all required notices on the Office of the Long-Term Care Patient Representative’s (OLTCPR’s) webpage, in the Forms tab. Facilities have the option of using these templates or creating their own forms. However, all information included on the OLTCPR’s templates must be included either way.

  • 3. Do required notices have to be provided in a resident’s primary language?

    Yes. All written notices must be provided to residents in the resident’s preferred or primary language. If translating a written notice is not possible, it may be provided in English.

    Copies of all written notices must be provided to the resident’s patient representative (whether public or private) in English.

    All notices that facilities provide to residents must be provided verbally as well as in writing. In the case of a verbal notice, the information must be provided in the resident’s primary or preferred language, if known.

    Copies of all written notices, in English, must be entered into the resident’s record.

  • 4. Can facilities forgo the notice requirement to the resident if the resident is non-responsive?

    No. Failure to provide notice is what led the Court in California Advocates for Nursing Home Reform (CANHR), et al. v. Sonia Angell, to hold that the prior version of Health and Safety Code § 1418.8 violated the California Constitution. Section 1418.8(d)(1) states that notice of the IDT "shall" be given to both "the resident and the patient representative in accordance with subdivision (m)." Subsection (e)(1) further states that the interdisciplinary team review cannot occur "without the participation of a patient representative and until the notice required by subdivision (d) has been provided to the resident and patient representative." Based on these two provisions, a resident’s lack of responsiveness would not permit a facility to forgo the notice requirements. Even if the patient is non-responsive, the facility still needs to provide notice.

  • 5. Is the five (5) day noticing requirement recorded in the statute?

    Yes. Health and Safety Code § 1418.8 outlines the timeline for the various noticing requirements. Reference 1418.8 (d-h) for more information.

  • 6. Can the Office of the Long-Term Care Patient Representative provide facilities with templates of required notices in different languages?

    The Office of the Long-Term Care Patient Representative currently has required notice templates available in English only. Required notice templates can be found on the OLCTPR’s webpage in the Forms tab.

• Required Data Reporting for Facilities

  • 1. What data are facilities required to submit to the program quarterly?

    • The total number of interdisciplinary team (IDT) reviews conducted.
    • The number of unique residents who have had an IDT review conducted.
    • The total number of emergency medical interventions authorized pursuant to HSC § 1418.8(h).
    • The number of unique residents who have had an emergency medical intervention authorized.
    • A tabulation of the following:
      • Medical interventions authorized by type.
      • The outcomes of the interdisciplinary team reviews.
      • Instances when judicial review was sought.
      • Emergency medical interventions where the interdisciplinary team failed to meet within the time required by HSC § section 1418.8(h), including the causes of the delay and the number of days after the intervention that the interdisciplinary team finally met.
      • Any other demographic or statistical data as may be required by the program.

  • 2. How will facilities submit the required data?

    Facilities must report required data in the California Patient Representative Information System (CAPRIS). Data submitted outside of CAPRIS will not be accepted.

  • 3. What if my facility did not hold any interdisciplinary team reviews pursuant to Health and Safety Code § 1418.8? Do we still need to report?

    No. Although facilities are not required to report not holding any interdisciplinary team reviews pursuant to Health and Safety Code § 1418.8 during a reporting period, they may still report zero data in the California Patient Representative Information System.

  • 4. What are the deadlines for submitting the required data?

    Quarter	Reporting Period	Submission Deadline
    1	July 1 – September 30	October 31
    2	October 1 – December 31	January 31
    3	January 1 – March 31	April 30
    4	April 1 – June 30	July 31

  • 5. Does the Office of the Long-Term Care Patient Representative have any tools to help facilities track data internally?

    To assist facilities with internal data collection and tracking, the Office of the Long-Term Care Patient Representative (OLTCPR) has developed a Quarterly Data Tracking Tool. This tool is intended to assist facilities with organizing, compiling, and tracking data internally in preparation for submitting quarterly data to the OLTCPR. Use of this tool is optional for facilities.

    Note: Facilities must not submit the Quarterly Data Tracking Tool. Quarterly data must be submitted in CAPRIS.

  • 6. We missed the reporting deadline can we still submit our data? What happens if my facility misses the reporting deadline?

    Quarterly data must be reported in the California Patient Representative Information System (CAPRIS) on or before the submission deadline. Facilities will receive two (2) emails when CAPRIS becomes available to accept data submissions. The Office of the Long-Term Care Patient Representative is not able to receive late quarterly data submissions.

  • 7. What does the Office of the Long-Term Care Patient Representative do with the data collected from facilities?

    Under Health and Safety Code (HSC) § 1418.8 the Office of the Long-Term Care Patient Representative (OLTCPR) will collect required data from all skilled nursing and intermediate care facilities for all interdisciplinary team (IDT) reviews conducted pursuant to HSC § 1418.8. The OLTCPR will analyze data to identify IDT trends by facility, region, or county level, gaps in services, and opportunities to provide outreach and/or technical assistance.

    Data collected is deidentified and posted in an annual report by state fiscal year on the OLCTPR’s webpage in the Data and Reports tab.

  • 8. Can facilities access data they previously submitted?

    Yes. Facilities can log into the California Patient Representative Information System and navigate to the Reports tab to access their previously submitted quarterly data report.

  • 9. Do facilities have to report data for quarterly care conferences, monthly care meetings, planning meetings, annual care conferences, etc.?

    No. Facilities are only required to report data to the Office of the Long-Term Care Patient Representative for interdisciplinary team reviews that are conducted per the requirements set by Health and Safety Code § 1418.8.

• Proposed Medical Interventions/Treatments Requiring an Interdisciplinary Team Review

  • 1. The law is specific to informed consent for antipsychotic medications. Does it also apply to other psychoactive medications such as antianxiety, antidepressants, or other drugs used to control behavior?

    Health and Safety Code § 1418.8 applies to all psychotropic medications and not just antipsychotics.

  • 2. Does the administration of a vaccine/immunization require informed consent?

    It is the position of the California Department of Public Health that vaccines/immunizations do not require informed consent. If a physician has determined that a vaccine, immunization, or booster is a routine order, an interdisciplinary team review is not required.

    Facilities should refer to their internal policies and procedures for requirements related to vaccines/immunizations.

    Facilities should review Title 42 Code of Federal Regulations § 483.80 Infection Control.

  • 3. Should the Office of the Long-Term Care Patient Representative be involved in cases of residents with an appointed Public Conservator/Guardian?

    No. If a resident has an appointed Public Conservator/Guardian, the Office of the Long-Term Care Patient Representative (OLTCPR) would not be involved since the resident already has a legal representative. The facility is only required to engage the OLTCPR if the resident does not have a legal surrogate or decisionmaker, or a family member or friend to act on their behalf and all other criteria under Health and Safety Code § 1418.8 are met.

  • 4. If a resident is alert and oriented, but they do not have any family or friend support, do they need a representative?

    If the resident has the capacity to give informed consent for their treatment, then a public patient representative (PPR) is not necessary. A PPR is only required when all the following are met:

    • The facility received a physician’s order for a medical treatment/intervention requiring informed consent.
    • The physician has determined the patient lacks capacity to provide informed consent.
    • The patient has no legal surrogate or decision-maker.
    • The patient has no available friend or family to participate in the interdisciplinary team review.

  • 5. When an unrepresented resident is admitted to a facility with active psychotropic medication orders, is a public patient representative referral needed?

    No. In such instances, a public patient representative is not needed because informed consent was obtained by the hospital physician. As long as the resident's medical record contains documentation that informed consent has been obtained prior to the administration of psychotropic medications, then a patient representative referral is not needed.

  • 6. Are facilities required to provide notices to representatives of all residents who lack capacity or just if the public patient representative is involved?

    Facilities must follow the notification requirements for any resident who lacks the capacity to provide informed consent. Per Health and Safety Code § 1418.8 (m) the facility is required to provide notice to the resident and a copy of the notice in writing, and a second copy translated into English if applicable, shall be provided to the resident’s patient representative. If a patient representative has not been identified, or if the patient representative cannot be readily contacted, the notice shall be provided to the Office of the Long-Term Care Patient Representative.

• California Patient Representative Information System (CAPRIS)

  • 1. What is CAPRIS?

    The California Patient Representative Information System (CAPRIS) was developed by the California Department of Aging’s (CDA), Office of the Long-Term Care Patient Representative and CDA’s Information Technology Bureau. CAPRIS was developed as a standardized data management system to initiate requests for public patient representatives, upload required notices, and to collect data submitted by skilled nursing facilities and intermediate care facilities for interdisciplinary team reviews as required by Health and Safety Code § 1418.8.

  • 2. How do I register for CAPRIS?

    To register for the California Patient Representative Information System (CAPRIS), you first must complete Section A of the CAPRIS User Action Request Form (UAR) and submit it via email to the Office of the Long-Term Care Patient Representative (OLTCPR). Facilities should review instructions on how to complete the CAPRIS UAR Form.

    Facilities should allow the OLTCPR 1-2 business days to process submitted CAPRIS UARs. Prospective users must gain approval from their facility administrator prior to submitting a CAPRIS UAR to the OLTCPR

  • 3. How many user accounts are available for each facility?

    Facilities are limited to three (3) California Patient Representative Information System (CAPRIS) users. If your request for access exceeds the maximum number of users for your facility, your request will be denied. Prospective CAPRIS users should verify number of existing accounts prior to submitting a CAPRIS User Action Request Form.

    Note: CAPRIS user accounts cannot be shared.

  • 4. How do I deactivate or make changes to an existing user account in CAPRIS?

    To deactivate an existing user account within the California Patient Representative Information System (CAPRIS), facilities must complete Section B of the CAPRIS User Action Request (UAR) Form.

    To make changes to an existing account within CAPRIS, facilities must complete Section C of the CAPRIS UAR Form.

    Completed CAPRIS UARs must be submitted to the Office of the Long-Term Care Patient Representative at OPR@aging.ca.gov. Facilities should allow the OLTCPR 1-2 business days to process submitted CAPRIS UARs.

  • 5. How do I unlock my CAPRIS account?

    To unlock your California Patient Representative Information System (CAPRIS) user account, please contact the Office of the Long-Term Care Patient Representative at 916-800-5084 or via email at OPR@aging.ca.gov.

    Note: As a security mechanism, CAPRIS user accounts will lock after 90 days of inactivity.

  • 6. What is my passphrase/How do I create my passphrase?

    Passphrases are created by approved users and must fulfill the following requirements:

    • Contain 16 characters, and at least three (3) of the following:
      • Upper case letter
      • Lower case letter
      • Number
      • Special character (e.g., ?, $, !, @, etc.)
    • Passphrases expire after 90 days of inactivity
    • Cannot be recycled
    • Cannot be shared

    The Office of the Long-Term Care Patient Representative cannot generate passphrases for users.

  • 7. I forgot my passphrase, how do I reset it?

    To reset your passphrase:

    • Log into the California Patient Representative Information System (CAPRIS).
    • Click the Forgot Passphrase link (located below the passphrase box).
    • From the Forgot passphrase window, click Request Help, then click Confirm.

    This action will send an alert to the Office of the Long-Term Care Patient Representative (OLTCPR) that you are attempting to change your password. Once the OLTCPR resets your passphrase, you will receive an email to log back into CAPRIS and to change your passphrase.

  • 8. Can I share a user account with another staff?

    No. California Patient Representative Information System (CAPRIS) accounts cannot be shared. Each user must have an approved account prior to accessing CAPRIS. To register for CAPRIS, please complete and submit a CAPRIS User Action Request form and submit it to the Office of the Long-Term Care Patient Representative at OPR@aging.ca.gov.

  • 9. Is resident information secured?

    Yes. CAPRIS is a secure web-based system requiring two-factor authentication (email address and passphrase). Users must be approved by their facility administrator and by the Office of the Long-Term Care Patient Represent prior to gaining access to CAPRIS. First time users must complete the confidentiality agreement prior to accessing CAPRIS. Facility users cannot share CAPRIS user accounts.

  • 10. I am not an employee at a skilled nursing facility or an intermediate care facility, can I still have access to CAPRIS?

    No. CAPRIS is intended exclusively for current skilled nursing facility and intermediate care facility staff to meet statutory requirements set forth by Health and Safety Code § 1418.8 related to interdisciplinary team reviews and cannot be accessed by individuals outside of the intended user group.

• Contact and Technical Assistance

  • 1. Is the Office of the Long-Term Care Patient Representative able to provide my facility training or technical assistance on specific program areas?

    Yes. The Office of the Long-Term Care Patient Representative (OLTCPR) may provide in-service training to facilities on various program areas. To request training and technical assistance from the OLTCPR, please submit the Technical Assistance and Training Request Form.

    Additional training materials can be found on the Training and Resources section of the webpage at: Training and Resources.

    You may also contact the OLTCPR at 916-800-5084 or via email at OPR@aging.ca.gov.

  • 2. How do I contact the Office of the Long-Term Care Patient Representative for questions?

    The Office of the Long-Term Care Patient Representative can be contacted at OPR@aging.ca.gov or 916-800-5084. You may also request technical assistance/training by completing the Technical Assistance and Training Request Form.

  • 3. Is the Office of the Long-Term Care Patient Representative open 7 days a week, 24 hours/day?

    No. The Office of the Long-Term Care Patient Representative staff can be reached Monday through Friday, 8:00 a.m. - 5:00 p.m. via email at OPR@aging.ca.gov or 916-800-5084.