What Is DNR
A Do Not Resuscitate order, or DNR, is a medical directive instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating or they stop breathing. When a DNR is in place, medical staff will allow natural death to occur rather than intervening with chest compressions, medications, or mechanical ventilation.
DNRs are legally binding documents that become part of a person's medical record and follow them across care settings, including hospitals, assisted living facilities, and home care environments. Your home health aide or visiting nurse will have access to the DNR order and must respect it during their shifts.
DNR in Home Care Settings
For family caregivers managing care at home, DNR orders function differently than in hospital settings. Home health agencies are required to document the DNR status before beginning services, and Medicare and Medicaid both cover home care for patients with valid DNR orders. The key difference is response time. In a home setting, emergency medical services (EMS) must still be called if a person becomes unresponsive, and they are legally obligated to attempt resuscitation unless the DNR is visible to them (typically on a wallet card or posted near the bed) and matches their records.
This creates a critical gap. Many families don't realize that having only a signed DNR document isn't enough for home settings. You need to inform EMS ahead of time, ensure your home health aide knows the DNR status, keep a copy visible, and consider a POLST form, which EMS recognizes immediately and which includes DNR status along with other end-of-life preferences.
Who Can Issue a DNR
- The patient themselves, if they have decision-making capacity
- A healthcare surrogate or legal representative with appropriate authority (appointed through an Advance Directive)
- An attending physician with family agreement, in some cases
- A state-approved form or template specific to your state, as requirements vary
Common Questions
- Does a DNR prevent other medical care? No. A DNR only stops CPR. Your loved one still receives pain management, comfort measures, antibiotics, medication adjustments, and all other treatments. Home health aides continue to help with activities of daily living (ADLs) like bathing, dressing, and meal preparation. A DNR is narrowly focused on resuscitation only.
- Can a DNR be changed? Yes. DNR orders can be revoked or modified at any time by the patient or their authorized representative. If circumstances change, contact the physician, your home care agency, and emergency services to update records. This is especially important if the patient's condition or wishes change.
- Will respite care providers honor the DNR? Yes, but you must share the DNR order in writing with any respite care provider before they take over. A temporary caregiver, home health aide, or family member providing respite care needs clear documentation and verbal instruction about the DNR status.
Related Concepts
POLST forms complement DNR orders by clearly communicating the patient's wishes to emergency responders and are recognized by EMS immediately. Advance Directives are broader documents that authorize someone to make healthcare decisions and can include DNR instructions as part of the overall care plan.