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]

How do they get in then, without an ACAT?

I will qualify my answer, Azure (which will delight someone else here).  What I have seen done has been going on for 50 years, ever since some people started to get selfish and uncaring regarding elderly parents.   Before that, there was no question about caring for parents, just as they cared for us when we were helpless.

But it is probably not so easy now, because the assessment process has been streamlined remarkably, probably because the numbers of elderly are burgeoning.

[azureline**]

Thank you. My father in law was assessed early last year for in home care (unbeknown to us but known to his youngest daughter) and was provided with some assistance with a care person visiting each day.

I only recently found the assessment in his paperwork.

Early this year, he was assessed while in hospital by the ACAT people again and was assessed as high care, secure unit. He was reassessed last month, after being in the nursing home for 6 weeks, as per the usual criteria for keeping his place.

I very much doubt he could be there if it was not necessary, too many people involved? However, he does have days when I feel he doesn't need to be there, then he says or does something that brings me back to reality.

[cherry*135]

But it is probably not so easy now, because the assessment process has been streamlined remarkably, probably because the numbers of elderly are burgeoning.

Exactly.  You don't need to add the snide remarks, just because anyone asks you to expand your comments.

[cherry*135]

I had an Uncle that had a stroke when he was in his early 60's (his wife had died the previous year) and he went into to a home and was in there for many years. This would have been in the 1970's. He certainly wouldn't qualify now.

[cherry*135]

Yes they are, and yes they do.  Ever heard of porkies?

No they aren't and no they don't, by your own admission in a later post, that is no at all likely to happen under the current system.

[*crikey*mate*]

Currently looking for one but can't find any. So far all I have found, have Gov funding. ACAT assessment is needed for a place.

Check out the one at Runaway Bay on the water near the shopping centre. Not sure of the ins and outs - didn't pay that much attention as we weren't looking for me so it wasn't me who had to be happy with it, but you can buy into it, and it has many different levels of care, so you move to different sections as you need to, don't know who decides that or what red tape you have to jump.

But from memory there was something about you couldn't sell it or when you died, it didn't pass into your estate...

[*crikey*mate*]

should have added, they start out with little units where you can live with your spouse, and then progress up to differing types of accomodation depending on need I guess.

but in theory I thoiught it was a pretty good concept as even if one person needs a higher level of care, at least their spouse was nearby and they weren't really separated iykwim

[cherry*135]

But from memory there was something about you couldn't sell it or when you died, it didn't pass into your estate..

Yes, there are varying options like that, some you get money back if sold others you don't. If the elderly person moves into something like that and lives there for a reasonably long time, it is a good option, if they die 6 mths later after moving in not so good. Bit of a gamble in that respect.

Were I live the majority of the population is retired. There are retirement villages (gated communities) for aged 55 and over, 24 hour medical alert external, and security etc, popping up..not a retirement home as such but a step before that.

[azureline**]

Thanks Crikey, they have no secure high care suitable for him but by default they put me onto a place that has with a vacancy 🙂

[*crikey*mate*]

I spose once you die it doesn't really matter what happens to your money, eh?

We have a fair few of those over 50 places here too - lots of varying prices and facilities and locations.

I don't really understand the point of them. I get that as you age some people might not want to live surrounded by kids etc, so that would work, but I dunno, I reckon if you move into where everyone is over 50 and lots would be older, that you would kind of age really quickly. And with age does come a lot more medical situations, reckon it'd do my head in seeing your neighbours continually being carted away in ambulances.

And some of them are like rabbit warrens! no room to swing a cat, nowhere to park your caravan or boat, neighbours right on top of you and can hear you flush the toilet!