THE DNRO RULE IS FINAL. IS YOUR ALF READY FOR SEPTEMBER 17?
AHCA’s Amendment to Rule 59A-36.009 Takes Effect September 17, 2026
For the past several months, Florida assisted living facilities have been watching a proposed amendment to the state’s Do Not Resuscitate Order regulation.
It isn’t proposed anymore.
AHCA’s amendment to Rule 59A-36.009, Florida Administrative Code, is FINAL.
The rule was filed on August 28, 2026, and becomes effective:
SEPTEMBER 17, 2026
The official title is now:
Rule 59A-36.009 — Do Not Resuscitate Orders (DNROs) and Advance Directives
You can review the official rule here:
https://flrules.org/gateway/ruleno.asp?Section=0&id=59A-36.009
For ALF owners and administrators, the message is simple:
It’s time to stop watching the proposed rule and start making sure the final change is actually implemented in your facility.
WHAT CHANGED?
This isn’t a complete rewrite of how DNROs work in assisted living facilities.
Much of the existing DNRO framework remains intact. The amendment primarily modernizes portions of the rule and expressly incorporates advance directives into the regulation.
One of the most noticeable changes is the title itself.
It is no longer simply:
Do Not Resuscitate Orders (DNROs)
It is now:
Do Not Resuscitate Orders (DNROs) and Advance Directives
The amended language requires ALFs to have written policies and procedures addressing residents’ rights concerning advance directives, in addition to explaining the facility’s implementation of Florida laws and rules concerning DNROs.
So don’t treat this as simply:
“AHCA updated the DNRO form.”
Your facility should be reviewing its overall DNRO and advance-directive process.
THE OLD ADVANCE-DIRECTIVE HANDOUT IS BEING REPLACED
This is one area where I would pay particular attention.
The previous regulation specifically referenced:
Form SCHS-4-2006, “Health Care Advance Directives—The Patient’s Right to Decide.”
The amended language instead requires the facility to provide each resident, or resident’s representative, at admission with a written or electronic copy of health care advance-directive information pursuant to Chapter 765, Florida Statutes.
The amended rule provides that this requirement may be satisfied by providing information and sample advance-directive forms available through AHCA.
This is exactly the type of regulatory change that can get missed.
Why?
Because an old document may have been sitting inside your admission packet for years.
Nobody thinks about it.
Nobody removes it.
And every new resident continues receiving it.
Pull your admission packet and actually look.
Don’t assume somebody else updated it.
THE DNRO FORM HAS ALSO BEEN UPDATED
The amended rule incorporates:
DH FORM 1896 — FLORIDA DO NOT RESUSCITATE ORDER, 02/2024
The official Florida rule materials identify DH Form 1896, 02/2024 as incorporated reference material.
You can view the official incorporated material here:
https://flrules.org/gateway/reference.asp?No=Ref-19567
Now ask yourself a very simple question:
WHAT VERSION OF THE DNRO FORM IS YOUR FACILITY USING?
Don’t answer from memory.
Go look.
Check your admission packet.
Check your forms binder.
Check the administrator’s computer.
Check your shared drive.
Check whatever folder your staff actually use when they need the form.
The problem isn’t necessarily that administration doesn’t know a newer form exists.
The problem is that an old version may still be sitting somewhere staff can access it.
DON’T FORGET YOUR POLICIES
Forms are only one part of this change.
Facilities should also review their written policies and procedures.
The amended language expressly addresses written policies and procedures concerning residents’ rights regarding advance directives and the facility’s implementation of state laws and rules concerning DNROs.
Pull your current policy and ask:
When was this policy last updated?
Does it reference SCHS-4-2006?
Does it reference an older DNRO form?
Does it contain outdated websites or contact information?
Does it appropriately address advance directives, or is the entire policy written only around DNROs?
Does the policy match what your staff are actually doing?
Those are the details I would be checking before September 17.
A DNRO CANNOT BE REQUIRED FOR ADMISSION
One important protection remains.
An assisted living facility may not require execution of a DNRO as a condition of admission or treatment.
That is important for anyone involved in your admission process to understand.
Your job is to provide the required information and follow the resident’s decisions and applicable law.
A resident should not be pressured into executing a DNRO simply because they are entering an assisted living facility.
SEPTEMBER 17 SHOULD BE ON EVERY ADMINISTRATOR’S CALENDAR
This is the deadline that matters:
SEPTEMBER 17, 2026
The final rule was filed on August 28, 2026, and becomes effective September 17, 2026.
You can review the official Final Adopted Rule notice here:
https://flrules.org/Gateway/View_notice.asp?id=31314818
A rule becoming effective doesn’t necessarily mean AHCA will walk into every Florida ALF on September 18 specifically looking for DNRO paperwork.
But after the effective date, the amended rule is the applicable regulation.
That’s why I wouldn’t wait until your next survey to address it.
DON’T JUST EMAIL THE NEW RULE
One of the biggest mistakes facilities make when regulations change is sending an email:
“FYI — new regulation attached.”
And everyone assumes the job is done.
It isn’t.
Someone needs to take responsibility for actually implementing the change.
Before September 17, I would use this checklist:
- DNRO policy reviewed and updated
- Advance-directive policy reviewed and updated
- Admission packet reviewed
- Advance-directive information updated
- Current DH Form 1896 verified
- Old forms and outdated documents removed
- Resident-record procedures reviewed
- Staff involved in admissions and resident records informed of the changes
And here’s one I would not overlook:
REMOVE THE OLD VERSIONS.
Check the administrator’s computer.
Check the shared drive.
Check the admissions folder.
Check your forms binder.
Check preprinted admission packets.
Because six months from now, someone may pull an old document simply because:
“That’s the one we’ve always used.”
DO A MOCK ADMISSION BEFORE SEPTEMBER 17
Here’s an easy compliance exercise.
Pretend you’re admitting a new resident tomorrow.
Ask the person who normally handles admissions:
“Show me everything we provide to a new resident regarding DNROs and advance directives.”
Don’t tell them where to find it.
Let them go through the normal process.
Then look at what they produce.
Is the advance-directive information current?
Are they using the current DH Form 1896?
Have outdated documents been removed?
Does your policy match what they’re actually doing?
Does the employee understand the facility’s process?
That 10-minute exercise may tell you more about your compliance than simply reading the policy.
THE BIGGEST RISK MAY BE SOMETHING VERY SMALL
This isn’t necessarily a dramatic operational change.
And that’s exactly why it can be missed.
The administrator updates the policy…
but nobody updates the admission packet.
The new form gets downloaded…
but the old one stays in the shared folder.
Administration understands the change…
but the employee completing admissions doesn’t know anything changed.
The facility prints 50 admission packets…
and they’re all based on the old materials.
Those small implementation gaps are where compliance problems begin.
THE BOTTOM LINE
Rule 59A-36.009 is no longer proposed.
AHCA filed the final amendment on August 28, 2026, and the amended rule becomes effective September 17, 2026.
The official title is now:
Do Not Resuscitate Orders (DNROs) and Advance Directives.
The amendment expressly addresses advance directives, updates the information provided at admission, and incorporates the updated DH Form 1896, Florida Do Not Resuscitate Order, 02/2024.
So don’t just read the new regulation.
Implement it.
UPDATE THE POLICY.
UPDATE THE ADMISSION PACKET.
REPLACE THE OLD FORMS.
INFORM YOUR STAFF.
REMOVE THE OLD VERSIONS.
Because on September 17, this isn’t an upcoming change anymore.
IT’S THE REGULATION.
OFFICIAL RESOURCES
Rule 59A-36.009 — Do Not Resuscitate Orders (DNROs) and Advance Directives
https://flrules.org/gateway/ruleno.asp?Section=0&id=59A-36.009
Final Adopted Rule Notice — Rule 59A-36.009
https://flrules.org/Gateway/View_notice.asp?id=31314818
DH Form 1896 — Florida Do Not Resuscitate Order
https://flrules.org/gateway/reference.asp?No=Ref-19567