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...

[azureline**]

Yes 🙂 I am very impressed, feel bad hoping for a place soon though.

29 women, only 1 man? and in our suburb so we can visit daily.

[the_great_she_elephant]

Sometimes it is because the children do not want the bother of caring for them.  Too selfish.  Australia has the reputation of being one of the worst countries where elderly parents get dumped.

I don't know about other states but here in WA you need to be assessed before you can get a place in a nursing home and the criteria are pretty strict. We also have what are called 'frail aged hostels' for people who are less incapacitated, but even for this you have to be assessed as unable to care for yourself.

[bright.ton42]

Some of them are lovely, start looking now and write a directive . I have found one for my fil that is perfect, resort like but homey, beautiful place. I think we are going to buy a unit there ourselves within the next 10 years.

Just waiting for a vacancy for Dad now.

But it doesn't it depend on how much you can afford?  And what's a directive?  I have no 

idea about these things   - obviously, lol.  

[*crikey*mate*]

I'm still stuck on the phrase "allowed to die peacefully" sheesh, it should be a right not a privilege!

[polksaladallie]

But it doesn't it depend on how much you can afford?  And what's a directive?  I have no 

idea about these things   - obviously, lol.  

The placement in nursing homes is extremely complicated.  If you go to Centrelink, they have lots of helpful publications, and if you Google or contact the government departments for Health and Ageing (there are several different ones), they too have big booklets with a wealth of information.  The money part is complicated too. 

An Advanced Health Directive can be obtained at a newsagent.  If you don't understand the terminology your doctor can help.  Your doctor has to sight it and sign also.  It has sections for you to state your wishes as to what you want when you become very ill or unconscious etc.  There is also an area which you can fill in if you have a special condition that a hospital should know about.  Hopefully they will read it and put it into place.

There are council and government departments galore which are very helpful with information.  Sometimes you have to make an appointment just to talk about what is available, but the booklets are good.

[ashjoma]

cardiac arrest

Having done CPR quite a few times over the years, I can  say it is for the vast majority of people (especially in an out of hospital situation) - a complete waste of time and does not do anything for a person's survival in most instances.

What does make the difference and is what is needed to be at hand is a defibrillator, which needs to be used pretty much immediately to try and revert an abnormal heart rhythm.

Once several minutes have past, any window of opportunity has passed and blood chemistry is now unfavourable.

I have done CPR on elderly- it feels awful to feel the ribs 'groaning' and cracking. The old bones are just so brittle.

I have never seen an elderly person survive.

I know there are exceptions to my views on CPR, but in my experience, these are the rare exception, and are the ones young enough to have the reserves to pull through, hopefully without any brain damage.

And usually very good CPR done and prompt defibrillation.

I have seen devastating  brain damage in a young man who had a cardiac arrest and resuscitation/CPR was attempted by bystanders, before an ambulance arrived and defibrillated and were able to get the heart rhythm back.

The man was left a brain damaged 'vegetable' who took months to eventually die.

Often when a cardiac arrest (even if this is  more a dead on arrival situation) is brought into a emergency dept (with relatives in tow), staff will do CPR for the relatives' benefit.

The relatives can be brought in to see the staff are attempting resuscitation and doing everything possible  (even though the staff really know it is futile).

It gives the relatives peace of mind and some closure to see CPR in progress.

Any one entering a nursing home should have their wishes recorded.

If I was working in a nursing home and a resident had a cardiac arrest, I would happily commence CPR and ring for an ambulance, if that was their wish.

And I would also happily do nothing but pull the curtain around the bed, if that was their wish.

.

[lyndal1838]

Some of them are lovely, start looking now and write a directive . I have found one for my fil that is perfect, resort like but homey, beautiful place. I think we are going to buy a unit there ourselves within the next 10 years.

Just waiting for a vacancy for Dad now.

That does not sound like any Nursing Home here in NSW....you cannot buy a unit in a nursing home. You cannot just admit yourself.  You have to be assessed by the ACAT team and they tell you what level of care you are entitled to, from low level care to high dependency.

There are retirement homes/villages where you can buy units and most of them also have a nursing home attached...maybe that is what you are looking at?

As for a DNR order...my Father insisted on having one in place when he went in for an operation. By the time he was admitted to the nursing home he was really not able to make his own decisions and we were using the POA and Guardianship order that were already in place....I just asked the nursing home to have his papers marked DNR as per his previous wishes.

I must admit I was a little surprised when we were finally called when he collapse to find that he was not even on oxygen to make his breathing easier.

[polksaladallie]

Azure is referring to the new idea of a combination of retirement home and nursing home, where you stay in your own unit and when the time comes you will pay more and receive nursing care in your own unit.  Sounds good in theory, but I can't see how the people who need a lot of care can be monitored, through the night for example.  Having worked in a nursing home, I know that staff have to be very close to everybody at all times in the high care areas.

As for the retirement homes with nursing homes on the premises, there is no guarantee that there will be a place in that nursing home when you need it.  You might have to move 100 km away in order to find a place.

[punch*drunk]

Sometimes it is because the children do not want the bother of caring for them.  Too selfish.  Australia has the reputation of being one of the worst countries where elderly parents get dumped.

Well you can lump me in the selfish and uncaring category, my dad is declining and we are doing our best to keep him living at home. When he cant live independantly any more, he'll be going into care. Neither my sisters or myself have the ability or means to care for him in our own homes, so I guess that makes us terrible children?

[azureline**]

The places I am talking about (my FIL is in one in NSW) has units that can be purchased/leased, which give independent living with a further option for varying degrees of care at different levels. ACAT do an assessment and depending on that result, a place is usually found in the nursing home that is suitable for you when that time comes.

Priority is given to people who are already residents.

The 2 places I liked recently, one is 40 yrs old (QLD) but has this same set up. The preferred one has just had a huge extension incorporating more independent units and is 15 years old. Both are Church owned, not for profit places. (as is his current place in NSW)