Mar 8, 2013

911 call should prompt Florida seniors to consider two important issues

The February 26 death of 87-year-old Lorraine Bayless is fueling a heated public discussion that this Florida elder law attorney believes is long overdue.

If you are not familiar with the news story, here's the short version: Bayless lived at an independent senior residence in Bakersfield, California. When she collapsed in the dining room last week, the staff person in charge called 911. The employee identified herself as a nurse but apparently, was not actually serving in that capacity at that moment. When the 911 dispatcher asked her to perform CPR, or to find someone who could, she refused, saying that would be against facility policy. By the time the EMTs arrived, Bayless was not breathing. She died at the hospital soon after. Whether she would have survived and in what condition had CPR been promptly administered are questions that remain unanswered. (To read a partial transcript of that call, click here.)

The facility's parent company confirmed that the employee was following policy, but at the same time said she misunderstood the policy. Bakersfield, California authorities conducted an investigation and just yesterday announced there are no grounds for criminal charges. Professionals in the long-term care community have expressed both outrage and support for the facility's action, or should I say, lack of action.

And Bayless' family? It supports the facility's actions, stating, "It was our beloved mother and grandmother's wish to die naturally and without any kind of life prolonging intervention...We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace." It is unclear whether Bayless had a Do Not Resuscitate Order, and if so, if it was on file with the facility or anywhere else.

This unfortunate event gives rise to two important points every Florida senior and family should consider:

Think about whether you want a Do Not Resuscitate Order: 

A Do Not Resuscitate Order, referred to as a DNR or DNRO, is available through physicians and medical facilities. It must be signed by the physician, and also by the patient or his/her health care agent or health care surrogate. The DNRO requests that CPR be withheld if the person experiences respiratory or cardiac failure. It should be readily available to Emergency Medical Technicians; without seeing it, paramedics are required to administer CPR.

Many Florida seniors incorrectly believe that a Do Not Resuscitate Order applies only to a person who is in a terminal or vegetative state only. Florida law has changed and that is no longer the case.  For example, one of my clients, in her 80s and healthy, insists on having one. She plays tennis three times a week - her only concession to aging is that she now plays doubles - and if she can help it, doesn't want those tennis games replaced with doctor's visits. She unabashedly tells me her desire is to pass away on the tennis court, and hopes her DNRO will keep the paramedics at bay. And she's not alone: see my prior blog post about the "Grandmother with the DNRO tattoo."

The choice of whether to have a DNRO is one only you can make. We do not know if Mrs. Bayless had a DNRO. But if you or your loved one choose to have one, it should be kept on file with your physician and kept handy for the paramedics to see. 

Read the fine print before you move into a senior facility:

You should be aware of the differences between "independent living" and "assisted living." Independent living facilities do NOT provide medical care to residents, and are NOT regulated by the State of Florida as assisted living facilities are. The Bayless family apparently grasped this distinction, but for the general public, the line between the two types of living arrangements tends to be fuzzy, for several reasons:

First, Continuing Care Retirement Communities often include independent living, assisted living and nursing home care. Thus, seniors who buy into these communities to ensure a lifetime of care may overestimate the kind of care available at the independent residence.

The distinction is further blurred because many independent living residences provide certain safety features, such as emergency pull cords and 24-hour staffing, and amenities like meals.  In fact, the definition of "assisted living" has become so blurry in the public's mind that the Veterans Administration recently had to clarify what constitutes custodial care and medical care for those seeking V.A. pension benefits.  But most independent living facilities are, essentially, apartments designed for older residents, pure and simple. Most are apartments for seniors.

The bottom line is, read the fine print, so you know what kind of care you or your loved one can expect. 

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