Programs & Services # 4-40 / Approved: December 7, 1998
Revised: June 2, 2006
Reviewed: March 10, 2017
Procedure: Advance Directives

Consumers of Cheshire’s services may choose to develop and write personal Advance Directives to indicate their wishes in the event of a significant illness or critical health issue. Cheshire will make all reasonable effort to support consumers’ wishes.

In the event that a consumer does not have a written Advance Directive, Cheshire employees will call the ambulance or the emergency medical system if the consumer needs emergency health assistance and is unable to direct the assistance. They will also provide First Aid or CPR if it is required, and if they are trained. Cheshire requires all employees to obtain First Aid certification within 4 months of employment and to maintain First Aid certification.

In the event that a consumer has an Advance Directive which includes that they wish employees to call 911, and receive CPR or First Aid if the consumer needs emergency health assistance and is unable to direct that assistance, employees will follow their directive, call 911, and provide CPR or First Aid. Employees will give the Advance Directive to the ambulance staff when they arrive on the scene.

In the event that a consumer has an Advance Directive which directs that the consumer does not want employees to call 911, and does not want to receive CPR or First Aid regardless of their health status when they are unable to direct their service, Cheshire employees will follow the consumer’s Advance Directive. Employees will not call 911 and employees will not provide First Aid or CPR. Employees will notify the individuals listed in the Advance Directive. A consumer whose Advance Directive states -- no First Aid, no CPR, no 911 is responsible to ensure this information is clearly visible to employees. The consumer shall place a large, red notice with the words “No CPR, No First Aid, No 911" beside the Advance Directive notice on the consumer’s refrigerator.

Cheshire employees cannot follow an Advance Directive which includes an assessment of health status.

For consumers who have a written Advance Directive, the consumer must ensure the following are in place:

  1. The Advance Directive must include a written, signed statement from their physician (or power of attorney) indicating that the consumer is cognitively able to make a decision about the desired treatment in the event of a serious illness or critical health issue.
  2. The consumer must include a release form, signed and witnessed by a Notary Public, absolving Cheshire and its employees from legal liability for ramifications when the Advance Directive is followed, or not followed as in #6 below.

Should consumers have an Advance Directive or EDITH (Expected Death in the Home) form completed by a Health Care Professional, (ie. family physician, nurse or CCAC Case Manager) it will be accepted by Cheshire. The following steps must still be followed:

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Programs & Services # 4-40 / Approved: December 7, 1998
Revised: June 2, 2006
Reviewed: March 10, 2017
  1. The completed Advance Directive must be discussed with the Program Manager, who initials the Advance Directive document to indicate knowledge of the contents.
  2. The consumer is responsible for ensuring staff are aware of the location of the Advance Directive. A prominent notice or the Care Wish refrigerator magnet posted on the refrigerator indicating the location of the Advance Directive is required. If the consumer’s directive includes “No First Aid, CPR or 911 called”, the Advance Directive notice on the refrigerator must include this information on a visible red notice. The consumer is responsible for ensuring the Advance Directive is stored in an easily accessible location.
  3. It is the consumer’s responsibility to ensure that the most recent Advance Directive has been communicated to the Program Manager and is available to staff.
  4. If the Advance Directive cannot be immediately located the employee will initiate CPR/First Aid and call the Emergency Medical System.
  5. Cheshire will review the status of every Advance Directive as part of the annual Service Quality Interview.

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