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Pros and Cons of “Do Not Resuscitate” Orders in Nursing Homes

Do you have an elderly parent or loved one who has survived cardiac arrest in a nursing home or assisted-living facility? A recent post in the New York Times blog “The New Old Age” suggested that recent medical studies show encouraging results for patient survival after experiencing a heart attack or other medical situation requiring resuscitation. This new study may have implications for certain patients’ medical decisions and advanced health care directives in nursing homes and assisted-living facilities.

In many cases, elderly patients have already made “do not resuscitate” (DNR) decisions, indicating that, in the case of cardiac arrest, the patient does not want to receive cardiopulmonary resuscitation. Depending on the type of “code blue” that the patient experiences, resuscitation can involve either an electric shock to the heart with a defibrillator, or a medication that’s intended to restore circulation. While cardiac arrest in a medical facility is “more often than not a killer,” you have a greater chance of living through the incident than in years past, and some doctors suggest that this may be a good reason to re-think a DNR decision in your advanced health care directive.

Study Shows Better Odds for Resuscitation Patients
A recent study in the New England Journal of Medicine shows that for older patients admitted to a hospital for cardiac arrest, approximately 18 to 20 percent left the hospital alive. This statistic may seem grim, but it’s actually a significant improvement from previous survival rates in the early 2000s. Of the group of patients who left the hospital alive, the study found that 58.5 percent were still living a year later, and 48 percent of that group had “little or no neurological impairment.”

While brain damage often is significant in cardiac arrest patients, Dr. Paul Chain, the lead author of this new study, finds the results to be a “reason for hope.” He said, “if you make it out alive, you have a significant chance of being alive one year later,” and he emphasized that the results suggest we may want to reconsider our opinions about resuscitation for elderly patients. Another clinical researcher, Dr. Benjamin Abella, echoed Chan’s position, indicating that “improvements in resuscitation done in hospitals have changed outcomes significantly, including among elderly patients.”

If many of these surviving patients had made different DNR decisions, they may not be alive today. However, the decision not to resuscitate may still be the best option for some patients in nursing and hospice facilities.

How Do DNR Decisions Affect End-of-Life Care in Nursing Homes?
Last month, an article in the Seattle Times suggested that a patient’s ability to make a DNR decision might not be upheld in nursing facilities or other long-term care residences. For elderly patients at the end of life, a DNR order may allow them to pass away peacefully, without unnecessary invasive medical procedures.

For example, in Washington state, nursing-home patients can fill out official forms called “Physician Orders for Life-Sustaining Treatment” (POLST), which allow them to decide whether they want to be resuscitated in the event of a heart attack or other “code blue” situation. The story in the Seattle Times referred to the form as a “sort of portable do-not-resuscitate order that could go with end-of-life patients wherever they went.”

However, some state laws have legal “loopholes” that patients can fall into. In Washington, the state informed nursing-home providers that they “might not have legal immunity” if they abided by patients’ DNR orders. In the sickest and oldest patients, DNR orders are “essential tools” for these elderly patients who “want death to occur naturally at home.” When they’re given electric shock, medications, and CPR despite their own wishes, they can face “very invasive, very painful, [and] very unpleasant care.”

Often, advanced healthcare directives can ensure that your loved one receives the care that she or he plans for in the case of a “code blue” situation. Do you have questions about DNR decisions, advanced healthcare directives, and patients’ rights in California nursing homes? Contact one of our experienced attorneys today to discuss your concerns.

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