Advance Directives in Nursing Homes: What Families Should Bring and Review
A nursing-home admission is an important time to review advance-care documents.
Federal rules require Medicare- and Medicaid-certified nursing homes to provide information about the resident’s rights under state law to make healthcare decisions, including the right to accept or refuse treatment and formulate an advance directive.
Bring the resident’s current documents, make sure the facility knows where they are, and confirm that the medical orders in the chart match the resident’s current wishes.
Advance directives can include different documents
Depending on state law, advance-care planning may include:
- living will;
- healthcare power of attorney;
- healthcare proxy;
- advance directive;
- organ-donation preferences;
- state-specific medical-order forms; and
- other instructions.
These documents do not all perform the same function.
A healthcare proxy names a decision-maker
The National Institute on Aging recommends choosing a healthcare proxy who understands the person’s values and can make decisions if the person cannot speak for themselves.
Ask:
- Who is the primary proxy?
- Is there a backup?
- Is the document currently effective under state law?
- Does the facility have a complete copy?
- Is the contact information current?
A financial power of attorney may be a separate document.
A living will describes treatment preferences
A living will can describe preferences about medical treatment when the person cannot communicate.
Examples may include views about:
- CPR;
- mechanical ventilation;
- artificial nutrition;
- dialysis;
- hospitalization;
- comfort-focused care; and
- other treatments,
depending on the document and state law.
The document should reflect the resident’s own wishes.
A DNR is a separate medical order
A living will that says a person would not want resuscitation does not necessarily replace a current medical DNR order.
Our guide DNR Orders in Senior Care explains that distinction.
Bring documents before a crisis
Give the facility copies of relevant documents during admission rather than waiting for an emergency.
Ask:
- Where are they stored in the record?
- Are they visible to staff on nights and weekends?
- How are changes updated?
- Does the facility use a state-specific portable medical order form?
Keep a family copy too.
Review after a major health change
Advance-care planning should not be “one and done.”
Review documents after:
- major diagnosis;
- hospitalization;
- significant functional decline;
- move to long-term care;
- change in decision-maker; or
- major change in the resident’s goals.
A person with decision-making capacity can revise their wishes according to applicable law.
Ask how emergency services receive the information
A facility may have the correct document in the chart, but emergency responders and hospitals need relevant orders during a transfer.
Ask:
- What document travels with the resident?
- Is code status included in the transfer packet?
- How is the healthcare proxy contacted?
- How is a portable medical order handled?
A practical example
Mr. Davis enters a nursing home with a living will completed eight years earlier.
His daughter assumes that means the chart automatically has a DNR order.
At the care-plan meeting, the family asks the clinician to review his current wishes and state-specific medical orders.
The documents are updated and placed where staff can access them.
The family has reduced ambiguity before an emergency.
Eight questions to review
- What advance-directive documents exist?
- Who is the healthcare proxy?
- Is a backup named?
- Does the facility have complete copies?
- Do current medical orders match the resident’s wishes?
- Is a DNR or portable medical order needed separately?
- What information travels with the resident during transfer?
- When will the documents be reviewed again?
Sources and review date
Sources checked October 12, 2026. Advance-directive law and forms vary by state.
- National Institute on Aging: Advance Care Planning: Advance Directives for Health Care
- National Institute on Aging: Preparing a Living Will
- eCFR: 42 CFR §483.10 — Resident Rights
