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