DNR

maifleur01

My husband has been in a nursing home for over a year. Recently he has developed a bad cold and they asked about sending him to the ER. I posted on another thread. "Found out Saturday that the nursing home my husband is in does not honor the DNR portion of my husband's living will. They just told me that they must have their own form countersigned by the doctor approving it. Nothing was mentioned when I gave them a copy a year ago. If anyone has a loved one in a nursing home please check with them about if they honor it. From my "discussion" apparently even a straight DNR would not have been accepted." Each state has their own laws about DNR's and how they are handled. When my parents were alive there Doctor would never have countersigned a DNR request.

For anyone perhaps thinking his Living Will was not a legal document it was signed, witnessed and notarized when he was in the hospital for a different problem.

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bpath

Maifleur, I'm so sorry for the difficult time you are in! This is good information for others. My parents are still living in their home; dad has a DNR, but mom wants every possible life-sustaining action taken. Whenever we go to the ER or admission, the staff give me a look when she tells them this. So now she is worried that they -- and her family -- won't honor that request. As we look at new living situations, your experience will be a good reminder of one more thing to verify. ((Hugs))

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maifleur01

Thank you for commenting. Having seen so many people that are not aware of how things work or like in this case how things change I post to hopefully help others. Some no doubt think I am playing the "pitiful me" until they have to face some realities that no one really wants to face. You would have to check with an attorney but depending on your dad's condition a POA for medical issues might help. This depends on your state laws. Sometimes a spouse's wishes will override all legal forms. In some states a blood relative's wishes will also override them.

You have at least two problems. By going to the ER they must do what is necessary at that time to treat the condition. In some cases that means overriding the DNR. Giving oxygen vs inserting a breathing tube is a easy example. The other is having a serious talk with your mother which will be more difficult. Start by asking her questions like, does she wants him in pain. Then lead into why doing what she wants only causes him additional pain. People understand pain more than understanding that they will not be alone. Even people who are dying worry about leaving their loved ones alone after death and like to be reassured that someone will care so reassure your dad.

These are things that my husband and I talked about which alas his children are having problems with.

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raee_gw zone 5b-6a Ohio

A common misconception is about what a Living Will covers. If the one for my state is consistent with others, it only covers a situation of permanent unconsciousness without hope of recovery -- in that case life sustaining treatment, including artificially provided food and water (via tube), is to be withheld.

Another common misconception is that DNR means no treatment. It does not -- it only means that in the case of cardiac arrest, CPR will not be given. So having simple DNR status will not rule out transfer to a hospital, or life-sustaining treatment in an emergency room, and does not mean that providing such treatment is over-riding the DNR.

In my state we have 2 classes of DNR. One is DNR in case of cardiac arrest (DNR_CCA) which means that treatment is to be given up to and until a cardiac arrest occurs. This usually means that a breathing tube would be put in and a ventilator used, unless "Do Not Intubate" has been specifically stated. The other class is DNR-Comfort Care (DNR_CC), which means that life-sustaining treatment will be held, and comfort measures only provided. This is particularly appropriate for people with terminal conditions, and is frankly underused in those cases. However, people can choose to have some treatment and not others, according to what they feel would be appropriate for comfort -- to reduce suffering. So one may choose IV fluids, for example.

But, these orders do need to be signed by an MD -- after that, they are valid and transfer with the person wherever they are. In my state, a facility cannot refuse to honor a previous DNR. Of course, they can be revoked by the patient or POA, or if family insists.

I am sure it varies region to region, but in my community, if the patient cannot speak for himself, and family is present, whether there is already a DNR order or not, the family's decision whether to treat or not will be respected. More often it is a case of families themselves choosing life support when a patient has previously expressed refusal (in my experience). If there is no one available (even by telephone) to ask, then treatment will be given unless there is a valid DNR_CC documentation from the nursing home or on record. ERs do not routinely override DNR_CC -- usually it is a case of not being informed of the status in an emergent situation.

A POA (with an accompanying thorough discussion) is an excellent thing for everyone, not just the elderly.

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maifleur01

I would not have had some of the problems I have had with a POA but you have to be wise with who you give it to. I worked as a bill collector in my career. I saw too many people taken advantage of by near relatives or close friends after a person gave a POA. There are several types of POA that I know of and probably more. Blanket POA covers everything. Medical POA covers medical care. Financial POA. You can give the last two to different people as long as within the documents it is stipulated that medical care will be paid. I have seen someone bankrupt the person that they were supposedly caring for using all kinds of medical quackery. Would not have mattered it that person had been single but the spouse was left with only a small income to live on after everything was sold to pay the debts.

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raee_gw zone 5b-6a Ohio

Very true, Maifleur. I was thinking only of a medical POA (Durable Power of Attorney for Health Care) which only give the right to make decisions about or consent to medical care, not to handle money, pay bills, or deliver medical care -- although of course someone unethical could partner with a medical quack to get kickbacks.

It is a serious choice, and you have to be sure that you and your choice understand each other and are of like mind, especially when it comes to end of life decisions. I actually wrote down my wishes on the POA form so that there would never be any question. (Hmm, maybe I should add a blanket refusal of any "alternative" health care?)

Something else many, even the medical residents at the hospital, often fail to understand is that the POA does not give the POA person the right to overrule the patient, or make decisions for the patient, if the patient is able to do so for himself. It only goes into effect when and if the patient is not able to understand and make decisions.

BTW, I'm going into such detail for the sake of any future readers of this thread -- not because I think you don't understand, Maifleur!

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