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Be Careful When Signing Do Not Resuscitate Orders
Jan L. Warner & Jan Collins

Question: After he fell and broke his hip, my father began a downward spiral that resulted in his admission to a nursing facility. Although physically healthy, he was unable to walk and became confused, but was still competent. Our mother was not able to lift him, and my brother and I live out of state. My mother admitted him to the nursing home. Later, my brother and were I shocked to find a “do not resuscitate” order that Mom had signed.

My brother and I went to the nursing facility were told by the administrator that the “DNR” was required of each resident. Our father is nowhere near terminally ill or at death’s door. The administrator won’t let us remove this from his file. What can we do to straighten this out?

Answer: Obviously, the administrator does not know what he/she is talking about. The facility is placing your father at significant risk and itself at significant potential liability.

Accepted by physicians in all 50 states, the “Do Not Resuscitate” order – more commonly known as a “DNR” – is a type of advance health-care directive that, based on the e-mail and letters we receive, seems to be the very misunderstood, by both individuals and facilities.

In its most simple definition, a DNR is a request that your father not be given CPR (cardiopulmonary resuscitation) should his heart stop or should he stop breathing. Without a DNR order, medical personnel must perform CPR under these circumstances. When signed, the DNR order will be put in your father’s chart by the facility physician.

Many patients in hospitals and medical centers may have DNR orders, but they are generally the folks who probably would not benefit from CPR – for example, terminal cancer patients, patients with severe infection, and end-stage renal patients who can no longer be helped by dialysis.

While the DNR is a useful tool in some instances, these documents should not be signed casually by unauthorized people just because some nursing home tells you to do so. Since your father appears to have mental capacity, the decision is his, not your mother’s. The only times your mother would remotely have this authority would be if your father were incapacitated and unable to express his desires and 1) she was the agent under your father’s health care power of attorney or, (2) your father had no written health directive under the adult health care consent act in your state.

While everyone should consider making advance plans about CPR with his/her doctor before becoming unable to make decisions, the manner in which this was handled by the facility is flat wrong. Just because a document is a part of an admissions package does not mean it has to be signed.

We suggest that if you can not talk some sense into the administrator, you report the facility to your state licensing agency and contact the ombudsman’s office to rectify what could become a major problem before it happens.

Taking the NextStep in Entertaining the Elderly: We have been pleasantly surprised with the benefits that XM Radio can provide to seniors, whether they are shut-ins, are in facilities, or just like to reminisce. Included among this satellite radio network’s hundreds of stations are 24-hour continuous music from the 1940’s; radio programs from the 1930’s, 40’s, and 50’s featuring Lucille Ball, Jack Benny, and other favorites; the Suspense series; the Lone Ranger; and many more. Based on communications we have received from caregivers, seniors with dementia seem to be soothed and entertained for hours by these types of programs. Available at modest cost, we believe that XM Radio is a wonderful resource for caregivers and facilities, to learn more click here.

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