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...

[polksaladallie]

Azure, how is your search going?

[polksaladallie]

I'll try again

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.

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.

[punch*drunk]

My dad has now been diagnosed with vascular dementia 😞

I'm going on holidays next month and the geriatrician wants us to put him in respite for the time I'm away. There's nobody else that can spend the kind of time with him that I am at the moment. He seems to have gone downhill even more in the last month or so 😐 I think taking his car away has contributed to his decline, he is totaly bored and just doesnt understand why he cant drive.

So now my search begins, I have about a month to find somewhere suitable for 3 weeks respite. Cant imagine how he's going to feel about that, he's not going to be happy.

[lyndal1838]

Punch, if he has the mental capacity to understand that he cannot live alone then he should be understanding that you need a holiday and he has to go somewhere while you are away.

If he cannot understand a simple explanation like that then you should not feel badly about doing it...he definitely needs care.

After two years of caring for my Dad at home, the decision to put him in a Nursing Home was made very quickly due to a rapid deterioration of his dementia and a series of falls and mini strokes.  It was very much a case of dragging him kicking and screaming...he even laid a guilt trip on my eldest daughter to give up work to care for him at home after I said I could not do it.  He really needed proper nursing care, not just a live in maid.

In this area at least respite care is relatively easy to get....ask the ACAT team who assessed your father.  They will know on an almost hourly basis when beds are available.  My father went from hospital to a top nursiing home in 4 days with their help.

[punch*drunk]

Unfortunately he doesnt understand that he cant live alone, he thinks he should still be able to drive and he thinks his memory is fine......it took him more than a minute to remember what country we live in when the geriatrician tested him 😐

In many ways he's still functioning quite well, he can still cook and take care of his own personal hygeine.....when he remembers to. He doesnt always take his medication when he should, sometimes too often, sometimes he misses taking them. I can tell him 8 times in an hour that he has a doctors appointment and when I say its time to go, he cant remember where we're going.

We just cant be 100% sure that he's safe if he's left alone for more than a day at a time.

[**otoli**]

Punch drunk - try Alzheimer's Qld if in Qld or those with similar names in other states as they have respite and day outings

[azureline**]

Sorry to hear that Lyndal, hope you get a nice respite place for your dad. I do believe vascular dementia has some aspects that respond well to occupational therapy? so maybe ask about that.

We visited Dad this weekend, while he was in hospital, the Dr said his meds were too much and needed to be halved.( Despite us asking the GP to do this a month ago) and he was so different this time, settled, happier and not so addled about stuff. 🙂

I am no longer looking for a place for him, we will wait until the preferred spot is available, I will pop in monthly and ask until they think I live there, lol