Nursing homes and other healthcare facilities must ensure that a resident's right to designate a representative is respected and that same-sex spouses are treated the same as opposite-sex spouses. The representative's decisions must be treated as the resident's decisions to the extent required by the court or delegated by the resident, and the resident's wishes and preferences must be considered in the exercise of rights by the representative. Facilities must also obtain documentation that the resident's representative has been delegated the necessary authority to exercise the resident's rights and must verify that a court-appointed representative has the necessary authority for the decision-making at issue as determined by the court. Surveyors must check whether there has been a delegation of rights or designation of a resident representative and must also determine if the resident's delegation of rights has been followed by facility staff. If the resident's representative is not acting in the best interests of the resident, the facility must report such concerns when and in the manner required under state law. Nursing homes and other healthcare facilities must ensure that they are protecting and promoting the resident's interests and that they are respecting the resident's wishes and preferences to the extent legally possible.

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