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The purpose of this study was to explore the policies and practices of nursing homes with respect to the resuscitation of residents who do not have a do-not-resuscitate (DNR) order. Responses from a survey of 36 facilities revealed that most residents had DNR orders and most facilities were capable of providing basic cardiopulmonary resuscitation (CPR). Less than 30% had performed CPR in the past 6 months, and 22.8% had no written CPR policies. More facilities required CPR in witnessed arrests of non-DNR residents (79.3%) than in unwitnessed arrests (24%). Methods for identifying CPR status need improvement to enable accurate identification and prompt resuscitation of residents who want CPR.

Carefully constructed policies or guidelines for the limitation of treatment in long-term care facilities are necessary to ensure that such limitation is consistent with ethical and legal principles. These protocols can be useful in protecting the rights of the residents, improving service, assuring the accountability of health care professionals, educating staff, and preventing legal controversies. Even the best protocol cannot eliminate controversy regarding decisions about limitation of treatment, but a clearly articulated policy can provide a process for addressing these concerns in a manner that takes into account the rights and responsibilities of all involved.

The practice of screening applicants for nursing home admission to determine whether less restrictive residential settings are possible is growing as states attempt to limit costs of Medicaid expenditures for long-term care. Preadmission screening (PAS) is a repetitive task conducted under conditions of complexity and uncertainty. Extensive knowledge and skills are required to make recommendations concerning appropriate residences for elderly persons that match their needs with available services while assuring their autonomy, as well as that of their families. We used task analysis to explicate the specific task characteristics and the knowledge and skill requirements for successful PAS.