May 28 2013_NH "Dear Administrator"

May 28, 2013

ALTSA:  NH #2013-008

Dear Nursing Home/Facility Administrator:

The purpose of this letter is to clarify the emergency response requirements that apply to nursing homes and to rescind and replace a July 2012 letter (NH #2012-008), which only provided information about a form called "physician's order 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.
  • Nursing homes are required to have policies and procedures on health care decision making and directing staff how to handle a resident's advance directives, per Washington Administrative Code (WAC) 388-97-1780 and WAC 388-97-0280.

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