Blanket 'no-CPR' policy can result in citation, CMS rules

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SNFs must be ready to administer CPR, federal regulators stress.
SNFs must be ready to administer CPR, federal regulators stress.

Federal regulators have come out strongly against facility-wide policies that prohibit cardiopulmonary resuscitation for residents in distress.

If a do-not-resuscitate order or advance directive is not in place indicating otherwise, operators must provide CPR to a resident in cardiac arrest, according to a recent memo from the Centers for Medicare & Medicaid Services. Violation of this policy can result in survey citations, with possible escalation of penalties.

CMS acknowledged in its memo that CPR has not been especially effective with nursing home residents, thus leading to no-CPR policies in some places. But these policies still may not be issued, due to federal rules allowing self-determination of advance directives, officials stressed.

“Any limits on how a facility may implement advance directives should be applied on a case-by-case basis, taking into consideration a resident's preferences, medical conditions, and cultural beliefs,” according to the memo, which was dated Oct. 15. 

The memo also discussed a general shift in nursing populations toward younger and short-stay residents. CPR is more effective with this group, officials pointed out.

In the memo's summary, CMS emphasized that before emergency medical services arrive, 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.”

“CPR-certified staff must be available at all times,” it concluded.


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