87-year-old woman who supposedly didn't want CPR got CPR regardless

[HiPointDem]

Last edited Fri Mar 8, 2013, 02:05 AM - Edit history (2)

Brookdale Senior Living owns Glenwood Gardens, where a staff member refused to give 87-year-old Lorraine Bayless CPR. The family recently gave a statement to the media:

Like so many Seniors, it was our mother's wish to live independently. She was fully-aware that Glenwood Gardens did not offer trained medical staff. Even so, she personally-selected the senior living community, and our family has come to know the staff and been very pleased with Glenwood Gardens as her home. It was our beloved mother and grandmother's wish to die naturally and without any kind of life-prolonging intervention.

http://www.bakersfieldnow.com/news/local/Statement-from-family-of-elderly-woman-denied-CPR-195476801.html#familystatement

But Lorraine Bayless *did* get CPR -- from the EMTs who responded to the 911 call:

Bayless did not have such an order (a "do not resuscitate/DNR" order) on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.

http://www.huffingtonpost.com/2013/03/04/nursing-home-cpr-case_n_2804575.html

The incident report states, "The facility was refusing to initiate CPR..." A do-not-resuscitate order was not present in Bayless' paperwork, the report states.

http://latimesblogs.latimes.com/lanow/2013/03/family-backs-nursing-home-that-refused-cpr-to-dying-woman.html

The evidence suggests that the facility didn't know or care what the deceased's wishes were -- if they had, they wouldn't have called 911 and wouldn't have allowed the EMTs to give CPR.

They didn't have a DNR on file and likely no such files existed for anyone in "Independent Living" because as management initially stated quite clearly, they don't give "medical care" and limit their involvement in emergencies to calling 911. So for them it's irrelevant whether the person has a DNR or not.

Glenwood Gardens "is an independent living facility," which by law is not licensed to provide medical care to any of its residents," (Christopher Finn, spokesman for Brookdale Senior Living) said in a statement.

"In the event of a health emergency at this independent living community, our practice is to immediately call emergency personnel for assistance and to wait with the individual needing attention until such personnel arrives," (Jeffrey Toomer, executive director of facility) said in a statement.

http://latimesblogs.latimes.com/lanow/2013/03/family-backs-nursing-home-that-refused-cpr-to-dying-woman.html

So any defense of this facility's policy which begins by saying residents "don't want CPR" and "get the death they want" is bullshit -- because they *do get* CPR.

They just get it later than they would if the facility were willing to initiate it. And later means less likely to be successful, & more likely to have a bad result even if partially successful.

So if people don't want CPR, they get it; if they do want it, they can't get it immediately after an incident when it is most likely to be successful.

The worst of all possible worlds.

Yet apparently many "democrats" find nothing problematic here.


Why does it matter?

Tennessee-based Brookdale Senior Living (NYSE: BKD) is the largest owner and operator of senior living communities in the United States, with over 645 senior or retirement communities in 36 states.

They operate under various brands; in my state they have 22 facilities & operate as "Claire Bridge," "Wynwood," "Villas," "Park Place," and "Foundation House". Their specialty is upmarket facilities and tiered care on one campus (independent living to Alzheimer's care). Charges start at about $2500 a month.

http://www.brookdaleliving.com/


A Washington state news outlet tried to find out more about their policies locally and got confirmation from corporate that "no CPR" was indeed corporate policy:

Nurses at the Lynnwood (WA) facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.

http://www.komonews.com/news/local/Assisted-living-nurses-not-required-to-give-CPR-to-dying-residents-195180431.html

Brookdale is trying to have it both ways.

1. They justify their policy by lumping CPR with "medical care". CPR isn't medical care; it's commonly given by unlicensed lay people without medical training.

2. They say they aren't required to have people trained in CPR at their independent living facilities, but in fact they do have trained people, such as the nurse who made the call; they just won't let them to do CPR.

3. They say "independent living" is like living in an apartment in the community. However, few apartments have community dining rooms where meals are served by the apartment owners. The woman collapsed in the dining room. If she'd collapsed at a restaurant it's unlikely the chef would have called 911 while refusing to allow anyone to initiate CPR, as the nurse in this case did.

How far does this "no medical care" rule go? Would staff also refuse to do the Heimlich maneuver if a resident choked at the community meal? Would they have let her choke until the fire department arrived, and let *them* do the Heimlich?

4. The corporation's website's Independent Living pages promote that product in a way that doesn't suggest an "apartment in the community":

Other more tangible services and amenities of independent living communities vary by community, but may include housekeeping, maintenance, meal plans, transportation, valet, companion services, paid utilities, cable television, emergency call systems and activities/events.

http://www.brookdaleliving.com/independent-living-choice.aspx

Brookdale also operates Innovative Senior CareSM (ISC), a fully-integrated therapy organization that serves residents in on-site clinics within the communities. With ISC, residents have opportunities to enhance fitness, improve health, or regain independence.

http://www.brookdaleliving.com/independent-living-choice.aspx

Your personal pathway to health and sustained wellness is facilitated by our in-house Innovative Senior Care team of professional therapists. And if you need occasional supportive services, our Personalized Living associates are ready to help.

http://www.brookdaleliving.com/independent-living.aspx

The family says the woman understood this policy and was fine with it. I have no reason to doubt it, but is it good policy to rely on what families say after a resident has died? That seems to leave the door open for abuses by the facility and by families.

Do residents understand that 'no medical care' also means 'no emergency assistance'? Do they understand the implications of such a policy, being: If you want emergency assistance, you won't get it until it may be too late to do any good, and if you don't want it you'll get it anyway?

How would anyone know if residents really understand if there's is no explicit statement of this policy with their signature, and no DNR on file?

Is it really enough for a family to say "she knew" after a person is dead?

5. Furthermore, Brookdale's "independent living" facilities are marketed as "active living" arrangements, not as facilities for people who are eager for death.



(Frail seniors with easily broken ribs, desperately longing for death because all their friends have died, interviewing for a spot at Brookdale Senior Living. Would you give CPR to these people?)


How does their advertising jibe with their blanket "no CPR" rule?

Our independent living communities, including life care retirement communities, are designed for people who choose to pursue their lifelong dreams in an engaging social environment, who have passion for life, and active living with purpose. At Brookdale, our story is about helping you continue your story and what's most meaningful to you in life.

In addition to generous personal space, Brookdale Independent Living communities provide you with dining rooms, game rooms, libraries, swimming pools, computer rooms with Internet access, gift shops, cafes, convenience stores, art studios, fitness centers, wellness centers, guest suites and more. At a Brookdale active living community, there truly is something for everyone – especially you!

http://www.brookdaleliving.com/independent-living.aspx

I find it very troubling that the largest "retirement living" corporation in the country has a blanket "no CPR" policy in its independent living facilities.

Troubling too are the corporation's obvious 'cover your ass' manuevers (first it defends the woman who spoke to 911 saying she followed policy, then it says she misunderstood the policy and is on leave; it says she was 'acting' as an administrator but won't say whether or not she was a nurse, etc.)

Why would any supposed "independent living" facility have such a policy? These expensive facilities always have staff present, lots of staff, and the staff has lots of interaction with residents. Why would the corporation mandate that the staff couldn't give CPR? What is the purpose?

It's also troubling that some media accounts are taking pains to 'normalize' this situation. From Forbes:

The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn

(Forbes, the corporate tool, will tell us what *we* 'should learn')

"Mrs. Bayless did not want life-prolonging medical interventions, and her family is fully satisfied with the care she received. And the staffer who called 9-11 may not have been a licensed nurse at all. One piece of the story is true: Glenwood Garden staffers are prohibited from performing CPR or other medical interventions and are instructed to call 9-11 in the event of emergencies."

(The facility did nothing wrong, the woman wasn't a nurse anyway, and the facility has this unproblematic rule.)

"If you or a loved one live in residential care, here are five lessons to learn from this episode:"

(The corporation's rule is not the problem; you are uniformed and need to learn how to deal with the rule.)

"Independent living communities are not nursing homes or assisted living facilities. You should not expect them to provide medical care or even personal assistance."

(This is the normal way of things.)

"One CCRC director told me her staffers are trained in first aid but her facility’s lawyers urged her to instruct employees to always call 9-11."

(A CCRC is a continuing care retirement community. You pay a huge fee and are supposedly guaranteed to be able to 'age in place,' adjusting your level of care from independent to assisted to skilled nursing as you degenerate.

If Forbes is saying that this CCRC doesn't give emergency assistance, that would certainly generate a lot of profit! Good for the CCRC if the resident dies in 'independent living' and skips the more expensive assisted living/nursing care parts after ponying up that hefty fee....)

http://www.aarp.org/relationships/caregiving-resource-center/info-09-2010/ho_continuing_care_retirement_communities.html

"You should distribute advanced directives as widely as necessary. Remember, people cannot follow your wishes if they don’t know what they are. The best outcome for Mrs. Bayless may have been for the staffer to not call 911 at all but rather to hold her in her arms until she passed away. But she had to know that."

(Except that, according to Brookdale, this is not a 'care facility'. It's an Independent Living facility. And they don't keep advanced directives on file -- because it's 'like living in an apartment'.)

Is it just me, or does the vision of dying in the arms of some corporate employee "holding you" as one of the services offered by a fancy facility with a blanket policy of "No CPR" kind of creep you out?

[hlthe2b]

1. I think this is emblematic of "corporatist ethics"-- i.e., no ethics at all.

[HiPointDem]

2. i agree. but apparently it's the wave of the future, as a number of supposed 'democrats' think

this is just peachy keen a-ok.

[HiPointDem]

4. Dozens of democrats, trilling about how the woman 'got the peaceful natural death she wanted'

when actually, she was given CPR.

I guess it's more peaceful when you get to lay sprawled on the floor of a public dining room as a nurse argues with the 911 operator over whether to give you CPR or not, while waiting for the medics to arrive and -- GIVE YOU FUCKING CPR.

[niyad]

3. k and r--and you are correct, that vision of dying in corporate arms is creepy. and, didn't a

number of people point out that the person making the call sounded completely indifferent and uncaring. yeah, that is the person I want holding me as I breath my last.

(hmmm, considering the loss of bodily function at the last, maybe there are a couple of people I would consider holding me. . .)

[HiPointDem]

5. it seems we're in the minority. i'd like to pee on a few people too.

[WCLinolVir]

6. It is horrible that they are allowed to do this.

People get into denial, or have no understanding about what they need in an emergency and how quickly they need intervention. We don't want to think that we will need intervention, but the family stating after the fact what her preferences were, is a little weird. Advance directives are important. I can imagine the soft sell on the no CPR policy. We have trained responders locally who will be notified in the event that you need help. What they won't tell you is that you will be dead when they get there. And they will be busy pro-rating your end of stay.
I hope people leave in droves.
But please, do not refer to elderly as

(Frail seniors with easily broken ribs, desperately longing for death because all their friends have died, interviewing for a spot at Brookdale Senior Living. Would you give CPR to these people?) "

It is demeaning to do so. I don't know any senior who was longing for death. Most have families and ties to the community who value them.

[HiPointDem]

7. i am mocking people on other threads who keep insisting seniors shouldn't be given cpr because

they are 'frail,' have ribs that break easily, and all their friends have died so actually they just want to die.

i'm not kidding.

[HiPointDem]

8. and kick

[dixiegrrrrl]

9. "but won't say whether or not she was a nurse,"

Several other news outlets report the staff member in question was not a nurse and that they do not have nurses in the facility.
It has also been reported that the woman who died had chosen the facility because of the DNR policy.

I am not "creeped out" at the idea of having a DNR and/or a living will. I have both.

Emergency techs however are not bound by such a directive, altho hospital nurses and docs are.

"One CCRC director told me her staffers are trained in first aid but her facility’s lawyers urged her to instruct employees to always call 9-11."

I have been trained/certified in first aid/CPR, annually, for years, and part of that training to always call 911 and then do CPR until help arrives. I see no conflict in the statement above.


This is a very good reminder for people to make sure they understand the difference between a "nursing home" and an independent living facility. The most obvious question should be about medical staffing.

We have both kinds of facilities in our town, both locally owned.

[HiPointDem]

10. They *do* have nurses at this facility, lots of them. If this woman wasn't a nurse, why

Last edited Thu Mar 7, 2013, 12:19 PM - Edit history (1)

did she claim to be one?

And why won't the management say she wasn't a nurse, instead of "she was acting in the capacity of director of resident services"?

Glenwood Gardens is a single facility with multiple levels of care in separate sections.

Glenwood Gardens located in Bakersfield, California offers Independent Living, Personalized Assisted Living, Alzheimer's and Dementia Care, and Skilled Nursing Care options for seniors.

http://www.brookdaleliving.com/glenwood-gardens.aspx

Furthermore, this facility is not locally owned, but corporate owned, the largest such corporation in the country, with 700 facilities in 36 states.

And it's their blanket policy not to give cpr to anyone in independent living.

[HiPointDem]

11. Please link me to a story which says definitively 'she was not a nurse' which includes the source

of that information. I have not seen that.

The 'independent living' section of this facility does not have a DNR policy. It has a "No CPR" policy. The family claims the woman chose this facility knowing its policies because she didn't want medical intervention.

However, there is nothing on file to verify that. She did not have a DNR order on file, or a living will.

Emergency techs in california are in fact bound by a DNR order:

What happens when paramedics or EMTs respond to a person with a DNR order?

If the person’s heart or breathing has stopped, there is a valid DNR order and the patient does not want treatment, paramedics and EMTs will not try to restart the heart or breathing.

The types of treatments that a patient with a DNR order would not receive include cardiopulmonary resuscitation (chest compressions and mouth-to-mouth breathing, or CPR), electric shocks to the heart, assisted breathing with mechanical devices, or the use of medications intended to start the heart again. (A person would not be placed on life support, such as a ventilator or a breathing machine).

http://healthdisasteroc.org/ems/issues/dnr#1203

[dixiegrrrrl]

12. ABC news, here: halfway down the page

"Although the woman identified herself as a nurse on the call, she was later reported to be a resident services director at Glendale Gardens. "
http://abcnews.go.com/Health/bakersfield-police-criminal-charges-death-woman-denied-cpr/story?id=18666182

[HiPointDem]

13. The staff member was "serving in the capacity of a resident services director, not as a nurse,"

said Christopher Finn, a spokesman for Brookdale Senior Living, which owns Glenwood Gardens.

Finn would not comment on whether she was licensed as a nurse.

http://latimesblogs.latimes.com/lanow/2013/03/family-backs-nursing-home-that-refused-cpr-to-dying-woman.html

"Serving in the capacity of resident services director" does not mean she wasn't a nurse. It just means she wasn't doing direct patient care.

The fact that the spokesman won't say whether she was a licensed nurse is telling (it's fairly common for such facilities to be administered by nurses, or former nurses).

[LiberalFighter]

14. How much of a profit do they make on that $2500 monthly fee with no medical services?

[madville]

18. They aren't doing a very good job as a business

If they are letting people die, I'm pretty sure that hurts the bottom line since they are no longer getting payment. Kind of counter productive.

Or it might be like the facility my grandmother lives in, they have a long waiting list, one dies and another is lined up to come right in. She loves it and the community there, the staff is very nice. She has a DNR on file, doesn't want any machines or CPR.

[Starry Messenger]

15. k&r

[HiPointDem]

16. kick

[dsc]

17. My grandmother lived in one of these for a few years before she moved in with my aunt

These facilities usually require you to be relatively healthy. You can't be ill enough that you can't make it to the dining area for more than a certain amount of time (I think hers was a week, maybe two). If you got that ill you were made to live in a nursing home and not the assisted living facility. My grandmother moved out precisely because she began to fear that she would be ill enough to need a nursing home. Given that the whole DNR thing does baffle me unless the lady was mentally unwell with dementia.

[HiPointDem]

19. as you say, independent living = healthy elderly. so that would preclude dementia i'd think.

very odd to have a blanket 'no cpr' policy for a generally healthy population.