Health Care Thoughts: The CPR Kerfluffle
by Tom aka Rusty Rustbelt
Health Care Thoughts: The CPR Kerfluffle
According to numerous media reports:
On February 26th, Lorraine Bayless, an 87 year old resident of the Glendale Gardens independent living facility, collapsed in the dining hall. Someone called 911, and eventually a person identifying herself as a “nurse” was on the call (whether she was working as a “nurse” appears to be in doubt).
The 911 operator pleaded, implored and demanded someone do something, and the “nurse” replied that facility policy prevented any such actions. The “nurse” refused to hand off the phone or to get anyone else involved. Ms. Bayless died. Someone notified the media (911 calls are public record in many states). Ka-boom!!! This became a media feeding frenzy. The stuff has hit the fan.
The initial media reports, both broadcast and written, were inconsistent on the facts. Recent reports (several dozen) seem to be more consistent, many based on AP reporting.
This has become a debate about possible legal duties, ethical duties, the duties of licensed health personnel in a non-medical setting, the need for advanced directives and consumer advocate criticism. Ms. Bayless’ family has issued a statement to the effect she would not have wanted life prolonging intervention and the family is not upset or litigious.
So have we learned anything here?
1) Most of us should have advanced directives and make copies of those directives available to anyone who might in anyway be responsible for our health and safety.
2) Anyone living in any sort of elder care facility should verify the presence or lack of medical services, both routine and trauma.
I’d be reluctant to administer CPR absent a state/local law exempting me from liability should the individual die or suffer injury during CPR. FYI. NancyO
Most (all?) states have a “Good Samaritan” law or the equivalent to protect non-licensed persons and also licensed personnel outside a work environment (road side at an auto accident).
Licensed personnel in their work environment are always targets for litigation.
Good, common sense lessons. Ultimately, we are responsible for our own healthcare. That includes directives of how we want to be treated.
many years ago i provided a technical service for some people whose business model was “lie to the people and take their money.”
when the supply of marks began to run low they started talking about their next “opportunity.”
they decided that “rest homes for the elderly” would be a good bet.
now i wonder, if those elderly pay in advance for “lifetime care”, does the rest home stand to make a profit if they die sooner than later?
If memory serves, the success rate for CPR is low. At 87 I expect it to be near zero. Also you are not doing it right if you don’t crack the sternum.
We we did search and rescue and I never wanted to be “first responder” as you are the incident commander till relieved and get to make all the first mistakes.
the vast majority of independent living facilities are pay-as-you-go
I helped run some of the crooks out of the business, FWIW.
“Rest homes” was indeed a long time ago.
Oh boy, could I tell you stories dealing with 2 demented parents, nursing/ assisted homes. There are two layers of problems:
1) Liability – these places get sued a lot and they go out of their way to limit any potential liability. Frankly I’d waive the right unless it was outright negligence.
2) Crazy State Laws helping home limit their liability – many of which were lobbied for by the home associations
For example, they would not let my mom live with my dad (when he was more competent to aid her) in the lighter care wing. We had to separate them. One to expensive lock down, and the other in the lesser care area. That increased the bill greatly. This was all based on the ability for my mom to evacuate – liability. Georgia, actually just changed their law, because this was forcing people to separate and pushing more folks to medicaid busting their budget. IMO a fire was the least of our worries.
Then there were laws that forced my mom to the hospital anytime she got difficult. Expensive hospital stay, and then we still had to pay the home to reserve the bed. This caused us to shuffle mom around to 4 homes – she is finally settled – because she is so drugged up she can no longer be difficult.
The thing that stunk is there was no other choice as my parents needed 24-7 assistance.
Awful industry, and poorly weighed regulations risk/versus need analysis.
glad to know it’s all cleaned up.
The biggest threat to the facility is not malpratice lawsuits (although it is a problem), it is penalties and sanctions by state and federal surveyors.
I just finished printing an up-to-date set of fed regs, and it runs to 4 3″ ring binders (not really a full set).
The regs on hospital transfers are changing from the feds down, and the family can have some say (the doctor still carries the most weight so have a chat with the doc).
Many states have model forms and fill-in advanced directive forms.
Caveat – when necessary legal advice should always be obtained from a licensed and qualified lawyer.
not sure about this
consult a lawyer
who is an expert in laws
which are also known as government regulations
which may have cleaned up the rest-home industry
which you find too complex and burdensome?
[just to be sure… i also feel that the laws and regulations are too complex and burdensome.
almost as burdensome as the consequences of doing without them.
Not to be picky, but the term “rest home” is way out of date.
I have several hundred health care lawyers in my rolodex, most experts on one form or another of health care regulation.
I am in favor of smart health care regulation, defined as efficient and effective.
just to be picky, i am way out of date too.
Isn’t the appropriate naming assisted living, for those who have a semi independent capability but can’t handle full independent living and/or need closer medical supervision? And then there is the category of nursing home for those who really need full 24/7 care and/or supervision. They are both god awful expensive. The first running around $7,000 to $9,000 monthly depending on how much additional nursing supervision is needed. The nursing home is even more costly and that is the category that is usually paid for by Medicaid once the resident has run out of personal funds.
Assisted living generally looks more pleasant to the observer. I think that is primarily because the clients require less intensive over sight and care. And those clients have much better cognitive awareness. The nursing homes have the people who are not acute so the hospital is not required, but they are often in a mental fog to one degree or another and they may also have some chronic medical dysfunction or impairment.
just in case it provokes thought… i have no idea what the “right” answer it..
i worked in a nursing home (i think it was called) very briefly (in about 1975). it was hell. i would guess that all of the inmates were demented, and those who might not have been when the entered were certainly insane after a few months.
on the other hand some friends i know have kept their elderly parents at home until the end. this seemed far more humane to the old person, and perhaps not quite so hard on the children as you might suppose.
i hope to avoid both situations but i suppose i won’t know what i’ll think until i get there.
i don’t know if a society can develop a religious expectation (i don’t know what else to call it) that accepts some end to life that does involve prolonging the dying process beyond reason.
i don’t even like the use of the word reason in that context. and i didn’t even mention money.
Depending on the state there are ILFs, ALFs, NFs and skilled nursing facilities (SNFs).
The difference between ILF and the assisted living facility is very small, often depends on whether there is nurse monitoring resident condition. In some ALFs nurses “pass” medications.
Assisted living patients have more of an apartment-style quarters and are presumed to be somewhat independent and at least somewhat ambulatory.
A modern SNF is a whole lot different than what you say in 1975.
Having said that, no one wants to be in a nursing home, but some people simply cannot be cared for at home and are not ready to die.
SNFs also have rehab units (my mother did a post-operative hip surgery stay last year) which are much cheerier.
I hope to die at home in my own bed, or better yet drown at age 85 while canoeing some white water.
I probably won’t get to choose.