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Hello again,
Carolyn and Mikol here.
As a nurse and attorney, I can tell you I really had a problem reading about a nurse who refused to give CPR to a 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.
assisted livingThe 87 year old woman who collapsed at Glenwood Gardens was Lorraine Bayliss.  The nurse there 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?  She was not working as a nurse, but as a resident services director.  OK, but shouldn’t she deal with an emergency, even if it’s not her job?
A nurse who is on scene should be able to do what any trained lay person can do:  administer CPR when someone stops breathing.  If there is an Do Not Resuscitate order then no one should resuscitate the elder. The nurse should then see that no one calls 911 and the person’s wishes should be honored.
In this case, no Do Not Resuscitate (DNR) direction was in place.  Ms. Bayliss’s family believed that she wanted “to die naturally and without any kind of life prolonging intervention”.  Glenwood 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 who must decide.  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 everyone, including assisted living.
Either you want emergency intervention or you don’t. If you are 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 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.  It is not always so straightforward as stopping breathing, or a sudden event.
Perhaps Lorraine Bayless  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. They also need to  know residents’ wishes.  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.
If your loved one is facing terminal illness or a fragile medical condition and you haven’t figured out what your loved one wants at the end of life or in an emergency, now is the time to talk about it.  If this is uncomfortable to the point you’re not doing it, let us help you.  Get a free 15 minute consultation on practical expert tips to get the conversation going.Dr Mikol Davis & Carolyn Rosenblatt         CLICK HERE for your consultation request form.
Until next time,
Carolyn Rosenblatt

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