A Sometimes Fatal Distinction in CPR Policies in Independent Living and Skilled Nursing Facilities

Outrage across the country was sparked by a staff member’s refusal to render CPR to a collapsed 87- year-old woman at an independent living facility in Bakersfield, California earlier this year. The staff member, whose decision was backed by the Bakersfield facility, Glenwood Gardens, stated several times in the 911 tape that it was against the facility’s policy to provide CPR despite repeated pleas by the dispatcher to begin CPR on the woman; the elderly woman died before emergency response arrived. Although there was great public outcry regarding the facility’s policy, the facility employee was not technically wrong. While it definitely sounds morally outrageous to fail to assist a resident in peril, there is no regulatory requirement that independent living facilities provide CPR to residents. This is why understanding a facility’s CPR policy is crucial in making decisions on which facility is best for yourself or loved ones and is a factor most do not consider when making such an important decision.

Independent living facilities are housing communities for seniors. These facilities offer apartment-style quarters with amenities such as planned activities, meal preparation, and housekeeping. Independent living facilities are typically patronized by seniors who do not require much assistance with daily activities or constant medical care. Independent living facilities are not required by law to provide medical services or employ medical staff. If a resident of an independent living facility suffers an emergency requiring CPR, a facility with the “No CPR” policy does not have to and will not render CPR while waiting for emergency response, regardless of any advanced directives a resident may have.
To the contrary, skilled nursing facilities are prohibited from implementing “No CPR” policies. These facilities provide 24-hour professional nursing services as required by law. Most SNF have physical therapy programs, cognitive therapy programs, dietary programs, and programs to encourage activity. Seniors who choose SNF require significant assistance with activities of daily living and are in need of around the clock medical care. A SNF may only withhold CPR to a resident if that resident has a “do not resuscitate” directive (DNR).

It is important to understand and appreciate the risk of living at an independent living facility with a “no CPR” policy. While senior residents and family members are made aware of such policy before moving in, not fully considering the consequences of the policy can lead to devastating outcomes for both resident and family. Even if a SNF is chosen as the better facility and CPR will be provided absent a DNR directive, it is always a good idea to discuss what options are available and the consequences of each option.