3.4 Advance Directives, DNR Orders, and End-of-Life Care
Key Takeaways
- Illinois recognizes living wills, healthcare power of attorney, POLST forms, and mental health treatment preference declarations
- CNAs follow the care plan (which reflects advance directive wishes) but do not interpret directives
- DNR means no CPR if the heart stops — CNAs should know what the care plan says and follow it
- End-of-life care focuses on comfort, dignity, and emotional support for both the resident and family
- Direct advance directive questions from residents or families to the nurse or physician
- Post-mortem care must be performed with dignity and according to facility policy
Last updated: March 2026
Advance Directives, DNR Orders, and End-of-Life Care
Illinois has specific laws governing advance directives and end-of-life decisions. As a CNA, you must understand these documents and their implications for the care you provide, while respecting the resident's wishes and working within your scope of practice.
Illinois Advance Directive Laws
Illinois recognizes several types of advance directives:
| Directive | Illinois Law | Purpose |
|---|---|---|
| Living Will | Illinois Living Will Act (755 ILCS 35) | States wishes for life-sustaining treatment if terminal |
| Healthcare Power of Attorney | Illinois Power of Attorney Act (755 ILCS 45) | Designates someone to make healthcare decisions |
| POLST (Practitioner Orders for Life-Sustaining Treatment) | POLST form recognized by IDPH | Medical orders for treatment preferences — signed by physician |
| Mental Health Treatment Preference Declaration | Mental Health Treatment Preference Declaration Act (755 ILCS 43) | States preferences for mental health treatment |
Key Terms CNAs Must Know
| Term | Meaning |
|---|---|
| DNR (Do Not Resuscitate) | No CPR if heart stops or breathing ceases |
| DNI (Do Not Intubate) | No ventilator/breathing tube insertion |
| Full Code | All resuscitative measures should be attempted |
| Comfort Measures Only | Focus on pain relief and comfort, not curative treatment |
| Hospice | End-of-life care focused on comfort rather than cure |
| Palliative Care | Symptom management alongside curative treatment |
| Healthcare Surrogate | Person designated to make decisions if resident cannot |
CNA Role in Advance Directive Situations
What CNAs CAN do:
- Observe that an advance directive is on the chart
- Follow the care plan as written (which reflects advance directive wishes)
- Provide comfort care as directed by the nurse
- Report changes in the resident's condition to the charge nurse
- Provide emotional support to the resident and family
- Maintain the resident's dignity and comfort
- Document care provided and observations
What CNAs CANNOT do:
- Interpret advance directives or make decisions based on them
- Decide whether to perform CPR based on reading a document — follow the care plan
- Give medical advice about advance directives to residents or families
- Witness or notarize advance directive documents (unless state law permits)
- Override a nurse's orders based on a personal interpretation of the directive
End-of-Life Care Responsibilities
When providing care to dying residents, CNAs should:
Physical Comfort:
- Reposition frequently for comfort
- Provide excellent mouth care (lips, tongue, mucous membranes)
- Keep the skin clean and moisturized
- Ensure adequate pain management (report signs of pain to nurse)
- Maintain a comfortable room temperature
- Reduce noise and keep lighting soft
Emotional and Spiritual Support:
- Be present — sitting quietly with the resident is valuable
- Listen without judgment if the resident wants to talk
- Allow family members to be present and provide for their needs
- Respect religious and cultural practices
- Never give false reassurance ("everything will be fine")
- Allow the resident to express emotions freely
After Death:
- Follow facility policies for post-mortem care
- Treat the body with dignity and respect
- Provide privacy for family grieving
- Assist with post-mortem care as directed by the nurse
- Document the time you were notified and actions taken
- Support grieving coworkers — caring for dying residents is emotionally challenging
Test Your Knowledge
A resident's family member asks you what a DNR order means. What is the correct response?
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C
D
Test Your Knowledge
Which Illinois law governs the Healthcare Power of Attorney?
A
B
C
D
Test Your Knowledge
Which of the following is the MOST important aspect of end-of-life CNA care?
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B
C
D