Assisted Living and DNR (Do Not Resuscitate)

Posted by fatherscaregiver @fatherscaregiver, Jan 27, 2021

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?

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@windyshores

In our state, we have a MOLST form that tells providers whether my mother, who is in assisted living, wants resuscitation, artificial nutrition, artificial ventilation or even transport to hospital. (I may be missing something else on the form, that is what I remember.) It is bright pink and is posted in her room and a copy is on her desk. She has dementia so I have an invoked proxy and make decisions for her.

She was briefly on hospice and they recommended having the maximum limits on what anyone could to to prolong her life. Because I could then reduce those limitations, but it would be harder to add them in and, for instance, ventilator could be initiated before I could stop it. With the MOLST, the facility always has to call me when they want to send her to the hospital. I have stopped at least two ambulance trips in the last year, one for nosebleed and one for vomiting. But I okayed a trip for inability to breathe due to severe anemia, for which she had infusions. This year, I am not going to do that either.

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@windyshores You brought up a very important point. That is, the conditions of a MOLST or POLST can be changed/modified. Thank you.
Ginger

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@gingerw

@windyshores You brought up a very important point. That is, the conditions of a MOLST or POLST can be changed/modified. Thank you.
Ginger

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This came up just now with a new palliative care nurse. She asked about the MOLST and the no transport to hospital part, which was put on when my mother was on hospice. In the end she agreed it was a good idea to keep that limitation because to override it they have to call me. In other words, the assisted living cannot send her to hospital without my permission. I do have an invoked proxy, which is a factor- otherwise my mother herself could override it.

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