Florida Advance Directive for Nursing Home and Assisted Living Residents

Moving a parent into a nursing home or assisted living facility in Florida triggers an immediate need for advance directives. Every licensed facility is required to ask about existing healthcare planning documents during intake — and most families discover at that moment that their documents are missing, outdated, or incomplete.

The facility will not create these documents for you. They will ask whether you have them, note the answer in the chart, and move on. Getting the paperwork right before or during the admission process prevents gaps that can lead to unwanted medical interventions.

What Facilities Ask for at Intake

During the admission process, Florida long-term care facilities typically request:

• Designation of Health Care Surrogate — who the facility should contact for medical decisions when the resident cannot communicate
• Living Will — the resident's preferences regarding life-prolonging procedures in terminal or end-stage conditions
• Pre-Hospital DNRO (Form DH 1896) — if applicable, the yellow-paper form that instructs EMS not to perform CPR during emergencies at the facility
• POLST form — if the resident has a physician-signed POLST, the facility uses it to guide treatment decisions across shifts and staff changes
• Durable Power of Attorney — the financial agent authorized to handle billing, insurance, and property management

Federal regulations under the Patient Self-Determination Act require all Medicare and Medicaid participating facilities to inform residents of their right to accept or refuse treatment and to document their advance directive status. This is not optional — it applies to every skilled nursing facility and most assisted living communities in Florida.

The Facility's Role (and Limitations)

The facility cannot:

• Draft advance directives for residents
• Serve as a healthcare surrogate
• Override a valid living will or DNRO
• Pressure a resident to sign or refuse any document

The facility can:

• Ask about existing documents and record their existence
• Place copies in the resident's medical chart
• Follow the documented instructions when making care decisions
• Contact the designated surrogate when the resident lacks capacity

Facility staff are trained to follow physician orders and documented instructions. If a resident has a POLST ordering comfort measures only, nursing staff follow that order. If the POLST orders full treatment, they follow that. Without a POLST or clear advance directive, staff default to full treatment — which may include calling 911 and initiating CPR for a 90-year-old with advanced dementia.

Coordinating Documents for Facility Care

Surrogate Designation with Immediate Authority

For residents entering long-term care, the immediate authority option on the surrogate designation (added by the 2015 amendment to § 765.202) is particularly important. Many nursing home residents have fluctuating capacity — they may be lucid in the morning and confused in the afternoon. Immediate authority means the surrogate can participate in care discussions, access medical records, and coordinate with staff without waiting for a formal incapacity determination each time.

DNRO Placement

If the resident has a valid yellow-paper DNRO, the original should be placed in the facility's medical chart and a copy posted in a visible location in the resident's room. Facility staff and responding EMS personnel need to locate it quickly.

Some facilities have their own internal code-status documentation systems. Make sure the facility's internal records match the resident's DNRO. A disconnect — DNRO says no CPR, but the facility chart says full code — creates dangerous confusion.

POLST for Medical Orders

A POLST form is especially valuable in the facility context because it translates the resident's wishes into standing medical orders that nursing staff can follow during a shift. It covers not just resuscitation but also decisions about antibiotics, hospitalization, tube feeding, and IV fluids — the daily medical decisions that arise in long-term care.

The POLST must be signed by the resident's attending physician. If the resident's physician changes after admission (many facilities assign their own medical director), the POLST should be reviewed and re-signed by the new physician.

When Advance Directives Conflict with Family Wishes

Facility staff occasionally face situations where a resident's documented wishes (no feeding tube, comfort measures only) conflict with a family member's demands (do everything possible). Under Florida law, the documented wishes take precedence if the advance directive is properly executed.

A surrogate's authority is to carry out the principal's known wishes — not to substitute their own preferences. If a living will clearly states no artificial nutrition, the surrogate is legally obligated to honor that instruction, even if they personally disagree.

Family disagreements in this context are emotionally devastating. Having clear, properly executed documents reduces the conflict by removing ambiguity about what the resident wanted.

The Florida Advance Directive & Living Will Kit covers the full document set for facility admission — surrogate designation with immediate authority, living will, DNRO protocol, and POLST coordination — with a checklist for the intake process.

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