The Centers for Medicare & Medicaid Services (CMS) issued a letter mandating that nursing homes may not establish or implement facility-wide no CPR policies. The letter, “Cardiopulmonary Resuscitation (CPR) in Nursing Homes” (Ref: S&C 14-01-NH), notes that nursing homes must provide basic life support, including the initiation of CPR, in accordance with the resident’s advance directives or in the absence of advance directives or a DNR order prior to the arrival of emergency medical services (EMS).
Under F-155 Right to Refuse; Formulate Advance Directives, all residents should have the ability to form an advance directive. Decision-making for advanced directives must be individualized and documented, as well as implemented facility-wide, taking into account the resident’s preferences, medical conditions and cultural beliefs. CMS states that facilities may not implement policies that prevent the full implementation of advance directives and do not promote person-centered care, which may occur if a blanket No CPR policy is implemented.