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 CMS Strikes Down ‘No-CPR’ Facilities

​Care centers will have to perform CPR (cardio-pulmonary resuscitation) on stricken elders unless the resident has already signed an advance directive, officials at the Centers for Medicare & Medicaid Services (CMS) announced in new rules earlier this month.

A few states, such as Wisconsin and Kansas, had allowed some providers to declare in advance that they wouldn’t provide CPR to fallen residents. But CMS officials announced that this wasn’t kosher.

“Facility policy should specifically direct staff to initiate CPR when cardiac arrest occurs for residents who have requested CPR in their advance directives, who have not formulated an advance directive, who do not have a valid DNR [do not resuscitate] order, or who do not show AHA [American Hospital Association] signs of clinical death as defined in the AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC),” CMS said in a memorandum, issued Monday.

“Additionally, facility policy should not limit staff to only calling 911 when cardiac arrest occurs. Prior to the arrival of EMS [emergency medical services], nursing homes must provide basic life support, including initiation of CPR, to a resident who experiences cardiac arrest in accordance with that resident’s advance directives or in the absence of advance directives or a DNR order,” the memo said.

The memo also makes clear that providers will have to default to heroic measures when they don’t know if their residents have completed and signed advance directives.

“While acknowledging that research shows that CPR is generally ineffective among elderly nursing facility residents, the memo also notes that trends in the nursing facility population, including more younger residents, more individuals seeking short-term rehabilitation, and increasing ethnic and cultural diversity, underscores the need for effective, individualized, well-documented and consistently implemented policies and procedures for advance directives,” said Ruta Kadanoff, vice president for quality and regulatory affairs at the American Health Care Association, in a note to her association’s members.

The memo will have some impact on those centers that haven’t already hired CPR-trained staff for each shift of the 24-hour day. But Kadanoff told us that Monday’s memo underlines the importance of getting to know residents right away and making sure their needs and wants are understood from the first day. 

Click HERE for the CMS memorandum.

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