A hospice CPR policy is shaped by two things at once: federal law says you cannot be required to sign a Do Not Resuscitate order to enroll, and hospice medicine says CPR almost never helps a terminally ill patient and often causes serious injury. Most programs will strongly encourage a DNR and spend real time explaining why, but the choice stays yours, and you can change it at any point during your care.
Why Hospice Teams Discourage CPR
Hospice treats dying as a natural event rather than a medical emergency to reverse. Care centers on managing pain, controlling symptoms, and supporting the patient and family. CPR works against all of that. It uses forceful chest compressions, artificial ventilation, electric shocks, and emergency drugs to restart a heart or lungs that have stopped, and for a body already shutting down from terminal illness, that intervention rarely succeeds.
The outcome data explains why clinicians push back on it. A meta-analysis of metastatic cancer patients who received in-hospital CPR found only a 5.6 percent survival rate to hospital discharge.1Nature. Outcome of Stage IV Cancer Patients Receiving In-Hospital Cardiopulmonary Resuscitation Out-of-hospital survival, which is what most hospice families would actually face, is lower still. A systematic review of CPR-related injuries found roughly 60 percent of patients who received CPR sustained some form of injury, with rib fractures in about 55 percent of cases and sternum fractures in about 24 percent.2National Center for Biotechnology Information. Rib Fractures and Other Injuries After Cardiopulmonary Resuscitation For a frail patient near the end of life, that can mean spending final days in pain from broken bones. The chance of benefit is small; the near-certain cost is a harder death.
A DNR Is Not Required for Admission
One of the most common misconceptions is that signing a DNR is a condition of hospice enrollment. It is not. Federal law prohibits healthcare providers participating in Medicare from conditioning care on whether a patient has signed an advance directive.3Office of the Law Revision Counsel. 42 U.S. Code 1395cc – Agreements With Providers of Services The Patient Self-Determination Act of 1990 established that protection, and it applies to hospice programs alongside hospitals, nursing facilities, and home health agencies.
Hospice programs must also tell you, in writing, about your rights regarding advance directives when you begin care.4eCFR. 42 CFR 418.52 – Condition of Participation: Patient’s Rights Expect a detailed conversation about code status. The team will encourage a DNR, and there are legitimate medical reasons behind that encouragement. But they cannot refuse to admit you, or treat you differently, if you decline.
Patients who stay “full code” on hospice are uncommon but not unheard of. The practical picture is simple. Hospice continues to provide comfort care. If cardiac arrest occurs, someone calls 911, and emergency responders perform CPR. If the patient is hospitalized as a result, hospice coverage pauses during the hospital stay, and the patient can re-enroll immediately after discharge. Some families find comfort in keeping CPR on the table even when they understand the odds, and after adequate education that choice belongs to the patient.
DNR, POLST, and Advance Directive: Which One Stops CPR
Three documents get mixed up here, and the distinction matters because only some of them actually prevent CPR in an emergency.
DNR Orders
A DNR is a medical order written by a physician, or in some states another authorized clinician, instructing healthcare providers not to perform CPR if your heart or breathing stops.5MedlinePlus. Do-Not-Resuscitate Order It covers CPR only. You can still receive antibiotics, IV fluids, pain medication, or any other treatment consistent with your goals. Some facilities now use the phrase “Allow Natural Death,” which families often find clearer.6National Center for Biotechnology Information. DNR, DNAR, or AND? Is Language Important?
POLST and MOLST Forms
A Physician Orders for Life-Sustaining Treatment form, called MOLST in some states, is broader than a DNR. It is a portable set of medical orders covering CPR, mechanical ventilation, hospitalization preferences, and sometimes artificial nutrition. A healthcare professional and the patient (or representative) sign it. Because it is a medical order, emergency personnel can act on it immediately.
Advance Directives
Living wills and durable powers of attorney for health care are legal documents that express your preferences and name a decision-maker if you cannot speak for yourself. They are planning tools, not medical orders. Paramedics cannot follow them in the field. If responders arrive at your home and the only document available is a living will, they will still attempt CPR. That is why hospice teams push for a signed POLST or out-of-hospital DNR in addition to any advance directive.
How the Policy Plays Out at Home vs. Inpatient
Inpatient Hospice
In a dedicated hospice facility, the DNR sits in your medical record and functions as a standing instruction. Staff are trained to provide comfort measures during a terminal event rather than initiate resuscitation. Facility protocols govern the response, and there is no ambiguity about what happens.
Home Hospice
Home is where confusion causes real harm. Your hospice nurse is not present around the clock, and a frightened family member’s first instinct may be to dial 911. Once emergency responders arrive, they operate under their own legal obligations. In virtually every state, paramedics must attempt resuscitation unless someone physically shows them a valid out-of-hospital DNR form at the scene.5MedlinePlus. Do-Not-Resuscitate Order A verbal assurance, a DNR noted in a hospice chart at a different location, or a living will in a desk drawer will not stop them.
Every state has its own out-of-hospital DNR form, and many also issue a distinctive bracelet or necklace that paramedics are trained to recognize. Keep these visible. If the form is upstairs while CPR has already begun in the living room, it may be too late. Ask your hospice team where they recommend keeping it, and have that conversation more than once so everyone in the household knows.
Call Hospice, Not 911, When Death Occurs
This is the single most important practical rule in home hospice, and many families miss it. When you believe your loved one has died, call the hospice agency, not 911. Every hospice provides a 24-hour phone number for exactly this situation. A team member will come to the home, confirm the death, and help with next steps including contacting the funeral home and completing paperwork.
Calling 911 sets a different chain in motion. Dispatchers send paramedics, and paramedics treat cardiac arrest as an emergency. If they arrive and do not immediately see a valid out-of-hospital DNR, they will begin CPR. That is how families who carefully planned for a peaceful death end up with their loved one on a stretcher headed to an emergency department. Post the hospice number somewhere visible, and make sure every person who might be in the house at the time of death knows to call it first.
Changing Your Mind
Revoking a DNR
A DNR is not permanent. You or your legally authorized healthcare representative can revoke it at any time, for any reason, regardless of your medical condition. Revocation can be as simple as telling a member of your hospice team verbally that you no longer want the order in place. Once the team is notified, the attending physician removes the order from your medical record. Destroy any physical copies of the form, bracelets, and necklaces immediately so that emergency responders do not rely on an outdated instruction.
Families sometimes worry that revoking a DNR will create friction with the team. It should not. The decision about whether to accept CPR is a fundamental patient right, and hospice providers are trained to respect it. If you feel pressured to keep a DNR you are no longer comfortable with, raise it with the hospice administrator or your state’s hospice ombudsman.
Leaving Hospice Altogether
Separate from the DNR question, you can leave hospice entirely. Federal regulation allows you or your representative to revoke your hospice election at any time during any election period by filing a signed, dated statement with the hospice.7eCFR. 42 CFR 418.28 – Revoking the Election of Hospice Care Once revocation takes effect you are no longer covered for hospice services under Medicare, but your regular Medicare benefits resume immediately, and you can re-elect hospice later if you remain eligible. This matters when a condition stabilizes or when a patient wants to pursue a curative treatment that hospice does not cover.