Thursday, March 7, 2013

Does a Do Not Resuscitate order mean anything? Not if you call 911.

"A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist." -- Stewart Alsop, American newspaper columnist.

My 98-year-old mother sits in her wheel chair at the care center dressed in her cute jeans and sweater, her hair perky and fingernails done. She is a killer at the bingo table, keeps up with sports and politics and wants to know what's going on with her grandsons and great-grandson. But she's frail and growing more frail.

Her eyesight is marginal, her energy levels in decline and her balance precarious.

Over the course of the conversation I know that at some point she's going to ask "the question." That's the question that I'm sure many 90-something people ask...."Why am I here?"

When I tell her that we all admire her courage in her old age, that we appreciate her life force and continue to learn from her and love her, she smiles and shrugs. When I tell her that she could easily live another three or four years, she furrows her brow and sighs.

She's often told me that she hopes to die in her sleep and that she certainly wants no heroic attempts to resuscitate her if she has another stroke or a sudden heart attack.

She's signed plenty of paper work at her care facility, saying just that. She does not want 911 called in an emergency. She wants to die naturally...not in a coma, hooked to machines.

But where does the news this week out of California leave us all? The story is about the 87-year-old woman who died after a nurse at her retirement home refused a 911 dispatcher's pleas to perform CPR after she collapsed.

The local media jumped all over this, painting the caregiver in a bad light even though the she said was trying to meet the 87-year-old's wishes. Despite the "outrage" over this death, we now learn that the family has said they are satisfied with the care their mother received.

"It was our beloved mother and grandmother's wish to die naturally and without any kind of life prolonging intervention," the family said. "We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens (Bakersfield, Calif.) and is at peace."

The family said it would not sue or try to profit from the death, and called it "a lesson we can all learn from."

"We regret that this private and most personal time has been escalated by the media," the statement said. Ummm, they got that right.

When elderly and frail people sign papers saying they do not want emergency resuscitation does it mean anything? Or are we all so outraged by death that the wishes of the old person are to be ignored?

The people at my mom's care center have explained that if 911 gets involved, all the legally signed requests go out the window. The emergency folks are legally bound to preserve matter what.
Yes life is precious but can't people die in peace at 87 or 98? I'm sure every care center manager in the country is now on the phone to their legal counsel looking for clarification.

Tennessee-based Brookdale Senior Living owns the California care facility. Initially, according to the news report, it said its employee acted correctly by waiting until emergency personnel arrived when the woman collapsed. But later, it issued a new statement saying the employee had misinterpreted the company's guidelines and was on voluntary leave while the case is investigated.

"This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents," the company said.


The 87-year-old collapsed in the Glenwood Gardens dining hall. Someone called 911 on a cellphone and asked for an ambulance. Later, a woman who identified herself as a nurse got on the line and told dispatcher that she was not permitted to do CPR on the woman. The dispatcher implored the nurse to find someone else and said she would instruct them on how to do the procedure.

"I understand if your facility is not willing to do that," the dispatcher said. "Give the phone to a passer-by. This woman is not breathing enough. She is going to die if we don't get this started, do you understand?" By the time paramedics arrived, the woman had stopped breathing.

The death has prompted multiple investigations. Bakersfield police are trying to determine whether a crime was committed when the nurse refused to help even find someone to perform CPR. The Kern County Aging and Adult Services Department is looking into possible elder abuse and the state Assembly's Aging and Long-term Care Committee is investigating to see whether legislation is needed. Oh boy.

The nation's largest trade group for senior living facilities has called for its members to review policies.

"It was a complete tragedy," Maribeth Bersani, senior vice president of the Assisted Living Federation of America, told the Associated Press. "Our members are now looking at their policies to make sure they are clear. Whether they have one to initiate (CPR) or not, they should be responsive to what the 911 person tells them to do."

There are lessons here:
- Tell your "friends" at the care center to not call 911.

- Make sure you have a "Do Not Resuscitate" directive on file with everyone. Each state has its own DNR be sure yours is in line with state regulations. Post it on your door.

- Make it clear to family members that there are to be no heroics. Get legal instructions filed with your doctor, the fire department, the care center and with all family members.

But even then your wishes may not be met. Tell friends and fellow residents at the care center to stay off the phone.

For more information:
How to write a DO NOT RESUSCITATE directive, click here.
Assisted Living Federation of America, click here.
"Getting Ready to Go" executive summary from AARP, click here.
New York Times editorial,  The New Old Age, click here., "The CPR Death: What Really Happened and  Five Lessons You Should Learn," click here.

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