Involve the Facility in End-of-Life Conversations


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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Hi Bob--You are so correct about that Advance Directive. I'm working on wishes (as they are today) so I can share with my brothers, who are my financial and medical durable Powers of Attorney. I've also begun discussions with my oldest niece so she'll be in the loop too. I'm thinking about donating my body to science; my niece said she'll accept my remains when science is done. :) She'll then bring my remains to rest with my parents.\r\n\r\nPhew!\r\n\r\nAnd, you are absolutely correct about checking the documents we sign. We understand what we're signing after we have those important discussions about what we want.