<p>“Agreed Onward. Many people would go for the cash grab in these circumstances.”</p>
<p>Perhaps the family is going for the cash grab. I doubt independent living is covered by medicaid or medicare, someone is paying for it. At least in my state, independent living is paid for privately. It would be interesting to find out if this facility is being paid for by the elderly lady (or her daughter–I doubt it), as some may consider it a waste of “their” inheritance to keep an elderly parent alive in an expensive facility.</p>
<p>Which would make perfect sense to why the daughter is “satisfied with the level of care” given to her mother. Perhaps she was ready for Ma to stop spending her money. Sounds mean, but if there isn’t much more to the story, that seems likely.</p>
<p>I think part of the problem with this story is confusion of terms, beginning with the writer of the article. In that article, “independent living” was used interchangeably with “nursing home.” The writer got it wrong.</p>
<p>Assisted living is most emphatically NOT a “hospital-like setting.” Just like independent living, it is an apartment complex with cooking and cleaning provided. Like independent living, it has community social events, field trips, and cheerily decorated common spaces. Like independent living, it is not a medical facility. The ONLY thing that distinguishes AL from IL is that the residents get assistance with dressing, bathing, meds, etc. – assistance which takes place mostly in the residents’ apartment, and thus cannot possibly contribute to a perception of a “hospital” atmosphere.</p>
<p>I think the posts by cptofthehouse and others above bring up some good points, and thinking about it has crystallized my own thoughts a bit.</p>
<p>We have standardized rules in place which we apply to all. I agree that
CPR should have been attempted. But here we have an 87 year old. People more knowledgeable that I have pointed out that CPR would be overwhelmingly likely to fail; with the next most likely outcome a lingering period of helpless convalescence, followed by… death. The likelihood of a good outcome is very slight. While I think those odds don’t militate against making the attempt in a young person unless they have unambiguously expressed their desire not to have such steps taken, doesn’t it make sense to reverse the presumption after a certain age, so that DNR/DNI is assumed to be in effect unless one takes steps to provide notice to the contrary?</p>
<p>
Okay, but why do we have to assume the opposite? That the assumption/presumption I’ve expressed doubt about. We use arbitrary age cutoffs all the time. Driving age. Voting age. Drinking age. Retirement age. You have to be this tall to ride on this roller coaster – etc. </p>
<p>Is it really a bad thing to have a reversal of DNR presumption age cutoff? Say, 85? After that age you have to have a “please do resuscitate” bracelet or somesuch? I suspect that some people would opt for a PDR - but most would not. And if they lack mental capacity to decide to opt in, we’re making that decision for them, aren’t we? People criticize the “random facility worker” for doing what she said was following policy, but in fact, the people who are outraged by this are asserting the opinion that that “random” person should not have made that decision. I agree such a decision should not be left in the hands of various persons of unknown talent or training. I just think that the policy which should be in place is quite likely something like the policy she described, and a person in her position should follow it. I don’t care if her affect is flat or it sounds bad on tape. The 911 operator wasn’t there, but was merely expressing the presumption posters here have, in varying ways, echoed - all efforts to save a life should automatically be exercised in all cases - specifically including the case of an 87 year old who is in an assisted living situation because she is no longer able to live independently. </p>
<p>No member of my family would have disagreed with the outcome of this incident. I have lived through the deaths of my own parents and now three elderly inlaws. I was present when my mother and MIL died; I was the last family member my father saw before he died. Death isn’t joyful but it is part of our lives. I have some real life perspective on this. No family members have been motivated by financial considerations in letting any of them die, but none would say they went “before their time.” The opposite, however, probably is true. </p>
<p>Fighting death tooth and nail is honorable in the young. At some point, however, it becomes vanity. Accepting the inevitability of death is the challenge of the old. We live in a society where we are urged to deny aging - we must be “forever young.” But in fact, we can’t be. We will grow old. We will die. The ability to accept that with grace and honor is a challenge, but it is one many of us will have to face, being denied the mercy of a sudden and overwhelming fatal event. The insistence on denying the elderly even that simple and natural end is cruel, not noble.</p>
<p>Comments bring up a good point.
By shifting medical care- even CPR ( although if they are still breathing on their own, does that count as resuscitation?), to 911, this facility is shifting costs to the taxpayers ( & increasing costs to everyone)</p>
<p>Relying on 911 makes administering CPR both more expensive & less beneficial ( because of delay).</p>
<p>We know nothing of the daughter to come to any conclusion such as the above -to deem it “likely” that she wanted Mom dead so she could have more money just because she isn’t angry her mother wasn’t pounded on, shocked incessantly, intubated, and put through hell to stave off an inevitable outcome.</p>
<p>This exact scenario happened to my Mom on 12/12/12. Only she was pounded on, shocked incessantly, intubated, and put through hell-as was my stepdad for 1 and 1/2 hours. She had NO chance of surviving and didn’t. I’m sorry she and my stepdad had to go through that. And I can assure you it’s not because I was salivating over a potential inheritance.</p>
<p>So sorry to read that, Nrdsb4. My condolences on losing your mother.</p>
<p>kluge, I want to thank you for your excellent posts on this thread. I work with seniors (not in a medical setting) and end-of-life issues are a frequent topic of discussion. I do think that we often refuse to accept the inevitable. Somehow we expect that people can be returned to a state of good health, or at least to a state in which their every moment is not a struggle against pain. Yet the time comes when this is not possible. Most of the seniors I know would consider dying quickly of a massive stroke at the age of 87, when still able to live in independent care, a very lucky break. I feel the same way.</p>
<p>A few years ago my FIL realized that he was struggling to handle his investments and other financial affairs. Because I am lawyer he hired me to take over the management of those things, with an agreed fee for doing is. As a result, I get paid to handle his assets while he’s alive. When he dies I’ll wind up my work in a few months and that’s it. I inherit nothing. (He has so many children that I figured that if he lives 12 more years, I’ll have been paid more out of his estate than any of his own kids. When he dies that “gravy train” stops.) I love and respect the man, who is now in a sad state, dealing with a confusing and unhappy situation as best he can. I speak with him every day. If he were to have a stroke and I was standing there I would let him go, without hesitation. It would not be in my financial interest, but I owe him that, without question. </p>
<p>I held my own mother’s hand while she died. My sisters and I could have extended her life by shoving a tube down her throat and forcing food and water into her mindless body (at no expense to ourselves) but we honored her DNR/DNI directive. We had no financial incentive one way or the other. We let her go. We owed her that much.</p>
<p>The idea that financial considerations would drive an elderly person’s children’s thoughts in this type of situation strikes me as incredibly mean-spirited.</p>
<p>^^ Me too, kluge, and thank you for yet another thoughtful, generous, realistic post on this subject. </p>
<p>The extend-life-at-all-costs approach is unfortunately prevalent, especially among people who haven’t experienced life with an aged parent. In our family, our goal for our parents is not longevity at this point. They’ve already achieved that. What we want is for them to be comfortable and happy. If that means they don’t get no-holds-barred emergency care – and they die at 90 instead of 92 – we’re at peace with that. And kluge, you’re right, we owe them peace and dignity more than we owe them extra days on the calendar.</p>
<p>And, busdriver, I very much resent your assumption that any adult child who doesn’t want life extended at all costs must have ulterior motives. My brothers and I have no financial incentive to hope our parents die sooner rather than later. Whenever they go, there will be little if anything left. These are terribly difficult situations for families, no matter what happens. Don’t presume to judge.</p>
<p>Kluge and LasMa, I think you are overreacting a bit. You think my comment about this one situation somehow is a comment about your personal situations or a generalization about all end of life situations? Seriously? Talk about exaggeration.</p>
<p>My comment is specific to one person who was absolutely fine with a woman refusing to allow anyone to give her mother a basic life-saving effort. Not extending life at all costs, which I definitely don’t agree with. How you can possibly even compare this situation to yours?</p>
<p>It definitely occurs to me that someone who wouldn’t want anyone to lift a finger to help a woman who while elderly, was relatively healthy (otherwise she’d be in assisted living or a nursing home instead of independent living), might be interested in her not spending down her assets. Why else do you think they preferred her to die?</p>
<p>I want to make it clear that I am not flaming the family. I fully acknowledge that I don’t know the full story and am just going by what is being reported. I am just stating that in such situatons just because the family is fine with something does not necessarily mean it is a go. I’m also not flaming those who believe that the line to intervene medically is not where I would draw it. Where I draw my line, where you draw your line, all of those things are irrelevant when it comes to anyone else. And when anyone is drawing that line for an individual, the matter is important enough that certain procedures be follwed. </p>
<p>Some years ago, these procedures and directives were not so readily accessible. Now they are whipped out the instant anyone goes into the hospital for any procedure even removing an ingrown toenail, so they are no longer buried in the sand. If someone does not have a DNR or that sort of paper work in place, especially living in an assisted living environment, it’s because that person has refused to fill it out. If that person is no longer competent to fill it out, a guardian has to be named according to the law. </p>
<p>In my MIL’s case, she has consistently made it very clear that NO DNR should be filled out for her. She wants EVERY attempt to keep her alive. She’s at the point now where it’s a no brainer that she is no longer competent to make those kind of decisions, but when my DH is named as guardian and it becomes his decision, though he could make his own, that she has been so strongly against withholding of any care, makes it unconscionable to not take that line. What if treatment becomes agonizingly painful that she begs to be taken out in her mental state as it is now? That’s when it gets rough. She’s never had to make that sort of decison while suffering the agonies of such treatment. It’s a lot easier to make these decisions one way or the other when one isn’t directly under the gun, you know. When she had one knee operated on, she tried to get the other surgery delayed indefinitely and we did override her wishes and push the surgery through, as the result of not doing so would have rendered her a paraplegic. She had also not addressed those knee problems for over 20 years. So how would such a person react to very painful, miserable procedures leaving her in a state that most who are cognisant will decline? So, I do see the issues in all of this and am living them as well.</p>
<p>My comments about what happened here are exactly why this is news. An assisted living place, any place should not have a rule against any CPR. Perhaps a hospice could have such a designation with all those who enter there having to sigh a DNR to do so, but even then, I don’t like the idea. You can be terminal and then need some life saving moves for something totally unrelated to your outstanding medical condition. I can think of too many situations where it makes no sense to have such a policy. The place featured in the story is saying that it has no such policy, and if it did as an unwritten rule, they may find themselves in trouble as they will be investigated. The way that nurse handled the situation was terrible. </p>
<p>So,with these situations, it’s not what actually happened to which I am reacting and commenting, but what is reported and the possibilities.</p>
<p>Many people I know in independent care facilities/ALFs are using Long term care plans. Many were teachers, who paid very little for the plan. In my N of 30, greed would not be a factor among the children.</p>
<p>But the “basic life-saving effort” you think should have been done is this:</p>
<p>
</p>
<p>and that a daughter who didn’t want that done to her elderly parent must have been motivated by money.</p>
<p>Honestly, having volunteered in a nursing home for several years, I think that many of the things that are done to the elderly in the name of “saving their lives” are really more like elder abuse. If you want to know who is motivated by money to do these things, look at the health care system.</p>
<p>According to the family, their mother/grandmother knew there was a no CPR policy at the independent facility when she signed the lease and was okay with it. Until we know differently, I am not going to make the assumption that they wanted her dead so they could get their grubby hands on her money. If I am going to make an assumption without full knowledge, I’d rather err on the side of accepting their statement than accusing them of “preferring her to die.”</p>
<p>
</p>
<p>As has been stated numerous times, this was not an assisted living place. It was an independent living facility, which offers absolutely no medical treatment. It’s an apartment complex marketed towards seniors, nothing more.</p>
<p>It sounds as though the “nurse” (and possibly the supervisor heard in the background) may have misinterpreted the company policy, However, if she was in fact a nurse, the Good Samaritan law may well not have protected her while she was at work. This company needs to consult with their lawyers and come up with a better policy which protects both the residents, their visitors, and their employees and then make sure the policy is understand by all.</p>
<p>Can a little space be given in this discussion for the possibility of a little decision making inertia? </p>
<p>Maybe their long term, emotionally attached Dr. who usually brings up this discussion was reluctant to push the discussion to a conclusion. Perhaps the physician brought up the topic, but the family was still thinking over the issues? Perhaps some family members, as I have seen happen, hate the idea of ‘nothing being done’ for mom, yet can’t quite envision the ICU hell us health care folk are trying to avoid, so can’t agree with a DNR order. Perhaps the patient did not want to engage in the discussion, and so it was deferred. Some families don’t do well with honest discussions about death. There are cultural variants. Events presented themselves, ‘God’s will was done’, and they certainly didn’t want or expect a media fest after the event. </p>
<p>More than once I’ve seen well meaning physicians rush in to discuss code status when someone is admitted to the hospital unstable. The discussion is certainly warranted, but the family is taken aback at the frankness of the talk, and sometimes no decision is made, though us rational folk, less emotionally involved in the situation, long for one.</p>
<p>"But the “basic life-saving effort” you think should have been done is this:
Quote:
she was pounded on, shocked incessantly, intubated, and put through hell</p>
<p>and that a daughter who didn’t want that done to her elderly parent must have been motivated by money."</p>
<p>I have no idea if she was motivated by money. As cpt says, we are only going on what is reported, and money can be a consideration for some. We are all viewing this through the prism of our own experiences, and I cannot imagine listening to that phone call without being enraged and horrified, if it was for my mother/father or MIL. My parents are as healthy (or more than) people 30 years their junior, my MIL is healthy and full of life. Whether CPR was appropriate or not, to listen to the lack of concern or interest in helping this lady, refusing the 911 operator not because of humane reasons, would cause a completely different reaction to me. I couldn’t fathom the lack of interest in helping her, if it was my mother.</p>
<p>I think of CPR as a temporary measure to keep someone alive until the medics show. I don’t consider it as putting someone through hell.</p>
<p>And, by the way, my mother is horrified also.</p>
<p>Some of us who have performed it on the elderly countless times, seen it performed countless times, and seen the aftermath countless times might beg to differ.</p>
<p>My mother was going to die on 12/12/12. Instead of the horrific ordeal she and my stepdad went through that day, I really wish it had played out differently. I wish my stepdad had instead gotten to hold her in his arms, kiss her forehead, stroke her hand, and say loving things to her as she made her exit. Instead, she was pounded on, shocked incessantly, intubated, and put through hell in a complete exercise in futility. CPR can be a good thing, but make no mistake, it can also be pure hell.</p>
<p>“I think of CPR as a temporary measure to keep someone alive until the medics show. I don’t consider it as putting someone through hell.”</p>
<p>So maybe I’m wrong. I’m not a medical professional. But my parents, while elderly, are healthy and strong. I would be disgusted if someone refused to allow CPR on them just because they are old.</p>
<p>“You were OK with making mean-spirited assumptions about her motives a couple of days ago”</p>
<p>Money is a serious consideration in many families, and I don’t think acknowledging that is mean spirited. I just can’t think of many reasons that one wouldn’t have been upset by that phone call. I could come up with a list, but I’m sure you’d dislike it.</p>