Many in Aged Care Allowed to Die Peacefully without CPR

[grandmoon]

Most nursing home managers and staff do not support giving cardio-pulmonary resuscitation to elderly residents who suffer heart attacks, and the technique has been found to be ineffective in reviving most.

While the policy of most nursing homes is to administer CPR, a survey of managers of the homes by Dr Bill Silvester, who heads the Respecting Patient Choices program based at the Austin Hospital, found fewer than one in five thought heart attack patients should be revived.

The reality was that in three-quarters of the homes no CPR was used in the past year, and in the few where it was, it was used only once, Dr Silvester said. ''It would appear that frequently residents were found deceased or were known to be dying and were allowed to die peacefully"

The results of the study prompted calls for new national guidelines on when CPR should be used.

Dr Silvester said in his analysis of the study findings: ''We would also recommend that guidance be provided on when and how to discuss this with residents and their families. NSW Health state that it is reasonable to withhold

CPR without explicit discussion with the patient or family if a) the resident or family do not wish to discuss it, b) the resident is aware that they are dying and has expressed a desire for comfort care or c) the facility does not provide CPR as a matter of course, consistent with the values and practices relevant to its population.''

Of more than 400 managers surveyed, fewer than 20 per cent thought CPR should be used in cases of ''witnessed cardiac arrest'', despite four out of five homes surveyed having a policy of providing CPR if the need arose.

''This revealed a significant difference between what the staff thought would be appropriate for their residents and what they were expected to do,'' Dr Silvester wrote in the report.

He cited international studies showing that on average fewer than 1 per cent of residents who had heart attacks and were given CPR survived and returned to the aged-care ho me.

He said the use of CPR on aged-care patients appeared to be driven by an expectation of what medical staff needed to do, rather than its effectiveness. ''The reason we did this study was we were appalled at the number of elderly people being resuscitated in aged-care homes and being brought into hospital and ending up in the intensive care unit.

''So we asked the ambulance people why this was, and they said they had no choice. And then we asked the nursing homes and they said it was because of expectation.''

The findings come on the eve of a conference in Melbourne on planning end-of-life medical care.

Read more: http://www.theage.com.au/national/many-in-aged-care-allowed-to-die-peacefully-without-cpr-study-sugg...

[cherry*135]

I guess they do initially bright. They may be able to request to transfer somewhere else, if they aren't happy in the first home they are placed in. (if they have the mental capacity to make requests/decisions like that).

[azureline**]

Nursing homes usually have respite beds available that can be used until a place is found, or if they know a vacancy is coming up. Also, the hospital will keep them until a bed is available.

[i-once-was-bump]

Just wondering -  what happens to people who suddenly need a nursing home but 

have no-one close to find one for them.  Do they have to go where they are put?

In NSW you have to go where ever there is a bed but usually they don't need a bed suddenly.

It is something that happens over a few weeks or more as the person is usually in hospital and then off to rehab to assess them for returning home or being placed somewhere.

My father didn't go to rehab because it was decided he couldn't remember anything 2 minutes after he was told so there was no point trying to get him back walking etc.

He was put at the top of the list by ACAT so that he went into respite but into the home we wanted him in and then he had 9 weeks respite approved and then he was "forgotten" for about 2 weeks and finally a permanent room became available.

(I should mention that he was in a private room but it was suggested that, as he was high care, he might be better off sharing a room with another high care man that way he would have lots of comings and goings from the room everyday and it made a big difference to his happiness once he was in a shared room because there was so much to see and do.)

[polksaladallie]

Just wondering -  what happens to people who suddenly need a nursing home but 

have no-one close to find one for them.  Do they have to go where they are put?

Bright, if someone has no relative or friend they have appointed as Power of Attorney, they will be in the hands of the Adult Guardian.  The Adult Guardian contols the finances of the person, where they will live, and many other aspects of life.   While I do not know a lot about them, I have heard some awful stories- where relatives of a person in a nursing home are unable to change nursing homes because the person is under the control of the Adult Guarduian, where relatives want some money released to buy toiletries etc and they have been refused.

There was a story on a current affair programme a few months ago where a woman was being ill-treated in a nursing home, and when her son found out (don't remember why he had not been involved) and she was under the control of the A G and he was not allowed to move her out of that home.  I think he begged them for months to move her.  In the end, he kidnapped her.  He had been a detective and knew how to do it.  Then he fought the court to prove that he had done the right thing by her and now cares for her at home full time. 

I would advise you to get as much information now as you can about everything.  Is there someone who you could appoint as your Power of Attorney?  Everybody should have that in place anyway.

To answer your question, if you are in hospital and need to go to a nursing home and have no-one to help you, you will be put in the hands of the Adult Guardian, then you will have no say about anything.

[polksaladallie]

I would advise you to get as much information now as you can about everything.  Is there someone who you could appoint as your Power of Attorney?  Everybody should have that in place anyway.

Make that Enduring Power of Attorney

[azureline**]

We have  power of attorney and Enduring guardianship.

[polksaladallie]

We have  power of attorney and Enduring guardianship.

Is that for someone else?

EPA is for yourself, which everyone should have.

[azureline**]

for dad

[azureline**]

More bad news today, 3 places I have booked "tours" have advised me that their high care places have a $200,000 bond. To be eligible for this, he has to actually have $243,000.

[grandmoon]

$200,000 is cheap we had to pay $375,000 for Mum when she moved from the low care to the high care.   We had to sell her house to get the money.