CPR Expectations In Adult Family Homes
Residential Care Services issued a Dear Provider Letter reminding long‑term care providers, including adult family homes, that trained staff are expected to initiate cardiopulmonary resuscitation (CPR) immediately when it is indicated and consistent with a resident’s wishes. The communication responds to reports of certified and licensed direct care staff delaying CPR while seeking direction from a supervisor, even when residents have clearly elected to receive CPR.
When a resident who has chosen to receive CPR is found unresponsive and requires resuscitation, staff who are trained and certified must begin CPR without delay and should not wait for authorization from an administrator, provider, or on‑call supervisor. Every minute without adequate oxygen increases the risk of irreversible brain injury or death, even when resuscitation efforts are ultimately successful.
CPR is recognized as a core competency and basic technical skill for Nursing Assistant–Certified staff and an essential requirement for long‑term care workers. Staff who hold these credentials are expected to be proficient in CPR and able to perform it independently when needed. As providers and administrators, you are responsible for ensuring that required staff maintain current CPR certification, meet all applicable training requirements, and have up‑to‑date documentation on file.
Honoring POLST, Advance Directives, and Resident Preferences
The Dear Provider Letter also highlights the importance of aligning emergency response with each resident’s expressed choices regarding life‑sustaining treatment. Many residents will have a Portable Orders for Life‑Sustaining Treatment (POLST) form or other advance directive documenting their preferences for CPR and related interventions. While a POLST is optional, providers are expected to have clear policies and procedures describing how staff should respond if a resident does not have a POLST or advance directive on file.
Within adult family homes, this includes:
Maintaining clear systems to identify each resident’s CPR/no‑CPR status.
Ensuring CPR‑trained staff know how to access POLST forms and advance directives quickly in an emergency.
Implementing systems that support and reliably honor resident preferences and choices regarding resuscitation and life‑sustaining treatment.
Recommended Steps For AFH Providers
In light of this updated guidance, adult family home providers are encouraged to:
Review and, where needed, revise emergency response and CPR policies and procedures to align with current expectations.
Confirm that staff training, CPR certification, and documentation are current and accurately reflected in personnel records.
Re‑educate staff that, when a resident has elected to receive CPR, trained personnel are expected to begin resuscitation immediately upon recognizing the need, without waiting for supervisory approval.
Ensure that all staff know where POLST forms and advance directives are stored and how to verify code status quickly.
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Membership fees enable the Council to cover legal expenses and fund staff to advocate with the state and regulatory agencies. The participation of every adult family home is vital to ensuring fair regulations and rates that accurately reflect the costs of caring for our vulnerable adults. Consider becoming a member of the Council to help us continue improving conditions for all adult family homes in Washington State.