Involve the Facility in End-of-Life Conversations

publicdomain-sun-and-cloudsBy now you’re probably heard the tape of the 911 call from Glenwood Gardens, an independent living facility in Bakersfield, Calif., for help after an 87-year-old resident collapses in a dining room. During the call, the 911 dispatcher directs the caller, a registered nurse, to begin CPR on the resident.

The nurse refuses. The ambulance arrives and transports the resident to the hospital where she later dies.

Jeffrey Toomer, the executive director of the community, released a written statement about the incident. “In the event of a health emergency at this independent living community our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives,” he said.

The incidence raises tough questions. Was the nurse professionally, morally and legally obligated to perform CPR? Was the resident’s family aware of the community’s policy? What were the resident’s wishes? How does the family feel about what happened?

These situations remind us of the importance of discussions about how life ends. For me, when I’m 87 and collapse in a facility, I don’t want the staff to call 911. I want one staff member to call my family members so they have a chance to be with me when I pass. I want another staff member to hold my hand and keep me as comfortable as possible. I want another staff member to play two songs, in this order: “Running on Empty” by Jackson Browne and “In the Sun,” a beautiful duet by Micheal Stipe and Chris Martin. To me, this is a great way to go. (I’ll promise the facility that I’ll keep a copies of the songs in my purse. I also will tell every staff member about my wishes, probably every day. And, I’ll carry instructions in that same purse.)

So, when I chose a community, I will have discussions about these kinds of situations. If I collapse, will you simply call my family rather than 911? Will staff be able to hold my hand and play two songs for me? If the community can’t honor my requests, then I need to look for another one.

If some day I change my mind and I decide I want everything done to keep me alive, then I would want to chose a facility with a different policy than the one Glenwood Gardens has. I would choose a facility that immediately begins CPR and calls 911.

So much of our discussion about choosing a facility focuses on quality care–and rightly so. Except we often neglect to discuss quality of care at the very end of life. We know to ask questions about staff ratio and the quality of rehab services, but we don’t think to ask questions about how a facility will manage our last moments or the decisions the staff will make during what will be our last moments if we don’t receive medical interventions.

What happened in Bakersfield provides us all an opportunity to talk about what we want for ourselves when our end happens. And, if the time comes for us to look for a facility for our carees and then for ourselves, we must continue the conversation with the facility staff. We want to make sure our last moments—wherever they happen–are spent just as we want.

What do you think? Please share your thoughts in our comments section, below.

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2 Comments on "Involve the Facility in End-of-Life Conversations"

Profile photo of BobinMO
Mar 5, 2013

My wife and me have over 40 years combined experience as 911 dispatchers i.e., also known as communications operators for those with frail egos. Never in our lives would we have believed a situation occur. Most law enforcement agencies require their 911 dispatcher be CPR certified so they’ll feel 100% comfortable as they talk through the process with the caller/life saver on the other end.

Nobody can second guess what the outcome would have been if only this RN would have provided this widely used life saving procedure but the fact that the facility has RN’s who don’t care to try and save another persons life makes this a morally unforgivable travesty. This incident is another reminder for the rest of us to NEVER assume certain standards of care care or life saving procedures will be provided when the need arises.

Got to love Denise for having planned out her final moments. Sounds like she dotted all the I’s and crossed her T’s, hence the sub-topic should be The Need to Review our Medical Directive.” The less specific we are with our final wishes, the more we’re exposed to others making those decisions based off of their values not ours when those final moments need to be fully implemented. Medical Directives are all about OUR personal choices. We then need to talk with our doctors, legal representatives and family in detail long before we arrive at that destination. Thanks to a legal system that now has review boards that reviews review boards, the final cause of death is more often the inability to make hard decisions than to have actually implemented the desires of the person who’s about to venture to more heavenly destinations. The only way we can avoid this is by planning way ahead. Be it a Medical Directive or a Simple Will, most legally binding documents loose their teeth unless three years or more has passed since these final decisions were made.

Meanwhile this shocking news story reminds us to double check all the documents we sign anytime we utilize the housing/care services of independent, assisted living, and skilled nursing facilities. Some nightmares like this sound unbelievable yet this is the real world. Avoidance of personal responsibility by employees for a job they’re supposed to do is not the exception, it’s the norm. What ever happened to a moral compass?