Admission to a nursing or other long-term care facility is a life-changing event. Regardless of the purpose for or duration of the stay, each Resident may be coping with the loss of family, a spouse or home, uncertainty about the future, and fears about his or her health status. At this emotional time, staff, family and friends may be reluctant to approach the Resident about health care decision making, especially decisions about the giving or withholding of life-sustaining treatment. Federal rules, however, require us to advise Residents about their rights to make health care decisions and formulate advance directives, and it is good policy to make this process meaningful. In addition, Maryland law requires us to offer Residents or their proxies an opportunity to summarize and communicate their current preferences using an Instructions on Current Life-Sustaining Treatment Options Form, ² although a Instructions on Current Life-Sustaining Treatment Options Form is not itself an Advance Directive. Our ability to provide care consistent with a Resident's wishes can only be enhanced by providing information about Resident rights and Facility obligations that will guide our conduct in these situations.

The need to make decisions about whether to provide, withhold or withdraw life-sustaining treatment is unpredictable and often does not occur during regular business hours. Health care decision making issues can arise at any time and are often very stressful events for Residents, families and staff. They also can have an impact on other Residents and families who have relationships with the affected Resident.

_______________________ (the "Facility") recognizes and will honor each Resident's right to make decisions about his or her own health care. The Facility recognizes that this includes the right to consent to treatment and the right to refuse or terminate treatment, even if the treatment is life-sustaining. In the event a Resident is no longer able to make or communicate health care decisions, the Facility will make every effort to identify and honor the lawfully expressed wishes of other persons authorized to act on behalf of a Resident or the written directions of the Resident.

When Residents make a health care decision using an Advance Directive, the Facility will honor that decision unless state or federal law prohibits or restricts that decision. When no final Advance Directive exists, or if it does not apply to the decision at hand, and a Resident is unable to make or communicate his or her wishes about medical treatment, we will act in a manner that is consistent with State and federal law.

The purpose of this policy is to assist Facility staff in handling these events confidently by providing information and guidance about health care decision making in general and decisions about life-sustaining procedures in particular. The following procedures provide mandatory guidelines: for identifying the legally authorized decision maker for the Resident; for verifying the authority of the decision maker; for diagnosing and documenting incapacity of a Resident; when necessary, for certifying the End-Stage Condition, Persistent Vegetative State, or Terminal Condition of the Resident; and for obtaining consent for treatment or for withholding or withdrawing treatment.

This Policy has been revised in accordance with Maryland's Health Care Decisions Act, effective October 1, 1993. ³