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CMS Addresses CPR in Nursing Homes

on Thursday, 30 January 2014 in Health Law Alert: Erin E. Busch, Editor

A Survey and Certification Letter (S & C 14-01-NH) issued in October 2013 reinforces the requirement for nursing facilities to initiate cardiopulmonary Resuscitation (CPR) unless otherwise directed by the resident’s advance directive or a Do Not Resuscitate (DNR) order. The guidance follows several highly publicized cases of nursing facilities adopting so-called “blanket” DNR policies that were not based on individual health care decision-making. The guidance is based on federal regulations (42 CFR § 483.10) providing for resident rights, including the right to a dignified existence, self-determination and a right to formulate an advance directive.


CMS pointed out that Medicare providers are also required to inquire about advanced directives under 42 CFR § 489.102 as well as to provide written information to residents about the right to formulate advance directives and participate in medical decision-making with respect to CPR.


The Letter acknowledged that survival rates after administration of CPR are low among the elderly, but pointed out that CPR is not always started promptly or at all for residents who desire it. Further, an increasing number of nursing home residents are younger and may be receiving care on only a short-term basis. The bottom line is that, in order to be compliant with the Conditions of Participation for Nursing Facilities, decision-making regarding life-sustaining care must be individualized and may not be determined by a policy applicable to all residents.


Surveyors are directed to review facility policies and procedures to assure that CPR is appropriately initiated—that is, whenever cardiac arrest occurs and:

  • the resident has requested CPR in an advance directive;
  • the resident does not have an advance directive;
  • the resident does not have a valid DNR order; and
  • does not show signs of clinical death as defined in the AHA Guidelines for CPR and Emergency Cardiovascular Care.


In addition, CPR policies, may not be limited to strictly calling 911. Staff certified in CPR must be available at all times to promptly initiate CPR prior to the arrival of a rescue squad.

Julie A. Knutson

1700 Farnam Street | Suite 1500 | Omaha, NE 68102 | 402.344.0500

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