Carolyn Rosenblatt, Nurse-Attorney, Mediator, Author

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Were You Shocked By the Nurse Who Refused to Give CPR to a Senior and the Senior Died?

emergencyroomAs 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.

The 87 year old woman who collapsed at Glenwood Gardens was Lorraine Bayliss.  The nurse was on the phone with the 911 dispatcher who was desperately begging the nurse to get someone else to give CPR when the nurse said she wouldn’t because of  “company policy”.  It shocks us because nurses not only know what to do in emergencies like this, they are supposed to care enough to do it.
I was not surprised to learn that there was “company policy” about a nurse in an independent seniors’ residence not giving nursing care. The law does not actually allow what we think of as hands-on nursing to be given to residents who are not in a skilled nursing facility (nursing home).  Neither the state nor federal departments of health license or regulate independent living or assisted living homes.  However, the horrible image of a nurse standing by refusing to permit anyone else there to get emergency instructions from the 911 dispatcher is most disturbing, no matter what kind of a home this was.
If the nurse was precluded from giving CPR, what was she doing there in the first place?

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,

Carolyn Rosenblatt

AgingParents.com

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Son Hit With Mom’s $93,000 Nursing Home Bill

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.

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Dangerous Older Drivers: A Car is A Lethal Weapon

“She only drives to the store”.

 
“He doesn’t drive at night, he just drives to the doctor and to church”.
These are statements from family members whose elder is no longer safe to drive, but they’re still driving.  No one has the guts to ask Dad or Mom to stop.  Imagine the justifications people can invent to allow dangerous aging parents to stay behind the wheel.  Since most accidents happen within 3 miles of home, the “only to church” or “only to the store” is not safer than anywhere else.
The National Safety Council publishes a journal called Family Safety and Health, and in its Fall, 2012 issue, an article, “Time to Hand Over the Keys” appears.  I was interviewed for the article.  As a former personal injury lawyer, I represented hundreds of victims of car accidents, some caused by older drivers who never should have been on the road.  That dangerous driver could be your dad, your grandma or your aunt.  The next generation needs to see the problem and face the fear about confronting it. Download the article by clicking HERE
Research indicates that most people, when approached respectfully, will voluntarily give up driving.  However, “most people” does not include the very stubborn, those in denial, and those elders with the kind of cognitive impairment that prevents them from actually understanding how impaired they are.  With those folks, their families desperately need a strategy.
Here’s a sampling of parts from the strategy I advocate that you use.
First, recognize the problem.  A car is a lethal weapon whether your elder is driving it a block from home or across the city.  It is not a safer weapon because your elder is closer to home.  That’s a fanatasy. Give it up. I met an 84 year old who was behind the wheel when he accidentally hit and killed his best friend in the driveway of his own apartment building.
Next, be honest and respectful and talk to your aging loved one about his or her driving. If you’ve see grandma careen across the street cutting off other cars, unaware of their presence, it’s time to gently ask her to give up the keys.  Try a one-on -one conversation first.
Next, add allies to your approach if the one-on-one is not successful.  Bring in a trusted friend, other family, or anyone Dad likes best.  Bring up the subject kindly and with acknowledgement that giving up driving is huge and that it means losing independence.  Use an outside professional if this doesn’t work.
Make alternative transportation arrangements.  If your elder lives in an urban area, many resources may be available for elders, from community vans to carpools from senior centers.  Beware of putting cognitively impaired elders on buses. They may be confused and get lost.  Rural dwellers must usually rely on family and friends to transport them.  The burden on adult children may stop them from facing the issue of a parent’s dangerous driving.
If the elder is too dangerous to continue driving, get rid of the car if you can.  Sometimes a caregiver can do the driving and the aging person keeps the car. If there is no caregiver or someone else’s car is used to transport, the elder’s car is a sad reminder and a temptation you don’t want kept in the driveway.  It’s too easy for Dad to get a duplicate set of keys made.
Use the law as a last resort.  The primary care doctor may be of help if willing to report the danger or need for retesting to the department of motor vehicles.  Some states allow you to report a dangerous driver and ask for license retesting anonymously.  The courts can be used to protect elders who are a danger to themselves or others. Guardianship can be used in extreme cases to give family permission to take the car away.
Asking an aging loved one to give up driving takes courage. It can draw extreme resistance, anger and refusal.  Facing that possibility requires a plan and perhaps a family conference before approaching a particularly difficult elder.  I urge you to find your courage if your elder is scaring you when he or she gets behind the wheel.  Sometimes elders know it’s time and will give up driving willingly when asked.  You might be lucky.  In any event, it’s time to take your chances if this article reminds you of anyone close to you.
Until next time,
Carolyn Rosenblatt,

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Son Hit With Aging Parent’s $93K Nursing Home Bill

Hello, again.  Carolyn and Mikol here.  We came across an article about a shocking case involving a son being stuck with his mother’s nursing home bill.  We wanted to give you a heads-up, as most people would never expect this. Could this happen to you?

John Pittas’ mother entered a nursing home for rehabilitation following a car crash. After she left the nursing home, she moved out of the country.  His mother’s $93,000 bill at the home was left unpaid.  The mom had applied for Medicaid, which would  normally pay the bill if she couldn’t.
The mom’s Medicaid application did not get approved in enough time to satisfy the nursing home, and it sued her son for the bill.  The state of Pennsylvania, like 29 others in our country, has something called a “filial responsibility law”.  Those laws require that spouses, children and even parents of needy adults support the indigent.  These laws were rarely ever enforced.  The nursing home  decided to enforce it rather than have Medicaid do what it was designed to do.
The trial court found for the nursing home.  Mr. Pittas appealed. He argued  that the court should have considered  Medicaid or going after his mother’s husband and her two other adult children.  Astonishingly, the appeals court not only agreed that the nursing home didn’t have to wait until the Medicaid claim was resolved, it also found that the nursing home could choose any family member it wanted to when seeking payment for the bill.
There is an adage in the law:  You can’t legislate morality. However that is exactly what the Pennsylvania courts in the Pittas case did.  If a son or daughter has the money and wants to pay for mom or dad’s care, that’s an upright choice.  But what if they choose not to pay? What if they have their own expenses, kids in college or a retirement they want to fund?  Since when is it okay to unfairly discriminate against a financially successful family member? Mr. Pittas’s tax returns, bank statements, and other personal data are now presumably public record.
Here’s the unspoken part of the picture that really rankles. Some parents  worked hard all their lives and never made enough money to pay for expensive things like nursing home care. I can’t justify any court making their kids pay.
A quarter of adult children, mostly baby boomers are already providing personal care or financial assistance to aging parents, according the the Met Life Mature Market 2011 study of the Caregiving Costs to Working Caregivers. These boomers are already out nearly $3 trillion in lost wages, pension, and Social Security benefits for themselves. Now some states want to saddle these same adult children with the nursing home bill too??
The pressure is on in all states to deal with the explosive costs of  Medicaid programs. States are not in trouble because of unnecessary spending for indigent sick folks.  They are in trouble because people are living longer, and having more health care needs as a result of longevity. Our aging persons who are in nursing homes for any length of time typically can’t pay the cost of being there.  The solution is not to force the high cost of care onto their children.  Historically, taxpayers have borne the burden of helping our indigent pay for care.  I can’t see any other choice, unless you think it’s okay to throw the sick and needy out into the streets.
Yes, it takes taxpayer money to fund Medicaid and cover Mr. Pittas’ mother’s nursing home stay.  So be it.  She was living on an income of $1000 a month.

What are the takeaways here?
First, if your parent is low income, see an elder law attorney who has expertise in Medicaid in your parents’ state and get the application going now if they qualify.  If assets need to be transferred to avoid losing a home, you need to do this years before your parent needs Medicaid.
Next, if there was ever an argument for buying long term care insurance, a state’s filial responsibility law is it.  If your parents are young enough and healthy enough to be insurable, get them to buy it or buy it for them.  If you just want to “think about it”, they may become unmeasurable while you drag your feet.
If you aren’t sure about what your responsibility is or may be for your aging parents, get competent advice before any more time passes.  We offer coaching programs to get  you through your aging parent transitions.  Learn about how the law, your parents’ health needs and your own emotional health can be managed to avoid costly mistakes.
Until next time,
Carolyn Rosenblatt & Dr. Mikol Davis
AgingParents.com

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Critical Tips About How To Protect Your Aging Mom

Carolyn and Mikol here.

We hope all of you are well and that the Moms out there will enjoy your special day.  Happy Mother’s Day to each of you!

As for our aging moms, here’s a reminder about a persistent and growing $2.9 billion a year problem.

Our aging loved ones are targets.  The thieves are extremely good at stealing.  They see our parents are an easy mark,  If you will be visiting or calling your mom on this Mother’s Day, think about these things and keep Mom close to your heart.  Aging moms and dads too need our vigilant protection, no matter how independent they seem.
Imagine this:

Two ruthless swindlers were arrested in New York for tricking an elderly woman out of her multimillion-dollar property in Harlem she had owned for over 40 years.

A  home care worker bilked a frail elder out of her life’s savings of $350,000.  Grandchildren get loans from grandparents without any intention of repaying them.  Unethical salesmen touting unsuitable annuities seduce unsuspecting elders.  A few scheming realtors take advantage of forgetful seniors.  Even lawyers prey on unsuspecting or impaired elders to rip them off.

Mikol’s mom, Alice, is 89 and still very sharp.  Someone tried to rip her off by sending her a legitimate looking check for $3800, advising that she was the second place winner of a sweepstakes. She does play various sweepstakes.  All she had to do, of course, was to deposit it and “pay the taxes” on her “winnings”.  Of course the check is rubber and the money is gone before the elder finds out that it has bounced.

Classic scam.  Alice called the number and quickly realized that it was a phony outfit.   Not everyone’s aging parent is lucky enough to be so alert to this kind of fraud.

What we know from research into Alzheimer’s Disease is that one’s judgment about financial transactions may be the first thing to become impaired when the disease is in the earliest stages.  “Mild cognitive impairment” as doctors may call it, is not so mild when you think about the financial damage that can result.  And the elder with this early warning sign of dementia may be living independently, paying taxes on time and otherwise appearing socially normal. For a time.

Vulnerable elders are truly sitting ducks, easy prey.  Isolation, confusion, forgetfulness, and fears about running out of money can all drive the susceptibility to entering into a “deal” with a clever scammer.

Here are seven basic things a family can do to reduce the risks of ripoff.  Pick any that apply and please do them!

1.  Check in often. If your aging parent lives alone this is crucial.  One of my clients at AgingParents.com emails her dad every day to check in. Others call every day or close to it.  They may not think they need this but they do.

2.  Ask to be a co-signer on the main bank account in case of emergency.  Some aging parents will agree and some will resist but ask regardless.  It will allow you to do online monitoring of the account activity.  A “new friend” who gets money from them is a huge red flag.

3.  Have your parent sign a Durable Power of Attorney appointing a competent and ethical agent, which could be you, a sibling or trusted other.  If cognitive decline happens, the agent can at least get the money out of the account and put into another safer one that the impaired elder can’t access. This is one way to stop the thieves who are looking for impaired elders.  Nothing in the account, no gain for them.

4.  Suggest having your parent use a licensed fiduciary to handle money if they don’t want you to do it.    If there are issues of not trusting you, an objective professional can protect them from abuse. You might do research to find a reputable one for them.

5.  Provide and encourage parents’ connection to others. Think of isolation and loneliness as two big factors in why elders get financially abused.  If you can provide encouragement for them to get involved in activities, it will make them less likely to want to talk to a smooth, slick “friendly” con artist on the phone.

6.  Monitor everyone who comes into your parents’ home regularly.  Even the most trusted housekeeper, gardener, caregiver or bookkeeper can be tempted beyond reason when their own financial circumstances change for the worse.  Your parents are all the more at risk when they trust the familiar person, who can use trust to exploit unsuspecting parents.

7.   Do background checks on any home care helpers who are hired to work for Mom or Dad.  The cost is modest, and you can find out a lot:  bankruptcies, poor driving records, and of course, criminal convictions and civil cases.

We urge everyone to think about the risks to our aging parents.  Your parent may seem fine, but be susceptible to poor money judgment.  If the question of whether your elder is safe with money is on your mind, call us for a consultation.  Our expertise will help you manage whatever is ahead of you.

If the decision-making is making you crazy and you don’t know where to turn, consider getting a free complimentary strategy session at AgingParents.com.  It’s a start.

Meanwhile, we both send you our best.

Until next time,
Carolyn Rosenblatt and Mikol Davis,
Aging Parents.com