Abstract
Nursing home patients in the United States have a constitutional right to refuse treatment. The federal Patient Self-Determination Act confirms that right. State laws address the obligations of health care providers and facilities to honor those rights. But state laws vary, and nursing home administrators may not know the laws of their states. In this article, areas of significant variation in state laws are identified so that educators of nursing home administrators and direct care providers can address providers' statutory obligations concerning end-of-life issues. The advance directives statutes of the fifty states and the District of Columbia were reviewed and analyzed to determine the principal areas of variation in state requirements. Three key areas with high levels of variation were identified. Recommendations for teaching about state requirements on advance directives were developed. Education of nursing home administrators is needed to alert them to their states' requirements, benefiting them and the patients they serve.
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