As a nurse and attorney, I can tell you I was so uncomfortable reading about the nurse who refused to give CPR to the dying resident in the seniors’ community where she worked. I got a sick feeling in my stomach. But there is a lot to this story.
I believe there should be exceptions in non health care residences for emergencies like the one involving this senior, Lorraine Bayless. A nurse who is on scene should be able to do what any trained lay person can do: administer CPR when someone stops breathing.
The press reports that there was no Do Not Resuscitate (DNR) direction in place. Ms. Bayliss’s family believed that she wanted “to die naturally and without any kind of life prolonging intervention” as they told the Associated Press. Glemwood Garden’s policy about what the nurse should do in an emergency was sufficiently unclear that owner Brookdale’s public statement was to the effect that the nurse had “misinterpreted the company’s guidelines.” What those guidelines were is not certain.
We have legal documents that allow anyone to make quite clear what they want in an emergency such as stopping breathing. There is a DNR statement or order. There is an advance health care directive to guide others if the person in no longer conscious or competent. There is a newer document called Physician’s Orders for Life Sustaining Treatment (POLST) in some states, also called Medical Orders for Life Sustaining Treatment (MOLST). A doctor signs it and it’s posted appropriately. It allows others to be comfortable following the person’s wishes, even if the wishes say don’t keep me alive.
This uncomfortable, ethically questionable, confusing scene over Ms. Bayliss’ end of life did not have to happen the way it did. If you don’t want to be in that kind of situation, you need to be responsible for deciding what you want and communicating it to those who will have to act on your behalf.
Either you want emergency intervention or you don’t. If you are very clear that you do not want to be resuscitated when you stop breathing, let the people where you live know what you want and put it in writing. Post it in a prominent place and give it to the administrator of any seniors residence you choose as your home. If you have clear statement that you don’t want resuscitation and you stop breathing, no one should call 911. Paramedics will attempt CPR every time. CPR is definitely life prolonging intervention. The legal documents mentioned above allow you to spell out under what circumstances you want to be kept alive. It is not always so straightforward as stopping breathing, or a sudden event.
We’re in a society that is generally phobic about death, much more than many other cultures in the world. Death in many other places is accepted as the natural end of life and people don’t spend as much time avoiding the very idea. In our culture, we seem to think it’s optional. We don’t like the idea of planning for the end.
Perhaps Lorraine Bayless has left us all with an important wake up call. Independent and assisted living senior residences need clear written policies about resuscitation of residents. If nurses happen to be working there, they should not be frozen in place when a resident collapses and CPR can be administered by someone, including themselves. Residents should be required to spell out their end of life wishes and emergency instructions and these should be available to those in charge. And each of us needs to face the reality that no one gets out of here alive. We need to think it out, write it out, and do our loved ones and those who help us the decency of making our wishes clear to them. If a person wants no resuscitation, we have to accept the idea that we don’t have to “do something” if they stop breathing.
As we’re in the elder and family consulting business, I made sure my husband Mikol and our kids know about my own wishes. I’m pretty sure that when it’s my time to kick the bucket, they’ll let me kick it and get out of the way. It’s not so bad to exit the way Lorraine did, fast, and probably without pain. Her family says she had it her way.
What would your way look like?
Until next time,
Learn how a son in Pennsylvania was ordered by a court to pay his mother’s $93,000 nursing home bill.
After his mom was injured and went to the hospital, she spend some time in a nursing home.
She then was discharged and left the U.S. The nursing home sued the son to pay the outstanding bill.
In this quick video, learn three things you can do to prevent this kind of nightmare from happening to you.
“She only drives to the store”.
Lots of Boomer-aged siblings find themselves fighting about their aging parents.
Should Mom be allowed to stay in her home even though she’s really not safe living alone? How about the driving issue? Does one parent have Alzheimer’s or some other dementia and some siblings are in denial about it? Who pays for a parent’s care? These are common areas of disagreement in families that can tear apart relationships if you are not mindful of how you fight.
You can’t stop your brothers or sisters from having a different way of seeing your parent’s situation, but you can change the way you approach the conversation with them.
Getting along, and agreeing to disagree are manageable if you know how.
In some ways it’s like the fair fighting rules for married people or couples. There are things you can do and things you should never do. The most destructive things we do when we are in a conflict with siblings can’t be undone. Emotionally loaded subjects can bring out the worst in families. If you are aware of fighting fair, you have a better chance of still being on speaking terms with siblings after your parents pass on.
Some of the worst mistakes are the same for any fight: they are verbally violent and cause harm that may last long after the fight ends. The basics of fair fighting are the equivalent of not “hitting below the belt”. They include setting up a few ground rules. We use them at AgingParents.com when we have to work with sibling warfare in a family meeting by phone or in person, sitting at a table.
The subject of parents in declining health brings up a lot of feelings, good or not, about the parent and each person’s relationship with the parent. It also brings up a lot about the siblings relationships with each other, sometimes things never discussed before. Things can get explosive.
Here are ground rules we always ask people to follow to keep it civil, though some can’t seem to restrain themselves from doing otherwise. These rules do help everyone actually communicate while struggling with a load of emotions rising to the surface about Mom or Dad.
1. No name calling, no swearing and cursing, and no shouting at each other. These are all forms of verbal violence and they can cause hurt you may not mean to cause. Restrain yourself and see if everyone can agree to do the same.
2. Define among you what you’re going to talk about ahead of the conversation and stick to it. It will reduce the magnitude of the disagreement and keep the door closed, for now, on other volatile subjects. Make a list or agenda if you need to. It can help.
3. Agree to avoid bringing up the past, especially about decades old hurts. If you focus on what Mom or Dad needs, things will go a lot better. Stick to the problem with your parent that caused this conversation in the first place.
4. Don’t start sentences with “You”. Statements like “You can’t be bothered!” or “You don’t care about anyone else” don’t get anyone anywhere in a fight. They tend to make the other sibling defensive and it gets worse from there.
5. No interrupting. You need to listen to the sibling who is talking. It helps to have a leader in the conversation to keep this rule in force. If there isn’t one, you can remind others that we agreed to not interrupt each other.
6. Don’t clam up, no matter how angry you get in a fight with a sibling,. Be honest about your feelings and keep your message about what you want to do clear. Take a breath or take a break, but come back and be straight about what is bothering you.
7. Ask your sibling what he or she needs. It sounds simple, but this rarely happens. You can find out a lot about how to resolve your disagreements if you ask more questions of those who are involved in the fight with you. If a sibling is angry with you because there is something he or she is not getting, perhaps they’ll admit it and you can do something about it.
8. Avoid absolute statements like “you never contribute a dime” or “I always know you’ll disappear when there’s work to do”. If you try another tack such as “I’m feeling overwhelmed by the work of taking care of Dad and I would like you to come next month and give me a break” is going to work a lot better than the “always’, “never” extreme statements.
No matter how your relationships have been with siblings in the past, we can all do better when an aging parent conflict comes up. The rules of fair fighting work. Try discussing them, passing them around or testing the waters with siblings by bringing up the idea before any meeting at which you anticipate an argument. It might be a big relief to you when things go better than ever.
Until next time,