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

Cause unless you are in that position of seeing someone you care about in that state you jump to save that person. My father had that also but I held him and for me it was horrific seeing it and I tried to save my father, I called 911 you panic you just do. Unless your a nurse or doctor.

First of all, anyone who was caring for your mother should have been aware of the DNR order. This is the same as a doctor's order and should be followed as such. As for the caregiver feeling like should have done something, she certainly could have. As a retired RN of 25 years in critical care, I participated in many codes. I did, however, have quite a few patients that were DNR. For those, as I could see that their time was getting close, I would go into the room, hold their hand and quietly speak to them, in an attempt to make the passing from their earthly life to their heavenly one a pleasant and peaceful experience. Remember hearing is the last sense to go. Often they can be in a coma or be nearing death and still hear what is being said. I hope that your mother can eventually have a peaceful passing into her eternal life.

rovana, my point is this person is a caregiver. I assume a professional person. If it was a family member who had never seen death before, that would be different. A caregiver should have knowledge of what to do in this situation.

kwyattearp,
I am glad that you have made arrangements for your Mom to receive hospice care at a new facility with private pay caregivers and that you have arranged that the caregivers will NOT call 911 if something happens with your Mom.

I think that you need to focus on your Mom as she is today and not worry about what "might have been". You cannot change the past, but you can make your last days and weeks with your Mom as happy and memorable as possible. Look at old photos, ask her about the stories behind the photos. Do a audio or video history with your Mom. Ask her if there are special items or belongings that she wants to give to a specific person. Enjoy the time that you have with her.

No more calls to 911. She is under very competent hospice care as of today. 911 is out of the picture.

MaryKathleen, I think a lot of people call 911 because it is so well advertised and how many people know who else to call? The ramifications of this are not well understood and to many people the idea that "my loved one is dying and please do not interfere" is alien. It may become harder and harder to "achieve death". (In a modern industrial society - in most of the world, this kind of thing hardly exists as a problem - the hard thing to do is to keep alive.)

Sounds like there is some kind of practical disconnect, legalwise - 911 operators are told they must push CPR, BUT are they informed about rules when a DNR is in place? Do they know how to respond then? Are there in fact laws that cover this type of situation? My sister is a doctor and when my Dad was dying she told all of us: DO NOT CALL 911 - because legally they have to attempt to resuscitate . (Don't know what current law would be.) Call Hospice. Thing is, it is an emergency and most everyone thinks "do something!!, "call 911" - they want to call somebody but don't know what to do or who to call. Please don't blame the caregiver too much - it is hard to know what to do unless you have really been drilled in procedure and even then you would probably find yourself arguing with 911. And as for 911, what does the law say, do they have any choice in response? Sort of stuff you don't think about until the emergency happens.

Thank you all for your thoughts on the original question, "Why would a caregiver not honor my mom's POLST?" A lot of insight on here, I appreciate your taking the time to share. My Mom is being discharged soon, she has been placed on hospice care, and is going to a new facility with private pay caregivers who will check in on her frequently. We have enough money for about a year of this care. They know what has happened and are assuring me this will never happen again. My brother wants to pursue legal action against the facility that allowed this to happen, but from many of these comments it sounds like it happens a lot and there will always be some way to justify it or excuse it. I did file a complaint with the State Licensing Board. Should have mentioned the MRSA issue during the process, maybe I can amend the complaint.

Doingitalone,
In regards to the ALF staff stating, "Don't worry, if she falls again, we'll call an ambulance like we always do" when you were at the ALF and found your mother trying to stand on her own. The ALF staff might have be quoting the policy and procedure for "What to do when a resident falls." Our ALF staff are NOT allowed to assist an resident off of the floor, the rescue squad has to be called every time and they have to assist the resident off of the floor. (Sounds stupid, right?) BUT that is what their POLICY is.

Talk to the Nursing Supervisor or Director and ask her what the policies and procedures are for assisting someone off of the floor after they have fallen. That way YOU will know WHAT TO EXPECT if your Mom ever does fall at the ALF.

Sometimes what we expect the nursing staff TO DO or NOT DO for our loved ones, is not the same as what the facility's Policies and Procedures are. As a result, the nursing staff is put in the middle between family members who want certain things done a certain way and the facility; because legally the nursing staff are required to follow the facility's Policies and Procedures (and if they do not, they can get into trouble with their State Board of Nursing for NOT following the P&P.) So how does the nursing staff serve "two masters" while also taking care of the resident??? Something to think about.

Never mind CPR on the elderly, my brother required CPR when he was 53. He has a very high pain threshold and he said he suffered a lot of pain in his rib cage area for 6 months. It is no small thing. We need to get this right so that kwayttearp's mom or anyone else who chooses to forgo CPR do not suffer!

realtime, your mother should have the discussion about CPR with her doctor. My mom, when first answering the question of CPR, said that medical personnel could try a little bit. The doctor explained that it didn't work that way, that they would likely use CPR techniques for a more extended period of time and that it often results in bruised and broken ribs, etc. When put that way, she then decided to decline CPR. In Massachusetts, a MOLST form must be signed by a doctor anyway, so having a doctor explain all the choices short and long-term is easy and it is clear that the patient is properly informed. It also helps to know that at any time in the future, a change can be made as long as a doctor signs, so if the patient's condition changes or they have a change of heart, it's easy to accommodate those changes.

A POLST can oppose your wishes. Let's say you go into the hospital with a clear advanced directive that says you want to be resuscitated and you do not want nutrients withheld. You've made the decision after careful consideration and you went to great lengths to ensure that it is documented correctly. A POSLT, however, can override your directive and, even worse, the person who makes the decision (signs the POLST) can be someone you may not have ever wanted to do such.

Your poor mother, CPR on an elderly person usually breaks ribs and the sternum. My heart goes out to you and her.

As has been discussed here. When you are under Hospice, you do not call 911, you call Hospice. When 911 is called, they have to try and save the person's life. It is the law. Otherwise, why call them? To me, this is why you want to get your loved one on hospice. If they are in a facility, get them at least on Palliative care. I just went through this with my Aunt. Thank God she was still coherent when she was admitted and she told them herself she did not want to be resuscitated, and get the oxygen mask off her face. She was admitted to Palliative Care and when she died, we held her hand as her heart stopped and she quit breathing.

My father died at my house back in 1974 before hospice. We knew he was terminal, when he died, we called his doctor who came out, pronounced him dead and we called the mortuary.

The caregiver called 911 and the 911 Call Center personnel told the caregiver what to do regarding CPR: Hands--Only CPR.

The American Heart Association (AHA) developed "Hands--Only CPR" in response to people refusing to perform the mouth-to-mouth breathing portion of CPR because they are/were afraid of getting an infection or illness from the person who is lying on the ground. The American Heart Association along with fire departments and hospitals throughout the US are promoting this version of CPR.

According to the AHA website: "Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting (such as at home, at work or in a park). It consists of two easy steps:
1. Call 9-1-1 (or send someone to do that).
2. Push hard and fast in the center of the chest. "

See the American Heart Association website for more information: https://cpr.heart.org/idc/groups/ahaecc-public/@wcm/@ecc/documents/downloadable/ucm_493890.pdf

In regards to a tattoo that states "Do Not Resuscitate" or "DNR". IT might NOT be HONORED!! In the 1980's or 1990's, a RN got a tattoo on her chest that stated: "DNR" or "No CPR" (I don't remember which) with her signature copied onto her chest. She was told by the EMTs at the Fire Dept. and by the Hospital ER Dept., that if she collapsed and wasn't breathing and had no pulse, they would STILL HAVE TO DO CPR, because the TATTOO was NOT A LEGAL DOCUMENT--the tattoo had NOT been "Notarized"!

The answer to your question is held in the head and heart of the caregiver. During the time I have worked with families, only to have this same question come up I have found several answers some overlapping. Although I advocate very strongly for individual rights be upheld. The main reasons I have found for this behavior are, religious beliefs, feelings the individual was push into signing or did not understand what they were signing and a reaction to the situation. In the same situation this kind of reaction has been made by EMS, doctors, lawyers, judges and individual family members (not all families can agree on this question). Was this a proper answer/action, I do not believe so. However, there are so many questions you may never have an answer that will be satisfactory. You are now in a situation where your actions must be calculated to provide the care your mother desired. Give this very careful consideration and move ahead with your knowledge of your mother wishes. Do not try to come up with an answer for the why and how of the caregivers actions. You are in one of the most difficult transitions of your life. Move ahead with full believe in your heart the next actions are what your mother wanted. Focus on family and loved ones during this time. Take the caregiver's actions to to the garden and bury them, at this time. You will have plenty of time to reflect later.

My mother has late stage dementia and heart disease and is now in Hospice. In this very long battle I have made sure all involved have a copy of her DNR. At this stage, Hospice is in charge of any emergency and should be the only contact besides myself. When I came to the ALF recently and found my mother trying to stand on her own I was told: "Don't worry, if she falls again, we'll call an ambulance like we always do." My God, you have to stay on top of everything for your loved-one to get the care she deserves!

Report the care facility to the proper authorities of licensing.
I just had to place both my Mother/Step-father with an assisted living group home.
They require this information and are legally bonded to follow the directive.
Your Mother is MOST LIKELY being taken to a hospital that the facility has contracted, so they're making money billing Medicare/Medicaid and any other health insurance you may have for your Mother.
You may want to find another facility. This one is being negligent to your Mother's wishes as well as scamming, but people are too afraid to stand up to facilities caring for a family member because that could create Elder Physical Abuse, not giving needed medication etc.

Go to the hospital where they are taking her. Go to the Director of Patient Welfare, give the Director a copy of the Directive. Then inform him/her that IF they do not follow this Directive they will be changing the name of the hospital because YOU as your Mother's agent have the right under HIPAA to SUE THEM.
I would also ask to see the records as to WHO has signed her into the hospital, the attending doctor(s) AND DEMAND A MEETING WITH THE DIRECTOR OF THE HOSPITAL NOW!
You'll get the run around, but screw that; go to his/her office start out politely to see the Director, do not take NO for an answer. As this goes back/forth become more agitated until you get what you want. Get the phone number of the Hospital Board Director and go to him/her. You may find that information in a brochure. It will provide you with the name, occupation AND the name of the company he/she works. Just go down that list.

TRUST ME....you'll get your answers.

I am not condoning anything by saying this, but it is quite possible that the caregiver didn't even know about the POLST---facilities that provide custodial care to elderly people are notoriously understaffed with minimally qualified people who may or may not know which patient is DNR & which are not. Furthermore, only doing chest compressions is not proper CPR & a person that is not CPR certified should not be doing ANYTHING like that in a facility like this.

I question why there isn't a nurse or other trained medical person at that facility that is called when a person is found unresponsive--doing chest compressions should only come after a proper assessment of breathing & the reality that one person can continue with CPR (not just chest compressions) until emergency services arrives. Your mother's heart apparently was beating, albeit weakly, likely due to the MRSA (which she got at that facility and should be a bigger gripe than the chest compressions, quite honestly--she would have lived with or without those chest compressions because she was still alive). How she contracted MRSA in a non-medical facility is a MAJOR issue---that means that someone else in that facility has untreated MRSA that has been spread to other people by caregiver(s) that have not washed their hands between touching the people there. I would have a much bigger concern about that issue much more than the chest compressions issue. It sounds like this "Board & Care" facility is taking in medically complicated people that they are not qualified or trained to handle. If someone there has MRSA that is not being treated, that is a MAJOR problem in my book. MRSA requires IV antibiotics, isolation rooms, gloves & gowns, very careful hand washing after contact, etc. Since you likely paid quite a bit of money for your mother to be there, you should be very angry about your mother getting MRSA there. That indicates totally inept care, poor housekeeping practices, lack of hand washing between contact with people. For the amount of money you were paying, that should not happen. If it were me, I would have scheduled a sit-down meeting with the administrator/owner of the place to discuss a refund of some of the money you paid---you paid for quality (non-medical) care, but they clearly admitted your mother when it is quite obvious that her needs exceeded what they were/are able to provide. To me, that is unacceptable. These places have money signs flashing in their eyes when they see somebody that can afford to pay to stay there and they will often take people that should not be there. "Assisted living" means that a person needs "assistance"---meal prep, laundry, social activities--someone that is 95% bedridden with severe dementia needs far more than "assistance", they need skilled nursing care.

I am not familiar with "Board & Care" facilities since I live on the east coast, so I looked it up & found that it is the same as what we call "Assisted Living". The way you describe your mother's condition--frail, severe dementia & basically bedridden--she did not belong in that type of facility to begin with. That type of facility cannot possibly have the type of care that she required/requires---just the fact that she is basically bedridden would require staff to turn & position her regularly to avoid bedsores. If she is incontinent, her underwear would require changing frequently.

I do hope that when she is discharged from the hospital that you don't put her back in that "Board & Care" facility. Try to get her into a hospice facility. If the "Board & Care" facility can't get CPR correctly, they damn sure can't get hospice care correctly either. Furthermore, unless she is in the care of family that would sign for responsibility of her care, I am not sure about the legalities of a non-medically trained person administering hospice medications like morphine to her, since that is considered medical treatment & "Board & Care" facilities do not provide any medical care. I would be very leery of any non-medical facility telling you that they can handle whatever hospice orders. People on hospice need more direct monitoring so that care can be provided. I don't think this "Board & Care" facility can meet her needs now.

I recently got a call from my mom's facility begging me to let them send her to the hospital. My sister was not in Cell Phone range (they had tried to call her). I gave in. My sister convinced my I did the right thing (thank goodness we have agreed to go through this supporting each other). It's a new facility and they don't realize that the DNR is in her best interest. We moved her there because the memory care facility she was in kept calling 911. Now that the new place and doctor understand her condition better, we hope that this won't happen again.

If a doctor has not written a DNR, there will be CPR. And if 911 is called, how can they be sure that there is truly a DNR document? You have to understand that in this day and age of so many lawsuits, disagreements between family members desires, that hospitals, facilities, 911 dispatchers must all protect themselves.

Anyone just filling out their wishes is not good enough. You have to have a DNR, and some states require 2 medical doctor signatures. So when the wishes - 5 Wishes Booklet or Living Will is completed and signed, you must then talk to the doctor when the time is appropriate to have a DNR. And then EVERYONE needs to know. In hospitals and other places, even at home with aides in and out, there is so much change in staffing that many times, someone could be covering for another nurse/aide while the one is on break, and I'm sure you could understand that in hectic areas communicating that someone is DNR can get missed. Sometimes death can occur quickly and unexpectedly so if someone is unsure whether there is a DNR, the mandate would be to perform CPR.

BetsySue, A tattoo! What a great idea! Is there an established protocol for that which EMTs or anyone would look for or recognize? I'm thinking of a big "DNR" across the chest, which wouldn't be very attractive, maybe.

The 911 Operator's behavior is surprising and a wake-up call for all caregivers.

I had a different but related experience when my Mom went into cardiac arrest.

The senior nurse came up to me to ask me if I wanted to "override the DNR" to have them start CPR. It was an emotional, harried, time when I initially said "yes, go ahead". Fortunately, the doctor pulled me aside and explained the ramifications of compressions on a frail 87 year old woman. She let me rescind my request.

I could have handled the situation smoother if I had recently reviewed my Mom's Durable Power of Attorney for Health Care, or/and if I had a copy of the document with me in the hospital.

This situation led me to make some changes to my personal Durable Power of Attorney for Health Care. I added specific language on when NOT to administer CPR.

My situation also made me realize that having "the talk" about the intent and contents of my Durable Power of Attorney's for both Health Care and Finances.

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.

There was a good article about this issue on KaiserHealthNews.org.
khn.org/news/that-living-will-you-signed-at-the-er-it-could-be-open-to-interpretation/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=63756297&_hsenc=p2ANqtz--ZmuVv63bCRpuIZhYzBmdt1LfZON6Ihru2I9azdkajXFJjcUYvBw6GtdPJ0N-2CvMphRM1Byz3OOz1rNSj5_Kjvj0wUQ&_hsmi=63756297

For all you who have elderly LO's: Atul Gawande's book, Being Mortal, goes into detail about CPR on old people. I think that chapter is available free on the internet for download. Maybe you could print it out, take it, and read it to your LO's. There is a form called 5 Wishes that is similar to an Advance Directive. Both are available online. Print them and take them along so you can have them with you when you are reading the chapter!! Get those filled out and signed, and make copies to give to every doctor and ER visited - and post on the wall of the facilitiy!

I have dnr instructions at the two hospitals in town. I have a tattoo. I also carry paperwork with me for when my husband and i go someplace away from here.

When i went to the er a couple years ago i told that to the emt who shrugged like ... so what.

Its a big yes/no decision ... no maybes. But i have heard stories like yours for years and want as good quality of life as possible not bad quality.

I sadly say to all of us ... good luck !

My dad's renter, of the mobile home on dads property died in his recliner. I went to check on him and found him. I called 911 and the dispatcher tried to get me to take him out of the recliner and do CPR. I refused. He was obviously dead, had been. My husband touched him and he was cold. But boy, that dispatcher was adamant that I do cpr.

maybe you should have made sure the caregiver knew t for sure ..around where your mother is have a big sign DNR & your polst maybe if it was to much to not DNR who ever it was put do not call 911 & dnr & polst .if to much just go out side for 10 minutes then call me = you to tell me what is going on ..but i do not know if that would agree with all there rules ..it might have been to much to handle to watch her go so going out side will get ?? ever mind off of it ..

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))))))))).

K watt, I am so sorry you had to experience this and your poor mom!
I hope she recovers soon and is able to return either to home or a SNF. I bet she is sore with bruising from going through the CPR and subsequent admission.
Will be thinking of you and she today...