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- who makes those decisions?

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Rose, good question. Curious who had placed the patient in the nursing home to begin with?
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I guess the state steps in.
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I saw this topic on a tv show last night, only, I think they got it wrong. I suppose the law may vary by state.

They had the doctors calling the shots, but, I think that the doctors can treat emergencies, but, if the patient is incompetent to make their own decisions, the county will apply to the court to be appointed the Guardian, unless some other person who is willing to step up and qualify. Then, they will make the decisions regarding health and finances.
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In the absence of consent - for example, while everyone's running round trying to track down relatives or apply to courts - a doctor is ethically obliged to treat his patient using his best clinical judgement and with a presumption of saving life if possible.

Well - just imagine trying to defend yourself if you were later sued or prosecuted and hadn't done so!
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