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...

[punch*drunk]

I know what you mean by being good at pretending. Although we had all been keeping what we thought was a pretty good watch over dad, we recently realised he was worse then we thought.

He has declined significantly since his brother died suddenly late last year. They were very close and saw each other almost daily.

We thought dad was still eating well and taking all his medications etc, but somehwere in the last 6 months he's slipped to a point that he just fogets to eat. If he doesnt remember to eat, he doesnt remember to take his meds. I often visited around lunchtime and he'd be cooking, but he seems to deteriorate towards the end of the day and he hasnt been eating dinner. He had off/mouldy food in his fridge that had been there for a couple of months and he hadnt even noticed the smell 😐

He now gets meals on wheels and that seems to be working well. He still forgets one of his tablets occasionally, but I've left a note on his table to prompt him (may not work for everyone, but dad loves notes) and the doctor says its not a huge deal if he misses one occasionally.

They've taken his license away, so we dont have to worry about him disappearing or having an accident which is good.

[azureline**]

I know what you mean by being good at pretending. Although we had all been keeping what we thought was a pretty good watch over dad, we recently realised he was worse then we thought.

He has declined significantly since his brother died suddenly late last year. They were very close and saw each other almost daily.

We thought dad was still eating well and taking all his medications etc, but somehwere in the last 6 months he's slipped to a point that he just fogets to eat. If he doesnt remember to eat, he doesnt remember to take his meds. I often visited around lunchtime and he'd be cooking, but he seems to deteriorate towards the end of the day and he hasnt been eating dinner. He had off/mouldy food in his fridge that had been there for a couple of months and he hadnt even noticed the smell 😐

He now gets meals on wheels and that seems to be working well. He still forgets one of his tablets occasionally, but I've left a note on his table to prompt him (may not work for everyone, but dad loves notes) and the doctor says its not a huge deal if he misses one occasionally.

They've taken his license away, so we dont have to worry about him disappearing or having an accident which is good.

yes, all that, dad stopped reading and we later found out he had double vision, no one noticed but I was meals on wheels( to freezer), it is heartbreaking to watch. 😞

[*crikey*mate*]

This thread has me literally crying reading about the hoops and red tape that our elderly (and those who care for them) have to face.

I find it incomprehensible that this is the best that we can do for our elderly and/or sick.

I've always been afraid of getting old and the ailing health, gradual loss of independence and other associated things, but now I'm damn terrified about it and I hope to God that I never have to face it.

[*crikey*mate*]

I meant to add up there that it is so good to see though that there are people who really are putting a lot of effort into finding the best place for the care of their loved ones.

[polksaladallie]

Crikey, only 20% of Australians ever go to a nursing home.  Most die at home or in hospital.  I hope I will be in the 80%.  But we still have to think about it all as we get older.

[*crikey*mate*]

I didn't mean any disrespect polksaladallie...

But sheesh, we can't even adequately cater for 20% of our elderly?

That's even more disheartening.

[*crikey*mate*]

My grandpa died at home. He was being treated for cancer but he got a blood clot in his head and that took him right away.

My Nan died in hospital. She was old and sick (probably smoking related) and was being treated for shingles. She was given morphine, apparently it was too much for her and she died from that. I think it was for the best.

My Gramps died at home sitting in his favourite rocking chair watching TV. His heart just stopped working. Their housekeeper just went into the loungeroom to take him a cup of tea and some supper and he just wasn't with us anymore.

[polksaladallie]

I didn't mean any disrespect polksaladallie...

But sheesh, we can't even adequately cater for 20% of our elderly?

That's even more disheartening.

None taken.  I agree, lots more $ needs to be spent on aged care.  The greedy operators need to be weeded out.

[fishwish24]

http://www.health.gov.au/internet/main/Publishing.nsf/Content/ageing-rescare-sanction.htm

this is the site for Dept of Health and Ageing for sanctions and non-compliance for every ACF in Australia -

you will see a box with links:

Current sanctions

Current non-compliance

Archived etc

you can search by the name of the ACF if you know it

this can be some clue as to which ones are dumps, especially the archived ones - some places come up again and again.

My advice for anyone would be not to rush into it: don't put the person in some smelly dump - it can be cheaper or comparable in cost to pay privately for extra care in their home, until a place comes up at a good nursing home.

and once you have their name on the list, keep on turning up, ringing, asking

and once you have them in a place, VISIT them as often as possible, and make sure they are being well cared for. If you see something that concerns you, WRITE to the manager with your concerns and ask for a meeting to discuss. Remember you're not there to make friends, but to get the best care for that person - walk the line between asserting your/their needs, and antagonizing the staff. 

to whoever said that people dump their parents in nursing homes - yes, some do. But sometimes it's necessary, and it can be as much or even more work to keep the person happy and well-cared for in a nursing home as it was at home - just a different kind of work.

good luck to everyone doing this- perhaps one day it will all be managed humanely, but at the moment it's really a matter of dumb luck and knowing what places to avoid.

[polksaladallie]

.

My advice for anyone would be not to rush into it: don't put the person in some smelly dump - it can be cheaper or comparable in cost to pay privately for extra care in their home, until a place comes up at a good nursing home.

and once you have their name on the list, keep on turning up, ringing, asking

and once you have them in a place, VISIT them as often as possible, and make sure they are being well cared for. If you see something that concerns you, WRITE to the manager with your concerns and ask for a meeting to discuss. Remember you're not there to make friends, but to get the best care for that person - walk the line between asserting your/their needs, and antagonizing the staff. 

to whoever said that people dump their parents in nursing homes - yes, some do. But sometimes it's necessary, and it can be as much or even more work to keep the person happy and well-cared for in a nursing home as it was at home - just a different kind of work.

I'm sorry if you have misunderstood my comments.  I said that Australia has long held the dubious record of children dumping their parents in nursing homes.  If it is necessary as you say, it is not "dumping".  I have worked in a nursing home and visited others.  There are residents there who are just old, they do not need any special care.  They have been abandoned by their children.  Many other cultures would never consider anything else but to care for their elderly parents themselves as their parents cared for them as babies and children.

It might be different now, because governments spend a lot of money trying to keep the elderly in their own homes as long as possible,  but it will still be happening.