To assure that Residents are educated about their right to make Advance Directives and that Residents who have made Advance Directives are identified, the Facility has adopted the following protocols:

1. Action.
1. Reasonably promptly following admission, a Resident (or a Resident's Agent or surrogate) will be asked if that individual wishes to state preferences about currently relevant life-sustaining treatment issues on an Instructions on Current Life-Sustaining Treatment Options Form, in accordance with Section VIII, below.
2. Residents will be asked if they have executed any Advance Directives in the past, and the response will be recorded by the Admitting Registrar at the time of admission to the Facility. The response will be documented on the Resident's medical record face sheet.
3. Residents will be informed, in a language the Resident can understand, of the right to make Advance Directives, but will also be informed that admission is not conditioned on the Resident having an Advance Directive.
4. Residents will be given admission packets by the Admitting Registrar at the time of admission. The packet will contain pertinent information regarding the definition and execution protocol for Advance Directives and resources to obtain further information.
5. A Resident's Advance Directives status will be recorded on the medical record.
6. The Social Services Director or designee will request a copy of all previously executed Advance Directives from the Resident and/or significant others to be placed on the Resident's medical records.
7. All staff members will direct Residents to discuss issues which pertain to Advance Directives with their physician.
8. Upon request, the physician will discuss with the Resident the Resident/Physician issues related to the Advance Directives.
9. The Social Work Department may be contacted for further information on resources to assist the Resident in exercising the Resident's right to make an Advance Directive.
10. At the Resident's request, the physician or Social Work staff will provide the Resident with examples of Advance Directives.
11. Whether or not the Resident has, or chooses to make, an Advance Directive, the physician or a designee of the physician will offer the Instructions on Current Life-Sustaining Treatment Options Formas a means of documenting preferences about currently relevant life-sustaining treatment issues.
12. The Social Work Department and Quality Assurance Committee will monitor compliance with this policy.
2. Specific Instructions for All Staff.

Advance Directives must be coordinated through Administration and the Social Services Department.

1. If a Resident wants assistance in making a written Advance Directive, contact _____________________, who will provide the Resident with a copy of blank forms for the Resident to use.
2. If a Resident wants to make an oral Advance Directive, make immediate arrangements with the Attending Physician, and document with signatures the contact in the medical record. Provide the Attending Physician with a copy of Attachment C.
3. If you are asked to witness a written Advance Directive, or to act as an Agent, report to the Administrator for review of the request under applicable laws and this Policy.
4. If a Resident wishes to orally revoke either a written or oral Advance Directive, this must be done in the presence of the Administrator or any other licensed staff. A nursing assistant may not witness oral revocation of an Advance Directive.
5. If you become aware that a Resident has revoked an Advance Directive by any means, immediately notify the Administrator and the Attending physician and document the contact made in the Resident's clinical record.
6. If you are aware of any actions that indicate a health care decision maker is not acting in the best interest of the Resident, the information must be brought to the attention of the Administrator and may be brought to the attention of the Patient Care Advisory Committee.
7. If you have any doubts about the Resident's capacity when making the Advance Directive, or have doubts about the authenticity of the document (if the Advance Directive is written), contact _____________________.