Assisted Living and DNR (Do Not Resuscitate)

Posted by fatherscaregiver @fatherscaregiver, Jan 27 2:04pm

Hi! My dad moved into an assisted living facility about six months ago. At the time of admission they asked if he had a DNR. He asked to be a full code and worked. He is fully aware of his medical conditions and fully understands his choice between being a full code or a DNR. I respect his decision as it is his life and he is fully capable of making the decision. He does have medical problems, he has had a heart transplant and now has Parkinson’s. He moved into the assisted living for safety reasons. He had several falls leading up to the move. One of the nurses on staff called me today about a minor issue, no big deal. They call about everything! I do understand they need to keep the family informed. However after calling me about his hemorrhoids (they call about everything) she told me I should consider changing his advance directives to a DNR. I was a little taken back by this for a couple of reasons. I feel like this might be overstepping on her part? Is she somebody that should be saying this to me? Should this be coming from somebody in administration, social worker, nursing director? The other thing is my dad is of sound mind, involved in his health care and he wants be a full code. So, I go back to why is she asking me to change his directive to a DNR? I should add I don’t necessarily disagree, if I was my dad I would be a DNR, but that is not what he wants. Looking for what others might think, am I just being overly sensitive?

I'll weigh in here, as we had this issue with my mother-in-law many years ago. She too entered the nursing home voluntarily while battling glioblastoma, but was totally aware of her situation. She wanted to be full code, and signed papers to that effect. I was handling her finances, but was not her medical power of attorney, and a finance person asked me the same. Needless to say, I was appalled. I reported the situation to the facility administrator, who reprimanded her and apologized to me. 10 years ago, my daughter was the RN Case Manager in the assisted living facility where my mother resided. Their policy was to address this matter only during a case conference with the resident and their legally named representatives. And management and administration were the only ones authorized to do it. In your situation, knowing your Dad's wishes as you do, I would report the matter to the Administrator or Director of the facility.
Sue

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@sueinmn

I'll weigh in here, as we had this issue with my mother-in-law many years ago. She too entered the nursing home voluntarily while battling glioblastoma, but was totally aware of her situation. She wanted to be full code, and signed papers to that effect. I was handling her finances, but was not her medical power of attorney, and a finance person asked me the same. Needless to say, I was appalled. I reported the situation to the facility administrator, who reprimanded her and apologized to me. 10 years ago, my daughter was the RN Case Manager in the assisted living facility where my mother resided. Their policy was to address this matter only during a case conference with the resident and their legally named representatives. And management and administration were the only ones authorized to do it. In your situation, knowing your Dad's wishes as you do, I would report the matter to the Administrator or Director of the facility.
Sue

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@sueinmn, Thank you! I didn't want to say anything if it was just me overreacting. I really needed confirmation that she had over stepped her bounds before bringing it to the attention of the Administrator.

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@fatherscaregiver

@sueinmn, Thank you! I didn't want to say anything if it was just me overreacting. I really needed confirmation that she had over stepped her bounds before bringing it to the attention of the Administrator.

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If you follow any of the Discussions where I am active, you will see me say, over and over again, that we must be our own best advocates. That applies when we are caring for and/or assisting loved ones as well. I wish you good luck in your discussion, let us know how it goes!
Sue

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@fatherscaregiver– Good morning. I'm wondering if you asked his nurse why she suggested this?

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@sueinmn, I agree completely. I learned years ago I had to advocate for my dad especially when he was not able to speak up. His transplant team knows me well (good, bad and ugly!) They know if I think there is an issue I will not stop until I get resolutions.

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@merpreb, She stated with his medical conditions she felt it would be best if I changed him to DNR. I was really shocked when she said it, as it wasn't a conversation I expected to be having with her and certainly not at that moment. I just said he wants to be a full code. It was after I was off the phone with her I really started to think about why she was giving me her opinion on my dad's decision and if it was appropriate for her to say it.

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@fatherscaregiver

@merpreb, She stated with his medical conditions she felt it would be best if I changed him to DNR. I was really shocked when she said it, as it wasn't a conversation I expected to be having with her and certainly not at that moment. I just said he wants to be a full code. It was after I was off the phone with her I really started to think about why she was giving me her opinion on my dad's decision and if it was appropriate for her to say it.

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@fatherscaregiver– Unless she has the authority to make such opinions to you she was not being appropriate. I agree. I was just asking if she was specific. You are right, and since your dad has made his decision and signed the paperwork unless his physical situation has deteriorated such that his doctor recommends it and you have talked with your dad things have to stay the same. I also think that you do need to talk to the administrator. She might be doing this with all her patients.

Good for you! Also, since your dad knows his physical conditions shouldn't that decision have been discussed already? He has only been there for 6 months, right?

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@fatherscaregiver

@sueinmn, Thank you! I didn't want to say anything if it was just me overreacting. I really needed confirmation that she had over stepped her bounds before bringing it to the attention of the Administrator.

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Run, do not walk to the head administrator and tell them they have a dumb, stupid uncaring nurse that needs to be removed from caring for your dad.
She over stepped her boundaries.
Can you put him into another facility?

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@sueinmn

If you follow any of the Discussions where I am active, you will see me say, over and over again, that we must be our own best advocates. That applies when we are caring for and/or assisting loved ones as well. I wish you good luck in your discussion, let us know how it goes!
Sue

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Hello Sue,
I think you and I have a mouth, and know how to use it.
I’ve had to speak up multiple times in medical settings, even to doctors who have no common sense.

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@funcountess– I have to laugh! I am not shy at all either speaking up to my new PCP or other doctors, technicians, etc. I had to tell my new PCP that I would not contact a doctor that he recommended for a minor thing. His eyebrows went over his forehead. He's been in practice less time than I have had cancer.

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Moving him to another facility really isn't an option. The place he is at is a really good facility and everybody up till now have been great. I am hoping this was a one time lapse of judgement. I have sent an email to the director this morning asking to have a conversation about this. Will see how he responds, I always try to start off nicely. 🙂

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@merpreb

@funcountess– I have to laugh! I am not shy at all either speaking up to my new PCP or other doctors, technicians, etc. I had to tell my new PCP that I would not contact a doctor that he recommended for a minor thing. His eyebrows went over his forehead. He's been in practice less time than I have had cancer.

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O K Merry, I’ll add you to the list of people who will speak up to medical personnel, or to whoever.
Sue came to mind because she posts a lot, and appears to always have a good answer.
I was a rather shy kid growing up, but quickly realized it got me nowhere.
Stay well

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