Honoring Dignity in Care: Important Update to Michigan’s Guidance on Do Not Resuscitate (DNR) Orders in AFC Homes

In the ever-evolving landscape of long-term care, staying informed about regulatory changes is essential to providing ethical, compassionate, and compliant services. Recently, the State of Michigan released a revised Technical Assistance (TA) update concerning the interpretation and application of Do Not Resuscitate (DNR) orders and Cardiopulmonary Resuscitation (CPR) in Adult Foster Care (AFC) homes. This update brings important clarity for both caregivers and families.

Understanding the Update: What Changed?

Previously, there was ambiguity around when CPR should be administered and how to respond if a resident had a DNR on file. The revised guidance—now detailed in the AFC Family Home Technical Assistance Handbook (pages 24–26) and the AFC Group Home Handbook (pages 49–50)—redefines roles and expectations for AFC staff during medical emergencies.

Here’s what you need to know:

1. CPR is Only for True Cardiac or Respiratory Arrest

The new guidance clarifies that CPR should only be initiated when:

• A resident is unresponsive and not breathing (or only gasping),

• And/or no pulse is detected.

It is not appropriate to perform CPR on individuals who are still breathing normally or who have a pulse. The guidance now specifically distinguishes between true emergencies and other medical concerns that may not require resuscitation.

2. DNR Orders Must Be Honored—Without Exception

Under Michigan’s Do-Not-Resuscitate Procedure Act, AFC homes are legally required to respect DNR orders. The updated TA reaffirms that no CPR may be performed when:

• A valid DNR exists, even if the resident is unresponsive or not breathing.

• The resident is wearing a state-recognized DNR bracelet or their order is documented and verifiable.

DNR orders include all resuscitative efforts, such as:

• Chest compressions

• Artificial ventilation

• Defibrillation

• Intubation or advanced airway support

• Cardiac medications

Importantly, abdominal thrusts (Heimlich maneuver) and NARCAN for drug overdoses are not considered “resuscitation” and may still be administered when appropriate.

3. Enhanced Staff Responsibilities & Communication

To support compliance and resident safety, AFC homes must now take proactive steps to:

• Verify and record DNR status in resident assessment plans.

• Ensure immediate accessibility of DNR forms in the event of an emergency.

• Educate staff annually on DNR procedures, legal definitions, and emergency response.

• Practice mock emergency drills.

• Communicate clearly with residents' families, guardians, and case managers about DNR expectations.

4. Hospice-Specific Considerations

When a resident is enrolled in a licensed hospice program and has a DNR on file, staff may contact hospice directlyinstead of calling 911—if this protocol is part of the agreed care plan. This ensures a more peaceful and respectful transition during end-of-life situations.

Why This Matters

These changes reflect a deepening respect for personal choice, legal rights, and end-of-life dignity. They also provide vital clarity for caregivers who face high-stress decisions in urgent situations.

By clearly defining when and how CPR should be used—and honoring DNR orders without hesitation—AFC homes can uphold both legal compliance and the emotional well-being of residents and families.

Final Thoughts

As caregivers and advocates, it’s our duty to ensure every resident receives care aligned with their wishes and needs. We welcome these updates from the State as they reinforce a standard of compassion, respect, and responsibility across Michigan’s AFC homes.

If you are a family member or guardian and have questions about your loved one’s DNR status, we invite you to reach out to our team to discuss documentation and ensure their care plan reflects their wishes.