The Ombudsman Report - May 2022

Be Careful What You Sign For

by Kathleen Heren, Rhode Island Long Term Care Ombudsman, Guest Blogger

Kathleen Heren

Don Drake, who writes the blog for Connelly law offices, recently published an article on CPR. The title really took me aback and I immediately read it. The title was "CPR is brutal, undignified...and few survive it". When any elder or disabled person is admitted to long-term care, somewhere in the vast pile of admission papers, the person is asked if they have advanced directives. A question that is mandatory to ask. There is no obligation for the person to sign one, although it may prove to be a sad situation if they become gravely ill, and the physician and staff must keep the person a full code.

Some think if they tell a family member or a friend what they wish to happen, should they not be able to speak for themselves, that it is enough. That is not an advanced directive. An advanced directive must be written on paper, signed, and notarized. Some nursing homes will take the word of the appointed party, some will not. Advanced directive forms are available at nursing homes. They can also be downloaded online.

CPR can be a brutal process for the elderly

Rhode Island has made it so easy to obtain and fill these out. An attorney is not necessary (sorry Mr. Connelly). It would be so much better if the facility did the advanced directive forms a few days after the admission paperwork so the person can then have time to ask questions. My office will help any long-term care individual with filling out the paperwork. We also have a notary available.

A resident who has dementia may not be able to communicate or understand what is being asked of them. Under these conditions, we would not be able to help. I want to stress that everyone who has a dementia diagnosis is not automatically stopped from filling out an advanced directive, it is a case-by-case decision. Another thing to know is, that when you die, the power of attorney designation dies too. Any action you may want to happen with real estate or personal possessions after you die requires a will.

Displaced sternal fracture from CPR

In closing if you have signed up to be a full code, read up on CPR, it’s not like the television shows. As a person ages, their bones become brittle and could crack easily. This cracking of the rib runs the risk of that rib piercing through the lung. If the person does not respond to CPR and the heart does not beat, the result is bleeding lungs along with brain and kidney damage. All of this results in the person being placed on a ventilator. This information is not a scare tactic, it’s the reality of what happens every day.

Your decision to have CPR should be based on your diagnosis, and the importance of what you consider to be quality of life. Please do not let your family influence you. It’s hard for families to face a parent's death. It will, however, be you on the ventilator. If you have any questions on end-of-life decisions, please contact me, and I will answer your questions or direct you to someone who can. The most important thing is to fill out your advanced directives. You have made your own decisions your entire life on how you wish to live, don't let other people make the last ones for you.

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