Understanding Advance Directives & Do Not Resuscitate (DNR) Orders
- Tim Slusher
- Jan 27
- 3 min read
Advance directives and Do Not Resuscitate (DNR) orders are critical topics to address during client intake. In regulated states, agencies are often required to ask about these documents. In non-regulated states, it is still best practice. Most home care clients are older adults, and having a clear plan in place helps ensure their wishes are honored if they can no longer make decisions for themselves.
Agencies should document this information clearly in the client record so staff know who to contact and what expectations exist if a situation escalates.
What Are Advance Directives?
Advance directives are legal documents that outline a person’s wishes related to medical care and decision-making if they become incapacitated. They are meant to reduce confusion, conflict, and uncertainty during emergencies or periods of decline.
Living Wills
A living will documents which life-sustaining measures a client does or does not want. This may include preferences regarding feeding tubes, ventilators, or other extraordinary measures. These decisions are typically made after thoughtful discussion and should be clearly written so family members and providers are aware of the client’s wishes.
Power of Attorney
A medical power of attorney designates a trusted individual to make healthcare decisions only if the client becomes unable to do so. This authority does not take effect while the client remains capable. Many clients worry this means losing control, but legally, it simply identifies who will step in if capacity is lost due to conditions such as stroke, dementia, or serious illness. Hospitals and medical providers frequently request this information.
A durable or financial power of attorney allows someone to manage banking and financial matters. In some families, one person handles finances while another oversees healthcare decisions. Agencies should note who is financially responsible for services and who is authorized to discuss billing.
Do Not Resuscitate (DNR) Orders
A DNR is not the same as a living will. While a living will outlines general end-of-life preferences, a DNR specifically instructs that CPR should not be performed if the heart stops. A DNR is a physician’s order, not simply a personal request, and most physicians will only sign one when there is a life-limiting illness.
It is also important to distinguish between in-facility DNRs and out-of-hospital DNRs. A DNR signed during hospitalization or surgery does not automatically apply in the home. An out-of-hospital DNR must be properly completed, often with multiple signatures, and posted visibly in the home. Emergency responders are required to perform CPR unless a valid DNR is immediately visible.
Helpful Resources
Home care agencies are not responsible for providing legal advice or completing advance directive paperwork. However, offering general information or pointing clients to reliable resources is appropriate. One commonly used option is Five Wishes, which presents end-of-life planning in clear, accessible language.
Most states also offer free, downloadable Living Will and Power of Attorney forms. These typically require witnesses or notarization and are sufficient for uncomplicated family situations. When family dynamics are complex or disagreements exist, referral to an elder law attorney is strongly recommended.
Guardianship Considerations
Guardianship is separate from advance directives. It involves a court decision made when disputes or incapacity require legal intervention. If a client has a guardian, the agency must have a copy of the court order and ensure all staff understand who is authorized to make decisions or discuss the client's care, and who is not. Guardianship orders must be strictly followed.
Agency Responsibility
Non-medical home care agencies are expected to honor documented client wishes while operating within their own policies. Agencies may have specific procedures regarding CPR and emergency response, which should be discussed at admission. Clear communication and documentation protect the client, the family, and the agency.
Advance directives are not just paperwork—they are an essential part of ethical, compliant, and client-centered care.
If your agency needs guidance on this topic, visit slusherconsulting.com and schedule a call. I'd love to help.
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