I certainly wouldn’t call my wife “elderly,” although she is now old enough to collect Social Security if she ever decides to retire.
Anyway, she had to go into a rehab center/nursing home after spinal surgery last year. (Mainly because the hospital wanted to discharge her just three days after surgery, and she was in no condition to come home yet.) Anyway, other than needing to recover from major surgery, she was in relatively good health. Nevertheless, we repeatedly got asked about living wills and advanced directives. On one of the forms, it asked about a DNR order. :dubious: I assume they are required to ask these things, but it was still jarring.
My 92 year old mother WANTED her DNR. She LOVES that little piece of paper. No pressure getting her to sign it, she repeatedly requested one. She makes sure that it’s in full view of all nursing home staff every day. When we take her to the house to spend holidays with us, she brings it with her and places the envelope in a prominent place on the coffee table and makes sure everyone knows about it. We are supposed to give it to the paramedics if she has a medical incident while out of the nursing home.
And that’s fantastic. It’s definitely for the good that competent elderly people are able to make their wishes for end-of-life care known, and that those wishes are, to some degree, enforceable.
That said, the pressure I have seen put on elderly people to sign a DNR is disgusting. And it’s always a form DNR written by the health care institution at that, with no regard to what the patient might actually want.
The patient, who is quite likely not in a position to read and comprehend a critical document, gets a piece of paper waved in front of him or her, by an administrator or nurse *demanding *that the patient sign it. The patient may believe that he or she is obligated to sign the paper to receive care. Certainly the institution does nothing to discourage that incorrect belief.
When my father was admitted to the in-patient rehab facility described above, the nurse demanding the DNR was not going to leave without it. It was obvious that this was the policy of the institution. And if my brother and I had not been there, she would have gotten it, too. Fortunately, after her repeated attempts at coercion, my brother and I were there to throw her out of the room.
And don’t get me started on what hospitals do to get patients to sign various kinds of consents to treatment, or commitments to pay certain bills. It’s staggeringly dishonest.
I’m really sorry. There are things you can do now to protect yourself later. I mentioned a nomination of guardian below. You can set up your end-of-life care directives now. There are things you can do to protect your assets now.
What you need, of course, is a good, trustworthy lawyer. Unfortunately, that’s kind of a unicorn, but there may be one out there. And these matters aren’t usually complicated. They’re routine for any lawyer who specializes in elder law and, depending on where you live, shouldn’t cost that much.
I’d advise that you find a lawyer through word-of-mouth recommendations, i.e., a lawyer who’s done work for someone you know and trust, and done a good job at a reasonable price. I’d recommend that you try to negotiate a flat rate with that lawyer, because the hourly billing system is nothing but an invitation to thievery.
I screwed up on that once. Had a prisoner die and I gave him CPR until the ambulance arrived. It then turned out he had a DNR on file so I shouldn’t have done CPR.
But I was able to beat it because I wasn’t part of medical staff (even though I supervised them) so I wasn’t supposed to have access to his medical information.
In many states, including the one I practice in (WI) the law doesn’t allow a person to be made DNR unless they are a ‘qualified’ patient, i.e. one with a condition which causes them to be expected to die within 6 to 12 months (>50% likelihood). So we don’t end up putting DNR bracelets on folks unless the writing is truly on the wall for them. Now many do live longer than that, as there are outliers, but that’s the rule here.
Patients of course are encouraged to have living wills and advanced directives spelling out what they do and don’t want should they become terminal or incapacitated, and those are honored, and do result in DNR status for lots of folks when they do reach such dire straits.
And don’t get me started on lawyers and the elderly . . .
I couldn’t agree more with the theme of the posts about arseholes in the industry of the elderly. However there are some decent ones- my mothers solicitor drove to her nursing home to have her sign an amendment to her will and never tried to take her funds. The Nursing Home was a disaster and I despise the lazy bastards who pose as carers and the Administration of the place.
I couldn’t agree more. And, by and large (with a few exceptions), my father’s actual caregivers, ranging from physicians to home aides, have been fantastic.
It’s the people who are involved with the money who tend to be unbelievable bloodsucking pieces of shit. There, the situation is reversed. The good ones (like your mother’s lawyer) are the exceptions.
A few months ago, in WI, I went into respiratory distress and ended up in ICU. I was adamant that I be made DNR and the doctor agreed. I got a bracelet.
I was 48 and had no life threatening chronic conditions but my situation was serious enough that they were preparing to intubate.
I explained that I’ve been an ICU nurse for 20 years, I fully understand that I could die, but I absolutely refused intubation, CPR, or defibrillation. They could try anything else but if it came to death, please make me comfort care (i.e. give me some drugs to ease my distress).
The doctor even ordered magnesium sulfate at my suggestion.
The patient has a right to refuse treatments they don’t want.
This is true, and such refusals should not require a DNR bracelet, and must legally be honored when spelled out as you did.
The actual statute 154.17 about who’s a qualified patient reads as follows:
There’s wiggle room in parts (b) and (c) for a doc to declare resuscitation futile or harmful. Which is great for patients who wish to be made DNR. But goes against the spirit of health care when the patient’s not ready for DNR status.
Thank you for citing the statute. It’s especially confusing when laws are different from one state to another. I’m an IL resident but was hospitalized in WI. I also worked in ICU in WI for 10 years.
I was grateful my caregivers followed my wishes. A patient who wants to be a full code has equal rights. Pressuring a patient either way is wrong, of course.
Our role should be to educate so the patient understands the choices, never
to coerce.
P.S. as a long time secret fan of yours, I wish YOU were my doctor.
Before this thread falls off completely, I do want to point out that vultures do serve a valuable ecological role in this world. By consuming larger chunks of the dying and dead, they speed up the process of natural/organic recycling greatly. In areas of the world where vultures have been hunted enough to reduce their numbers, significant problems are occurring when floods/droughts/etc. cause massive large animal die-offs. Rotting carcasses abound, polluting the waterways, stinking up the landscape for excessive periods of time. Small carrion eaters just cannot manage to fulfill the role of the vulture adequately.
So let us restrict the animus to those human vultures who torment the weak and dying members of our tribe.
