CMS Provided Guidance to the Indiana State Department of Health

Last week, the Bureau of Developmental Disabilities Services posted a bulletin providing guidance concerning the use of CPR.
 
In addition, the Centers for Medicare & Medicaid Services (CMS) has provided the following guidance to the Indiana State Department of Health regarding use of CPR when individuals being served in group homes have a DNR:

CMS stated that they agree that the group home provider should honor the individual’s DNR.

This is particularly clear when the individual is receiving hospice services as there is a system established whereby when the individual dies, the group home staff would contact the hospice who then establishes the death—therefore death is not being determined contrary to state law. Staff need to be educated and prepared for what to do. For example, if a client is on hospice for cancer and is accidentally choking on a sandwich, staff should still take steps to dislodge the sandwich and restore breathing. Over the years, I have had nursing home staff not respond promptly to a choking incident saying that the person was a DNR so we have to make sure staff can understand when to intervene and when not to intervene.

The same would be true if the individual is a DNR without being on hospice. The complication here is the fact that the group home staff cannot declare death. So they are going to have to have a system for calling EMS, a coroner, or physician to actually declare the death. 

If you have questions or need additional assistance, please contact the INARF office.