8.4 Advance Directives, Ombudsman & End-of-Life
Key Takeaways
- Advance directives state a person's care wishes in advance; in Florida these include the living will and health care surrogate under Chapter 765.
- A DNR / DNRO means no CPR if the heart or breathing stops; it does not mean stopping comfort, hygiene, or other care.
- The Florida Long-Term Care Ombudsman is an independent volunteer-based advocate who investigates resident complaints and rights concerns.
- Palliative and hospice care focus on comfort, dignity, and symptom relief, not curing the illness.
- Hearing is often the last sense to fade; keep speaking gently to and providing dignified care for a dying resident.
Advance Directives in Florida
An advance directive is a legal statement of a person's healthcare wishes for a time when they cannot speak for themselves. Florida's directives are governed by Florida Statutes Chapter 765.
| Document | Purpose |
|---|---|
| Living will | States wishes about life-prolonging treatment if terminally ill or permanently unconscious |
| Health care surrogate | Names a person to make healthcare decisions if the resident cannot |
| DNR / Florida DNRO | A medical order: do not perform CPR if the heart or breathing stops |
In Florida, the out-of-hospital order is the Do Not Resuscitate Order (DNRO), recorded on the state's official form. A DNR or DNRO means no CPR only. It does not mean stop feeding, bathing, repositioning, comfort measures, pain relief, or emotional support. The CNA must know which residents have a DNRO and continue all other care fully.
CNA Role
The CNA follows the care plan and the directive, never decides whether to resuscitate based on personal opinion, and reports any change in the resident's condition or any new statement about wishes to the nurse.
The Florida Long-Term Care Ombudsman
The Florida Long-Term Care Ombudsman Program is a state, largely volunteer-based program of independent advocates for residents of nursing homes, assisted living facilities, and adult family-care homes. The ombudsman:
- Receives and investigates resident and family complaints.
- Advocates for residents' rights, dignity, and quality of care.
- Conducts facility assessments and helps resolve concerns.
- Works independently of the facility, so residents can raise concerns without retaliation.
Residents have the right to contact the ombudsman, and posted contact information must be available. A CNA should support, not block, a resident's access to the ombudsman and report serious concerns through the chain of command.
Resident concern path
Resident voices concern
-> CNA listens, does not retaliate, reports to nurse
-> Facility chain of command / grievance process
-> Florida Long-Term Care Ombudsman (independent advocate)
-> AHCA oversight when required
End-of-Life and Palliative Basics
Palliative care focuses on comfort, dignity, and symptom relief rather than curing the illness. Hospice provides palliative care for residents near the end of life and supports the family. The CNA provides hands-on comfort care:
- Keep the resident clean, dry, and repositioned for comfort and skin protection.
- Provide gentle oral and skin care; lips and mouth dry quickly.
- Control the environment: calm, quiet, dignified, with privacy for the resident and family.
- Provide emotional presence; allow the resident and family to express feelings, and do not impose your own beliefs.
- Hearing is often the last sense to fade. Continue to speak gently, explain care, and avoid talking about the resident as if they cannot hear.
- After death, provide respectful postmortem care per facility policy, maintaining dignity and privacy.
Report changes such as new pain, restlessness, breathing changes, or the family's needs to the nurse.
Exam Tip
Florida items: a DNR/DNRO stops only CPR, not other care; the ombudsman is an independent resident advocate; comfort, dignity, and continued gentle communication are the right end-of-life answers.
A resident has a valid DNRO (Do Not Resuscitate Order). What does this mean for the CNA's care?
What is the role of the Florida Long-Term Care Ombudsman?