With your hectic schedule, it is sometimes easy to overlook simple compliance issues. Advanced Healthcare Studies’ “Tuesday Tips” will bring you a quick, helpful idea each week that can assist you in your operations related to regulatory compliance. We know that many of you implement outstanding practices in your community, and we welcome your ideas as well. If you have a tip that you would like to share, just reply by email and we may share your tip in a future “Tuesday Tip.”
Tip: Understanding Advance Directives
Because they are a legal document and involve healthcare decision-making, advance directives can be intimidating and confusing. While a full discussion of the legal intricacies of advance directives goes beyond the scope of this Tuesday Tip, here are a few key points to remember.
What Is An Advance Directive?
An advance directive is a legal document that helps ensure a person’s health care wishes will be honored if he/she becomes unable to speak or otherwise communicate. Advance directives may also be oral directions given to a family member or health care agent, but of course a legal document is more clear and more likely to be followed. While the actual format for an advance directive can vary, the most common types are a living will or a medical power of attorney.
Who Creates the Advance Directive?
Once again, and advance directive is a legal document. An assisted living or residential care provider should NOT attempt to develop an advance directive for a resident, nor give specific advice. The document should be developed by the resident and his/her responsible party in council with an attorney and the resident’s physician.
Is a DNR The Same As An Advance Directive?
A DNR (do not resuscitate order) may be written based on the resident’s wishes expressed in his/her advance directive. Once again, this should be developed between the resident, his/her responsible party, and the resident’s physician.
Your primary responsibility as a provider is to: (1) know if your residents have an advance directive, (2) maintain a copy of the advance directive in the resident’s record, and (3) provide the information to medical personnel in the event of an emergency or other health-related situation. So for example, if the resident is having chest pain and difficulty breathing, you would of course call 911 and then present a copy of the advance directive to the responding emergency medical personnel. Regardless of a resident’s advance directive, you must call 911 during a medical emergency.
What About Hospice?
When a resident is receiving hospice services they will typically have a DNR. This does not preclude the need for emergency care for trauma or other non-end-of-life medical conditions. In California, there is no need to call 911 in the event of death or a worsening condition related to the terminal diagnosis, rather you should contact hospice. As always, when in doubt, call 911.
What About the POLST?
Many states, including California, are now implementing the POLST.
We hope this information helps clarify your role as an assisted living or residential care provider related to advance directives.
This tip was provided by Advanced Healthcare Studies — your source for operational and training products and services.
Josh Allen, RN
Advanced Healthcare Studies, LLC