A COVID-19 Reminder: Ensure Access to Health Care Proxies, Non-Hospital DNRs and MOLST in Adult Care/Assisted Living Facilities

Linda O'Connell

This is a reminder for adult care/assisted living facilities (ACF/ALs) with respect to maintaining access to and transferring health care proxies, non-hospital DNRs, and/or Medical Orders for Life Sustaining Treatment (MOLST) of your residents in the event of an emergency or transfer to a different setting.  Given the risks to residents posed by hospitalization in the context of COVID-19 and the strain that the pandemic is expected to place on our health care system, it is particularly important for the health care providers that treat your residents to be aware of their advance directives and MOLST orders and avoid interventions that are inconsistent with their wishes and goals for care. 

Proposed Action Steps 

  1. Review your policies and procedures for residents who have acute or emergent care needs that require EMS or a transfer to a hospital or other facility. Ensure your policy includes staff access to those documents and the procedure to pass them on to the emergency health care provider.
  2. Ensure that any health care proxies, non-hospital DNRs, and/or MOLST orders are accessible to appropriate staff in the event of an emergency or transfer and train staff accordingly. 
  3. MOLST orders, non-hospital DNRs, and/or health care proxies should be transferred with residents when they go to a hospital or other setting.  When residents are admitted or return from a hospital or other setting, with a non-hospital DNR, MOLST orders and/or health care proxy, it should be maintained in the resident record.



Amy Kennedy
Executive Director, NYSCAL
518-462-4800 x17