Assisted Living and DNR (Do Not Resuscitate)

@merpreb I did speak with the social worker and nursing administrator early this week. They did explain the nurses know the residents the best, (in the facility) but also agreed that when calling about a hemorrhoid issue it would be an inappropriate time to bring up DNR status. They did say the nurses will go to them (social worker and administrator) if they feel there is a need and then a care conference will be scheduled to discuss it. They are going to address this with all nurses about when and how DNR status changes are addressed with the family to prevent this from happening again. I am hoping it was a lapse in judgement and will try to give the benefit of doubt but will also keep an eye on it best I can. I do understand that with the ongoing Covid pandemic procedures and normal meetings have not been occurring as they usually would. They were very apologetic and understood my concern.

@fatherscaregiver Anytime you feel a care conference is needed you can insist on one. With the pandemic it can be via Zoom, FaceTime, Skype.. There is Google app I cannot remember the name of. .... But sometimes talking face-to-face even through video conference is a big help. All those can be used to talk with your father if visitation is not possible. I called my mom everyday, but only face-timed a couple of times a month.. only one lady had an Iphone. I had to complain because no one would answer any of the three numbers I dialed.. one was my mom's phone.. they kept it out of her reach most of the time. She could not work a cell phone, but through Verizon we set up a phone that is a cell phone, but works like a regular house phone.. like she was used to. My brother could not get them to answer either. If I used my husband's phone to call they would answer. I think something to do with caller ID.. I think they thought I called too much. Mom got to where she could not dial.. even speed dial because she had more mini strokes and a mild stroke.

I thought Zoom would be hard to do with a lawyer.. signing papers to sell land.. but his assistant called a few days before and helped me with the app. I'm 69 1/2 with brain fog half the time and probably would be called a Luddite by the younger generation. I prefer old-fashion face-to-face or a regular old phone. Technology overwhelms my mind sometimes.

ZeeGee

@fourof5zs, Nice to meet you fellow Luddite. I believe that makes three of us. I surely understand brain fog. Maybe a lot of us have this now. I avoid technology as much as possible. My little grey cells are in need of updating! Best wishes, @joybringer1

Hello, fatherscaregiver and all. What a great discussion pertinent to so many of us. I come into this from 2 very different life experiences and viewpoints.

First, I was my precious mother's caregiver for 12+ years during her long, difficult journey through Altzheimers. I was with her every day, as I moved into a condo in the same area......as a normal daughter, we decided it best for me to live near-by, 2 streets apart....within easy walking distance. Perfect set-up for us at the time. As she progressed through this illness, she lived w/me for a few months until I moved her into assisted living so she could live independently but overseen by caring professionals. I was a small business owner at the time and this was our best determination.

I took care of her laundry at first

Well, friends......I just spent 15 minutes finishing the above note and lost it. Guess I may need to rest from the stress of the last several days, but have to go to Mayo for the rest of the day.
Just know, you are so important in your father's care, his life. I was a 12+ year caregiver. It is a lovely honor and an opportunity you'll cherish forever. Sit with your father, chat about things and family and history and his life and look at pics...identify folks...he may be the last in the family with the knowledge of these people and things. Learn everything you can from him. He's lived a long life and knows so much that may help you. Certainly adds interest to your life and understanding of family members....

Any children around? Be sure they have the chance to visit and get to learn from him....after covid, meet and enjoy his new friends....share. Have meals with him and his friends. Don't lose this precious time!

I was for 15+ years in retirement community administration, several years as an administrator. From behind the desk, it's important to meet and get to know the families of the residents. If you have an issue with something or someone, stop by and share, briefly, the circumstances so he/she will be in the know and can resolve the issue. Remember, too, these facilities are licensed be the state. They have large, thick books full of rules and regs from the state they must follow. They have regular inspections to ck they are indeed following precisely. So, you are helping him have a better community. By helping each other, all win.

Be sure to stick your head in the door and let the secretary know about something good that happened. That's a good thing.

Well, those are some thoughts that i hope help a bit. As we say in the lovely south, "Ya'll take care, now!"

I'm off to Mayo. It a lovely 64 degrees, clear and sunny, after several days of cool rain - in the 50's. Twill be good to get out, drive 15 miles and enjoy the day. Today are tests and a doc appt. Tomorrow is an endoscopy...Barrett's Syndrome, hernia, reflux, nodul????, who knows what else...at least I'll get a good little rest tomorrow! Then, on to fix anything fixable, spend the next week finishing the yucky stuff and hope for a time of rest. Get back to the heated pool and walking....get my new mattress the 16th! From Macy's...goodie! Great mattress clearance and close-out! Tell you more after a few nights sleep!

Blessings, all. elizabeth

@fatherscaregiver, As the primary caregiver for my mom and sister for years, I used to laugh that I was the CEO, CFO and first line supervisor for a non-profit group of extended family. My mom and sister both had strong desires for "quality of life" vs "quantity of life". I had medical power of atty for both and made certain that all medical providers had copies of their DNR's. Many a time over the years, I had to intervene to assure they were receiving the best care possible.

Although mine was the reverse desire of your dad's desire for full code, I so agree with what @sueinmn responded. The nurse was totally out of line in her call and recommendation to you. I wouldn't blink before calling and reporting her to the administrator.

Thank goodness, your dad has you to stand up for him! It took far longer for me to learn to advocate for myself in questioning docs or treatments but whether for the ones in our care or for ourselves, we have every right to push for best care practices.

I'd like to take this very valuable discussion in a slightly different direction. When do you review an aging loved one's or you own DNR orders? There's never an optimal time, but when is a good time to talk about the best of endings?

Do Not Resuscitate makes me realize, once again, that words really matter. For many people, the thought of not being resuscitated is unthinkable. Often people equate it with doing everything or doing nothing. But so much more has to be considered. Resuscitation can be a very invasive and rough intervention that may also include broken ribs, intubation and other interventions with additional repercussions. Thus for my father when he had late stage colorectal cancer with only months to live, a DNR was - for him and our family - the right choice.

For my mom, it's not right - yet. She's 81 and in great health. We've talked about the end and her wishes, but we haven't made a clear decision about DNR because there are still so many variables. I do, however, know which consequences she does not want to have to live with as a result of resuscitation. That will hopefully make choices easier if (when?) I may be forced to make them. It's a conversation we revisit every December and I learn a bit more about her every time. You may find this odd, but it has brought us closer together and it's a conversation I look forward to because we talk about the things we cherish about living.

What discussions do you have (or not) with family members?

My wife and I had such conversations and chose place such orders available for our children to make. These have become part of our living trust. We thought it prudent to look ahead and asked "what if" questions which led us to make our decisions regarding DNR.
Additionally, we discussed this with our adult children and continue with an annual review. Not only do we want quality of life but we want to assist in making of hard choices now when we can do so. Once when we are irreversibly unable to chose, we don't want to place such a heavy, very difficult burden on others.
We are very glad someone mentioned the subject of DNR orders. It allowed us to think, to counsel, and to discuss this decision point before a decision had to be faced.

Such good points @victorkach. While one can't possibly foresee all the "what ifs," talking about preferences and what you and you wife value and what quality of life means for you, will help future decision making. It helps ease burdens and possible difficult choices in the future. Do your adult children find these discussions difficult to have?

@colleenyoung A sensitive subject, at best. End-of-life issues are not a favorite subject for many people. It means a hard look at our own mortality, and those of loved ones.

When I was working in my last career, management asked everyone to fill out emergency information to "have on hand" not in the Human Resources Department. Not only were they upset that my emergency contact was my sister, in another state ["We need someone local." "I am single, and she is the contact I have."], but I included DNR orders, which they said they could not /would not follow if I was to collapse at work.

For my mother, my dad put in place to "keep her comfortable only" as her body shut down after a long journey with Alzheimers and dementia. For my dad, he chose DNR, but that was never called into play, as he passed from the effects of COPD at age 96.

Almost 10 years ago I put together my medical directives and filled out a POLST form [Physician's Orders for Life Sustaining Treatment]. All costs for handling my death were paid for. I also filled out a 5 Wishes document https://fivewishes.org/ My husband and the person he chose as a partner in the medical directive, know I have a DNR in place, a POLST completed, and 5 Wishes done. I know my husband's wishes and have asked him to document it all, so there will be no stressful situations with his family. We have spoken about timelines, and of course have no clue what our respective expiration dates are! For me, it is important that what I desire is followed through, even if I won't be able to change anyone's mind.

I consider it to be my personal responsibility to have things documented for me, as I have seen how families can be torn apart by differing thought processes. My sister knows my thoughts, but other family members rally to another approach to it all. I use a MedicAlert bracelet, and the information there indicates DNR, also.
Ginger