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<p>The article doesn’t state this. Or did I miss it?</p>
<p>The article doesn’t provide much info at all, really.</p>
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nrdsb4 is right, of course, but even beyond that harsh reality is the fact that old people, in addition to being frail, are generally prepared for death in a way that younger folks rarely are, and are subjected to far more painful, invasive and ultimately pointless medical interventions than many of them would prefer, because it is assumed that they should want it - even if they don’t. </p>
<p>In American we tend to think in terms of an idealized vision of life. All sick people can be cured, miserable people can be made content, old people can live full and rewarding lives, etc. But that’s not always true. And while striving for improvement of our individual and collective lives is a good thing, as a society it’s probably not beneficial overall to simply deny reality and act on the basis of assumptions that are usually not true.</p>
<p>This past month I had to put my FIL in an assisted care facility. His senility took a turn for the worse and it couldn’t be put off any longer. He doesn’t remember where he was yesterday. Forgets who he’s seen, who his children are. He imagines he’s been places and done things he didn’t really do. He’s unhappy; his driver’s license and car keys were taken away (finally!) and his freedom is gone. He talks of “jumping off a bridge.” And he’s actually pretty high functioning. Not ready for a skilled nursing facility (SNF) yet. So he’s going to live a frustrating and unhappy life for a few more years, moving into the SNF when he gets too far gone, and then he’s going to die. That’s his reality, and it’s the reality of most 85+ year olds. Sure, there are exceptions. But I’m not surprised that the family of the 86 year old is not unhappy with what happened. They probably are more realistic about the situation than all the Monday morning quarterbacks. </p>
<p>In our country’s “TV” mentality one kid stuck in a well has millions of people emotionally involved and demanding answers; while thousands with AIDS, ADHD, rat bites and lead poisoning hardly merits a yawn. So while millions of aged Americans suffer through each day in misery, pain, confusion, desperation and anguish, the failure to try a probably futile act which would - at best - have left the old lady injured, hospitalized, and possibly brain damaged, draws expressions of outrage.</p>
<p>My father lived his last year in a SNF 250 miles from my home. He was senile, sad, sick and angry. He died after refusing to eat for a week. They couldn’t make him; refusing food was the only control he had over his life - that’s the harsh reality of many old people. I had visited him ten days before and planned to see him the following weekend. In between he effectively ended his life. I didn’t blame anyone for letting that happen - least of all him. It was merciful. Years ago I had an elderly client - blind, half-deaf and bedridden - beg me to let her die. I couldn’t, of course. She suffered for years before receiving her release.</p>
<p>Yes, age does make a difference. Happy thoughts and anecdotal exceptions doesn’t make it untrue. As a society we’d be better if we faced this reality. Performing CPR on anyone under 60 should be an automatic, “default” decision. On people over 85 I’m not sure that’s true. It’s hard to face that - easier to adopt an “at all costs” approach to every medical situation - but denying that age makes a difference is, in my opinion, irresponsible and unrealistic.</p>
<p>^^^^^kluge, when I worked in the ICU we frequently posed the question, “Yes, we can, but does that mean that we should?”</p>
<p>The answer to that is not always clear, rarely easy to decide, and no matter the decision, often second guessed.</p>
<p>Perhaps that’s why I have mixed feelings about this particular situation.</p>
<p>^^^ The point is that it shouldn’t be decided by a worker at an ILF. They’re not in a position to make the decision and there’s no time do the research when this happens. They should follow the safe course which is to follow the DNR if one is readily evident otherwise perform CPR/Heimlich/etc. or try to find someone who can while awaiting the paramedics.</p>
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<p>Well, actually it’s “decided” by the company policy. This particular “worker” decided not to challenge the policy. </p>
<p>I would not be surprised if the publicity which has been generated by this incident leads to a change in policy.</p>
<p>This thread highlights the fact that so many of us who are preoccupied with thoughts about college for our children, must also make major decisions for our parents. Often, unlike the college decisions, we do not have the luxury of time when deciding the futures of our parents. In my case, an unexpected hospitalization of my mother forced me to make a rather quick decision on which assisted living facility she should move into. I did not find as much help online to guide me as to what criteria I should use when judging places. Those of us who actually have parents in AL facilities can help those who are confronting decisions requiring them to compare places with suggestions on how to compare them. (Sort of like how we help each other decide what the important considerations are when deciding on colleges.) I guess, if there’s interest, it would be a topic for a different thread, though.</p>
<p>Cheshire, we do have such a thread here –
<a href=“http://talk.collegeconfidential.com/parent-cafe/1385049-parents-caring-parent-support-thread.html[/url]”>http://talk.collegeconfidential.com/parent-cafe/1385049-parents-caring-parent-support-thread.html</a>
It’s pinned so it’s always at the top of the Parent Cafe list.</p>
<p>GladGradDad, you are stating that the default should be, at all times, to do everything which might prevent a person from dying in the absence of affirmative proof of a clearly stated intent to the contrary - even if the measure is likely to fail and if it “succeeds” will likely just keep them “alive” for a limited period of time but helpless and in pain or simply terminally unconscious. You term that the “safe course.” </p>
<p>I understand why EMT’s are required to have that policy. They’ll encounter lots of different people in different situations in a given day, with no time to make that call. But in an “old folks home” (which is what we called them back in the day) I’m not sure that’s an appropriate automatic response. As has been noted - this is a policy of the facility. I’m sure they thought it through, and I’m sure it’s disclosed in advance (although I agree, many such disclosures are meaningless in practical terms.) The thing is, I’m not so sure it’s a bad policy. </p>
<p>My father, my FIL, and many of their children have expressed on numerous occasions a preference for a merciful death before they lost their faculties. (My mother and MIL were both granted that boon, dying with their wits about them from a stroke and cancer respectively when they were each in their early 80’s.) In an earlier era, an octogenarian who had a heart attack would have simply and naturally died. Now we deny people that mercy while keeping them alive with modern techniques. Sometimes that’s a wonderful thing. More often, I fear, it’s just the prolongation of a dreaded and miserable fate.</p>
<p>The police have begun an investigation.</p>
<p>THE BAKERSFIELD CALIFORNIAN
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<p>[Document:</a> m](<a href=“http://www.bakersfieldcalifornian.com/health/x837006603/Document-Do-not-resuscitate-order-was-not-on-hand-for-Glenwood-Gardens-resident]Document:”>http://www.bakersfieldcalifornian.com/health/x837006603/Document-Do-not-resuscitate-order-was-not-on-hand-for-Glenwood-Gardens-resident)</p>
<p>I wonder if they would have enforced their no CPR policy if it had been one of the facility worker’s children who had collapsed, with the 911 operator telling them to perform CPR and that she would take responsibility.</p>
<p>If something happens to someone I love, I sure hope that 911 operator is on the other line, doing everything to keep them alive.</p>
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Not exactly - I’m saying it shouldn’t be this random facility worker, who likely knows very little if anything about the woman, who makes the decision and I’m taking about first aid resuscitation. The person giving the CPR typically would have no idea of the after-effects of the CPR - whether the person will revive, whether they’ll have any damage as a result, whether they would have died within a short time anyway, whether they’ll experience additional pain as a result of surviving, or whether they’ll have an additional year, or 5 or 10 as a result. This is another reason why they shouldn’t be the ones making the decision, they should act, unless there’s a known DNR.</p>
<p>When a lot of people express their desires it’s common for them to not want ‘extraordinary measures’ to keep them alive, i.e. usually keeping them alive in a vegetative or extremely debilitated state, but that’s different than a resuscitation effort that might simply clear their airway or intervene in a condition that’s correctable. Usually the DNR applies to people at their end stage when they truly know they don’t want to be resuscitated because the writing’s on the immediate wall if you will.</p>
<p>For example, I can say right now that I don’t want extraordinary measures to keep my body alive in a vegetative state but I definitely WOULD want someone to give me CPR if I happen to collapse and it’s called for. I don’t want that person to try to make the decision that I’d be better off dead because something negative ‘might’ happen.</p>
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<p>Sounds like they are not a “licensed” facility, but simply an apartment complex geared towards seniors. </p>
<p>If even lay persons can perform CPR (and one doesn’t have to be certified in CPR to give it, though it’s certainly preferred that they be), I wonder why giving CPR would necessarily be deemed as “providing medical care without a license.”</p>
<p>It never occurred to me to check any apartment complex or any place whether there was a no CPR policy in place. As I’ve said, it’s a whole other thing whether a person has a DNR or no CPR tag on him, or if a bystander declines to attempt CPR for whatever reason, but to not be permitted to do CPR because of specific rules against it??? That’s a nice little sign to have to put up at restaurants and assisted living centers. Anyone collapse here, even though we have employees who are trained in it ( that nurse probably was as even health aides are required to be trained in it most of the time), they won’t be permitted to do so. They’ll just wait around for emergency personale to show up. Real nice.</p>
<p>My 90 yr old uncle is a doctor, living in a top assisted living facility. While on a field trip of residents to an event in the city, one of the members of his group collapsed, and my uncle automatically went into action, performed CPR and saved the woman’s life. It turned out that the woman had a DNR, and my uncle got into some trouble over it. The event made the NY Times with discussion over the ethics in situations like this.</p>
<p>The questions raised in this thread about end of life care, DNRs, etc. are good ones. We’ve had numerous discussions with my 82 year old mother about what she wants and doesn’t want and we’ve talked to our kids about it too (as it relates to us, even though as 60 year olds we hope these questions don’t arise for many years to come!)</p>
<p>As for this particular case, the woman was living a relatively independent life, was at dinner, and had no DNR. Had she collapsed anyplace else, I suspect someone would have done CPR until the EMTs arrived. Would have it saved her life? No one knows, but the point is, someone would have tried.</p>
<p>But at this Senior Living Community, they have what I consider a very strange rule that NO ONE can do CPR under any circumstance. That makes no sense to me. </p>
<p>And moreso, having heard the 911 tape several times, the nurse’s affect was so cold and detached. Even if she was under orders never to give CPR, I would think she would have had SOME emotion in her voice watching a woman collapsed on the floor not breathing AND having a 911 operator begging her to do SOMETHING. In my opinion, there is something very off about this situation and I am glad the police (and I suspect others) will be investigating and, I hope there will be a reconsideration of this establishment’s blanket policy.</p>
<p>I agree, Proudmary. i can’t even listen to the tape. I don’t understand why the nurse didn’t just give the address and info and then say, she had to go help the patient without going into detail. Even if you cannot give CPR for any reason, yakking with the 911 operator,unless taking specific life saving direction, is not what you want to be doing with someone who is possibly dying. Some comfort, just the attention would have been nice, normal, even.</p>
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<p>[Family:</a> Woman denied CPR wanted no intervention - Yahoo! News](<a href=“http://news.yahoo.com/family-woman-denied-cpr-wanted-no-intervention-013800673.html]Family:”>http://news.yahoo.com/family-woman-denied-cpr-wanted-no-intervention-013800673.html)</p>
<p>Interesting.</p>
<p>I give the family a lot of credit for the way they are handling this. They are honoring their mother’s wishes.</p>
<p>Agreed Onward. Many people would go for the cash grab in these circumstances.</p>
<p>So a dozen agencies are investigating, new policies will be implemented, new laws will be drafted . . . and meanwhile the resident’s family says that this outcome is exactly what she would have wanted.</p>