May 28, 2013_ALF "Dear Administrator" Letters

May 28, 2013

ALTSA: ALF #2013-009

Dear Assisted Living Facility Administrator:

The purpose of this letter is to clarify the emergency response requirements that apply to assisted living facilities and to rescind and replace a July 2012 letter (ALF #2012-011), which only provided information about a form called "physician's orders for life-sustaining treatment" or POLST. 

Please become familiar with the relevant statutes and regulations:

  • State law, Chapter 7.70 Revised Code of Washington (RCW), provides everyone with the right to be fully informed of health care issues that have the potential to affect their lives. RCW 7.70.050 allows a provider to implement an advance directive in good faith if, in an emergency, the provider cannot obtain an informed consent decision due to the incompetence of the resident or the unavailability of the legal decision maker.
  • Assisted Living Facilities are required to develop, implement and train staff on policies and procedures to address what staff must do in response to medical emergencies.  This also includes when a resident stops breathing or a resident's heart appears to stop beating, and any action staff persons must take related to advance directives and emergency care, per Washington Administrative Code (WAC) 388-78A-2600.

According to the Department of Health (DOH), emergency medical services (EMS) personnel must have signed physician orders, in order to implement a resident's wishes for no cardiopulmonary resuscitation. If there is no signed physician order, then 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.

As a resource, a fact sheet is available on the Department's website under the heading 'Health Care Decision Making' at

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