§ 87469 — Advance Directives and Requests Regarding Resuscitative

MEASURES

(a)  Upon admission, a facility shall provide each resident, and representative or responsible person of each resident, with written information about the right to make decisions concerning medical care.  This information shall include, but not be limited to, the Department's approved brochure entitled "Your Right To Make Decisions About Medical Treatment," PUB 325, (3/12) and a copy of Sections 87469(b), (c) and (d) of the regulations.

(b)  Residents shall be permitted to have a Request to Forego Resuscitative Measures, an Advance Health Care Directive and/or a Do-Not-Resuscitate (DNR) Form in their facility file.

MEASURES (Continued)

(c)  If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following:

(1)  Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel and identify the resident as the person to whom the order refers.

(2)  Immediately give the advance directive and/or request regarding resuscitative measures form to a physician, registered nurse or licensed vocational nurse if the physician or nurse is in the resident's presence at the time of the emergency and assumes responsibility.

(3)  Specifically for a terminally ill resident that is receiving hospice services and has completed an advance directive and/or request regarding resuscitative measures form pursuant to Health and Safety Code section 1569.73(c), and is experiencing a life-threatening emergency as displayed by symptoms of impending death that is directly related to the expected course of the resident’s terminal illness, the facility may immediately notify the resident’s hospice agency in lieu of calling emergency response (9-1-1).  For emergencies not directly related to the expected course of the resident’s terminal illness, the facility staff shall immediately telephone emergency response (9-1-1).

(4)  Facilities that employ health care providers, other than Home Health Agencies or Hospice Agencies, may comply with Health and Safety Code section 1569.74.

(d)  After following the procedure in Section 87469(c)(1), (2), (3), or (4), facility staff shall notify the resident's hospice agency and Health Care Surrogate Decision Maker, if applicable.

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Health and Safety Code section 1569.73(c) provides in relevant part:

"(c)  A facility that has obtained a hospice waiver from the department pursuant to this section need not call emergency response services at the time of a life-threatening emergency if the hospice agency is notified instead and all of the following conditions are met:

  (1)  The resident is receiving hospice services from a licensed hospice agency.

      (2)  The resident has completed an advance directive, as defined in Section 4605 of the Probate Code, requesting to forego resuscitative measures.

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MEASURES (Continued)

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      (3)  The facility has documented that facility staff have received training from the hospice agency on the expected course of the resident’s illness and the symptoms of impending death."

Health and Safety Code section 1569.74 states in relevant part:

"(a)  Licensed residential care facilities for the elderly that employ health care providers may establish policies to honor a request to forego resuscitative measures as defined in Section 4780 of the Probate Code.

(b)  Any policy established pursuant to subdivision (a) shall meet all of the following conditions:

(1)  The policy shall be in writing and specify procedures to be followed in implementing the policy.

(2)  The policy and procedures shall, at all times, be available in the facility for review by the department.

(3)  The licensee shall ensure that all staff are aware of the policy as well as the procedures to be followed in implementing the policy.

(4)  A copy of the policy shall be given to each resident who makes a request to forego resuscitative measures, and the resident's primary physician.

(5)  A copy of the resident's request to forego resuscitative measures shall be maintained in the facility and shall be immediately available for review by facility staff, the licensed health care provider, and the department.

(6)  Facility staff are prohibited, on behalf of any resident, from signing any directive document as a witness or from being the legally recognized surrogate decision maker.

(7)  The facility shall provide the resident's physician with a copy of the resident's request to forego resuscitative measures form.

(c)  Any action by a facility that has established policies pursuant to subdivision (a), to honor a resident's request to forego resuscitative measures as provided for in subdivision (a) may only be taken in either of the following ways:

  (1)  By a licensed health care provider who is employed by the facility and on the premises at the time of the life threatening emergency.

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    (2)  By notifying, under those conditions specified in subdivision (c) of Section 1569.73, the hospice agency that is caring for a resident receiving hospice services.

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(d)  Licensed residential care facilities for the elderly that have not established policies pursuant to subdivision (a) may keep an executed request to forego resuscitative measures form in the resident’s file and present it to an emergency medical technician or paramedic when authorized to do so in writing by the resident or his or her legally recognized surrogate decisionmaker.  The request may be honored by an emergency medical technician or by any health care provider as defined in Section 4621 of the Probate Code, who, in the course of professional or volunteer duties, responds to emergencies."

Probate Code section 4780 provides in relevant part:

(a)  As used in this part:

      (1)  "Request regarding resuscitative measures" means a written document, signed by (A) an individual with capacity, or a legally recognized health care decisionmaker, and (B) the individual’s physician, that directs a health care provider regarding resuscitative measures. A request regarding resuscitative measures is not an advance health care directive.

      (2)  "Request regarding resuscitative measures" includes one, or both of, the following:

        (A)  A prehospital "do not resuscitate" form as developed by the Emergency Medical Services Authority or other substantially similar form.

        (B)  A Physician Orders for Life Sustaining Treatment form, as approved by the Emergency Medical Services Authority.

      (3)  "Physician Orders for Life Sustaining Treatment form" means a request regarding resuscitative measures that directs a health care provider regarding resuscitative and life-sustaining measures.

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NOTE: Authority cited: Section 1569.30, Health and Safety Code.  Reference: Sections 1569.73, 1569.74, and 1569.156, Health and Safety Code; and Sections 4621 and 4780, Probate Code.