May 28, 2013_AFH "Dear Provider" Letters

May 28, 2013

ALTSA: AFH #2013-008

Dear Adult Family Home Provider:

The purpose of this letter is to clarify the emergency response requirements that apply to adult family homes and to rescind and replace a July 2012 letter (AFH #2012-013), which only provided information about a form called "physician's order for life-sustaining treatment" or POLST.

The adult family home licensing rules contain specific requirements related to medical emergencies and contacting emergency medical services (EMS or 911).  Washington Administrative Code (WAC) 388-76-10250 includes the following requirements about a home's response to a medical emergency:

  • Staff must respond appropriately to any resident's emergency situation.
  • Except for certain situations, the adult family home must immediately contact local emergency medical services when a resident has a medical emergency.  (The adult family home is not required to contact emergency medical services when a resident is receiving hospice care from a licensed hospice agency, the emergency is related to the expected hospice death, and the situation is being directed and monitored by the hospice agency.  Physicians and nurses may act under the authority of their licensure.)
  • The home must develop, implement and inform residents about policies and procedures that require 911 to be contacted immediately.  The policies and procedures must also address situations that might arise during a medical emergency, such as (1) what the home will do if the resident does not want to be sent to the hospital; (2) what the home will do if EMS does not take the resident to the hospital; or (3) the circumstances under which CPR would not be initiated before EMS arrives.
  • If a POLST form or advance directive is available, the adult family home must immediately give a copy to the EMS personnel. (Please note: According to the Department of Health (DOH), if the POLST is not signed by a physician, EMS personnel are not allowed to follow the directions on the form.  If there is not a signed physician's order, EMS will proceed with resuscitative efforts.)

You may want to consult with your attorney about issues involving advance directives, POLST forms and emergency medical response policies and procedures.

DOH encourages adult family homes to contact the local EMS provider agency in advance to discuss the adult family home's policies regarding POLST.  This will avoid confusion and conflict at the time of an emergency.  Here is a link to DOH's regional emergency medical services and trauma resources:
As a resource, a fact sheet is available on the Department's website under the heading 'Health Care Decision Making' at

The DOH provides additional information at the following website:
Washington State Medical Association also has information at this link:

Please call your RCS Field Manager if you have any questions about medical emergencies.


Joyce Pashley Stockwell, Director
Residential Care Services