No Facility-Wide Bans on CPR in Skilled Nursing Facilities Due to Advance Directives and Changing Demographics

The Centers for Medicare and Medicaid Services (CMS) just issued a memorandum which would impose citations on skilled nursing facilities that have facility-wide policies that do not permit cardiopulmonary resuscitation (CPR) for residents. In the past, some facilities have had such policies because research has shown that CPR is not extremely effective among older individuals.

CMS has stated that such facility-wide bans fly in the face of federal regulations which guarantee a resident’s right to have advance directives. According to the memo, these decisions should be made on a case-by-case basis, taking into account the resident’s preferences and belief systems. The CMS memo also points out that the younger population in nursing homes is on the rise as strokes and other medical conditions are increasingly impacting younger individuals.

Facilities should take the opportunity to review their advance directive policies. Further, whether to use CPR or other life saving measures must be looked at on an individual basis, taking into account the resident’s wishes, medical conditions and any cultural or religious beliefs. Even more importantly, staff needs to be sufficiently trained on what to do in these life threatening situations and the interaction with advance directives.


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