Revisions to the state of Arizona’s crisis standards of care plan include guidance on honoring care and treatment preferences in federal skilled nursing facilities. The changes follow resolution of a complaint against the state brought by national and local disability and aging advocacy groups.

The complaint, spurred in part by pandemic-era considerations, was resolved by the Office for Civil Rights at the U.S Department of Health and Human Services, resulting in an updated CSC plan that seeks to meet legal requirements and best practices regarding the needs of people with disabilities and older adults, according to the OCR.

Key to nursing home operators in Arizona, “all efforts must be made to determine a patient’s goals of care and treatment preferences” prior to, as well as during, implementation of CSC, the revised plan states. 

Residents and patients in long-term care facilities, including nursing homes, skilled nursing facilities and other long-term care settings, should be asked about their goals of care and advance care planning documents, and they should be encouraged to appoint a proxy to help explain preferences if such documents are not available, according to the guidance.

“If advance care planning documents are in place and available the healthcare provider should verify the patient’s goals of care and treatment preferences remain the same. Medical orders and advance care planning documents should be updated if the patient’s treatment wishes have changed.”

Every effort should be made to avoid coercing residents or family on advanced care planning decisions “due to perceptions of quality of life or relative worth.” Nor should care providers require residents to consent to an advanced care planning decision in order to continue receiving facility services,” according to the plan.

Crisis standards of care determine who does and does not receive care in the event of a shortage of healthcare resources, according to The Arc, which advocates for people wit­­h intellectual and developmental disabilities. The organization was among one of the advocates filing the original complaint.

The state’s CSC addendum can be found here, and the HHS announcement is available on the agency’s website.