By now you know the story—or at least think you do: A nursing home nurse sees an 87-year-old resident in cardiac arrest and calls 9-11. Despite desperate pleas of the call center operator, the nurse refuses to do CPR and the resident dies.
Except most of the story isn’t true. Lorraine Bayless lived at a Bakersfield (CA) continuing care community called Glenwood Gardens, but in independent living, not in its skilled nursing facility. She did not die of a heart attack but of a stroke, according to the death certificate signed by her personal physician. CPR may have saved her, but it is very unlikely.
And there is more. Mrs. Bayless did not want life-prolonging medical interventions, and her family is fully satisfied with the care she received. And the staffer who called 9-11 may not have been a licensed nurse at all. One piece of the story is true: Glenwood Garden staffers are prohibited from performing CPR or other medical interventions and are instructed to call 9-11 in the event of emergencies.
Still, even the real story raises some important questions. If you or a loved one live in residential care, here are five lessons to learn from this episode:
What level of care can you expect? Independent living communities are not nursing homes or assisted living facilities. You should not expect them to provide medical care or even personal assistance. You have an apartment and perhaps access to a dining room and some social activities. Emergency response is probably limited to a pull cord in your unit. That’s about it. If you need additional assistance, you’re responsible for hiring your own aide. CCRC’s are more complicated since they may have a licensed nursing facility on site. Still, if you are living in an independent unit, don’t expect skilled nursing care.
Is staff trained and permitted to perform emergency care? Does the facility have at least one staffer trained in CPR and first aid on duty at all times? She doesn’t need to be a licensed nurse. And what is the staff allowed to do—bandage a cut, put ice on a bruise, CPR, or nothing? One CCRC director told me her staffers are trained in first aid but her facility’s lawyers urged her to instruct employees to always call 9-11.
What emergency care do you want? This may be the most important question of all. Mrs. Bayless’ family says she did not want life-prolonging emergency care. It is not clear whether she had a living will or do not resuscitate order, or had designated a family member as her healthcare proxy. But if you are old enough to be reading this, you should discuss end-of-life issues with family members and prepare your own advanced directives. Right now.
Is the facility aware of your wishes? It does you no good to prepare these legal documents if you don’t share them with the care facility, your physicians, your local hospital, and your family. You should distribute advanced directives as widely as necessary. Remember, people cannot follow your wishes if they don’t know what they are. The best outcome for Mrs. Bayless may have been for the staffer to not call 9-11 at all but rather to hold her in her arms until she passed away. But she had to know that.
Finally, lesson No. 5: Don’t believe all the news you read on the Web.
I was so tired of hearing “OMG”, “NO HEART”, “I’D MOVE MY LOVED ONE” – everybody blasting this poor nurse. To call or not to call? That is the question. I am licensed to care for 2 residents in my home and 90% in the past 14 years have come with DNR in hand. When that time truly comes, it is the hardest thing for a caregiver to abide by! If I have home health and not yet hospice, they cannot come to my home because they are obligated to call 911 and Ems is obligated to transport – even if I have the DNR papers and IT IS DOCUMENTED that the resident wants to be allowed to pass away in their bed with loved ones about, dignity and respect and myself making them as comfortable as possible!
Why is an elderly or any person who makes these well informed choices for their own end of life issues not allowed to have them fulfilled without all the drama? No one can speak for what might have been or the quality of life this lady may have had after a trip to the hospital. Only GOD knows the plan. Everyone should be happy that GOD took her as fast as he did and did not make her linger! We do not know what medical, psychological or any of this poor womans issues but NO HEROICS means no herioc measures. In 1978, when I became a nurse, one of my first patient was and elderly gentleman, a DNR, unresponsive and no family visited. GOD bless him for teaching me to talk to the unresponsive, take time during my shift to do comfort measures, tell them it is OK to go, pray for them and hold a hand when the respirations no longer meet the bodys need.
In my heart I know he would have loved to be at home with family, pets, familiar smells and noises but I did the best I could in a hospital setting! Accepting death is just not something an entire generation seems to have even thought about unless they are in the medical profession. My and my cousins (both of us nurses)families had to witness my grandfather being “coded” to finally appreciate what we were trying to tell them about letting him go!
Very well done, Howard. I was fuming with all of the news reports which I knew to be incorrect. When instances like this occur, the media always combines all types of senior living and generally identifies any as “nursing home,” totally overlooking the varying laws, regulations, and oversight pertaining to each type of senior living setting.
Letting our frail elders go in peace has so many barriers–thanks for getting to the bottom of the story and its deeper meaning
Thank you for the truth. We are senior move managers in Canada and most residences ask seniors whether they want to be recesitated. Usually if they are sent to the hospital the staff has to do everything they can to keep the person alive.