Why would a caregiver not honor my mom's POLST?

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Why would a caregiver not honor my mom's POLST?

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My mom is frail, 88, chronic dementia and 95% bedridden. She has been at a CA licensed residential Board and Care for a few months, many weeks of which she was away in hospital or SNF. Her Physician Orders for Life-Sustaining Treatment (POLST) has been in place for three years, indicating her wishes of DNR and Limited Medical Treatment, the details of which are included in her advance directive. On Monday, she was found unresponsive and without a pulse. The caregiver called 911 and then called me. I later discovered through the admission report and the EMT statements that the caregiver had administered chest compressions prior to their arriving. Mom is not doing well and is in a lot of pain, the entire attending hospital staff knows what happened and is astounded, as am I. I called the owner of the facility to ask why this happened. He denied it, stating that the staff is not allowed to touch the patient, just to call 911 when there is a DNR in place. He called me back after a few minutes, following an inquiry to the residence. His story changed and said that the caregiver had started the chest compressions at the instruction of the 911 dispatcher. (since when do these instructions override a legal document?) I have filed a complaint with the CA licensing board, what else can I do?

Alzheimer's & Dementia Elder Law Health Care Directives

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Why? Probably because it is confusing and traumatic to be in charge when someone is unresponsive, and the caregiver was following the direction to call 911 and then was following the direction she received there. She should have said, "I can't do that. There is a DNR on file for her. I'll wait with her until the EMTs arrive." But she simply followed their direction. I doubt this was in any way malicious, but whether it was a matter of insufficient training or a panic response would be hard to say based on what you've stated.

Chest compression on a frail 88 year old bedridden dementia patient with a DNR on file? Lordy, what was she thinking? How is your mother at this point?

I am glad the owner followed up and got back to you with the truth. Perhaps that is a good indicator that increased training will follow.

I am so sorry this happened to your mother, and that you are now having to deal with the consequences.

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I feel incredibly sorry for that caregiver, and I hope she is being treated kindly.

First off, it is overwhelmingly unlikely that chest compressions carried out by a lone caregiver acting on the instructions of a 911 call handler would be enough to save a patient; CPR is rarely successful even in skilled hands. So the inference is that this was not, after all, your mother's time to go. I'm still sorry that your poor mother had to endure being thumped around like that, it's no way to treat a frail elderly lady.

Secondly, as a human being, let alone as a paid caregiver, one's instinct to seeing another human being in distress is to help. It is not to stand by and think 'rules is rules.' The caregiver responded instinctively.

What she needs is better training in taking a step back and following a protocol, rather than stepping in and intervening; and her employers ought to have seen to it. I hope the licensing board will follow that up effectively.

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CM, you are right, I think, about the low success rate of CPR. Neighbors performed CPR on my husband, ten years before he developed dementia. There was a small ceremony honoring the neighbor at a city council meeting. They said there had been several such ceremonies over the years, but this was the first time the subject of the procedure was present. We were grateful, of course, but after Coy developed dementia he was absolutely adamant in not wanting CPR performed, to the point of having his implanted defibrillator removed.

A work colleague's husband, under age 50, was given CPR by a cardiologist who happened to be having dinner at the same restaurant. They were less than a block from an excellent trauma center. He survived and recovered. That was an excellent use of a life-saving procedure. Thumping little ol' ladies around is not.

I agree with you about that poor caregiver. I knew and supported my husband's wishes, but, boy, I'm glad I never had to stand by and do nothing while he was unresponsive.

BTW, for a year after his successful CPR, Coy was recovered but was just not himself. It was not until a psychiatrist convinced him he would need an antidepressant the rest of his life that I finally got my husband back.

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My Dad collapsed with sudden cardiac arrest at 63. He and my Mom had discussed his not wanting life saving measures taken as he had had several heart surgeries, defibrillator, stents, etc. When he collapsed, my Mom, being an retired RN, knew that he was gone. She did call 911 and was bullied by the operator for not performing CPR. The operator was adamant that my Mom go out there and perform CPR. My Mom continued to refuse. Had my Mom not had an RN background, she probably would have started CPR based upon the insistence of the 911 operator. Its a no win situation because the operators are trained to "make" an unwilling caller try to take lifesaving measures. Otherwise they could be held liable for the death of the patient. Either way its a horrible situation no matter which end of the phone line you are on. You just don't know what you are going to do in a situation until you are there.

As an aside, my Dad's cardiologist said that my Dad was more than likely dead before he hit the ground and CPR would have been of no value and traumatic to my Mom.......

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There was a huge uproar a couple of years ago when a 911 dispatcher instructed a caller from a California senior living facility to start CPR and the caller refused. All residents at the facility had signed DNR orders. The dispatcher was quoted as saying something to the effect of "If you are going to let this woman die, is there anyone there who will try to save her?" Her family said not performing CPR was in accordance with their mom's wishes, but that didn't help stem the outrage. Maybe the caregiver was aware of that event and was afraid the same thing would happen to them if he or she ignored the dispatcher.

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jeannegibbs, thank you for asking how my mom is doing. She has had an eating/swallowing evaluation and they are going to start giving her some food. She is in an isolation room with positive MRSA culture. She has a lot of bruising. She has answered correctly the number of her children, but everything else is incoherant. Doesn't want to wake up. This has caused my brother and I great grief, she was so ready to go to her husband and was praying for that daily. I am having a hard time inserting sympathy for the caregiver into this equation.

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I guess I wondering, NOT why CPR was performed, but why 911 was called.

Is you mom on Hospice? Are you thinking about involving Hospice in her care at this point?

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I'm so sorry you had this happen to you and your mother.
Notes to others: I have found that every time my mother goes into a hospital, on and off hospice, you name it, her DNR needs to be examined, put in place with her caretakers, AL, doctors - really every six months it should be brought up and procedures gone over WHILE YOU ARE PRESENT. AL tends to go to my mother and ask her medical questions which she has not been in charge of for 3 years. It depends on how they ask the questions as to how she responds. This is one of the "being a pushy daughter" things I have realized I have to do for her care.

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BarbBrooklyn, she will be on hospice upon discharge. I finally got a qualifying diagnosis after a few attempts.

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KW, I'm glad that your mom will be receiving Hospice services. That will make it easier for the caregivers to know what to do. (((((Hugs))))))))).

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My mother, aged almost 98, was checked into a rehab facility this week following an "aortic hematoma." She has had a DNR on file in the past, but no one can find it now. At check in, the nurse asked her if she wanted CPR, etc., if something happened and she said "yes," so I've let the family know and we will, of course, abide by her wishes. However, I know she has no idea what it involves. Should the nurse have explained it to her in detail? Should we?

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The facility should have access to a palliative care team. Maybe it would be best if someone very well versed in how to have this discussion could talk to your mom about her choices. It would be great if her family could discuss the issue together so there are no last minute disagreements.

Why would a caregiver not honor my mom's POLST?

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