By now, it’s likely you have heard the news story about the nurse who refused to do C.P.R. on a retirement community resident who later died.  Sally Abrahams did a good review of the story on her AARP blog.  It was a startling story for many and readers weighed in all over the internet with comments.  The reactions range from shock and anger that this nurse would not perform CPR to questioning the facility’s policy and contemplating the senior’s status regarding wishes (i.e. did she have advance directives or a DNR?).  Rather than delve in to the facts of this specific case, we’d like to broaden the discussion to a number of important issues for all families to consider.  Here are a few key take-away lessons and tips for families and elders:

1. When it comes to choosing a retirement community, understanding what you’re getting is vital.  Your best bet to cutting through the array of choices is to hire a care manager to help.  Even the reporters of this story were quite confused about the type of facility in question here, reported variously as a CCRC (Continuing Care Retirement Community), Independent Living Facility and Retirement Community.  Each state has different regulations for different types of facilities, and beyond that of course there is a wide range of care quality and scope. It can take a lot of research to figure all of this out, and it can still be hard to know all the questions to ask without some help.  Contact us at 727-447-5845 to talk about how we can help, if you are looking at Florida senior living options or retirement communities in Tampa Bay.
2. “Level of care” is a confusing issue for the public and families.  Facilities provide different levels of care, from the broad categories such as independent living and assisted living to specialty licenses and extra services. The big question is: what should I be expecting and how does this fit with what my aging parent needs?  It sounds like perhaps in this family’s case they did understand what this facility provided (and didn’t) and accepted the limitations, but often this is not the case.  “Level of care” is not only understanding what an elder may need, but also knowing when that level of care may no longer be sufficient and what your expectations should be in different scenarios.
3. Independent living retirement communities are often misperceived as offering more assistance than they are designed to provide.  Residents are entering retirement communities at later ages with more needs.  For a number of reasons, elders or their families may not be clear on the parameters of a retirement community.  The facility may indicate these issues on a contract, but during the emotional time of a major move the detailed parameters may not be evident.
4. Regardless of senior living situation, advance care planning issues must be addressed.  While we don’t know the status of this person’s advance directives, it is a reminder about the issues of resuscitation and life support.  C.P.R. is addressed through a document called a Do not resuscitate order (DNR) which is a doctor’s order and handled very specifically (by each state’s laws).  It is not included in other types of advance directives (though a person may state preferences and provide guidelines in those documents, the DNR is needed in order to direct emergency personnel not to start resuscitation). These are important issues to talk about with your family members and medical providers.  Make sure you really understand the documents you complete and the laws and policies about treatments and life sustaining measures.

Some additional resources and notes on senior living, C.P.R. and advance care planning:

Independent living retirement communities are especially misunderstood many times, because they may offer some supportive services on-site but should not be mistaken for a healthcare facility.  Most of the time a purely independent community is not regulated by state requirements that other healthcare facilities are, but is viewed just like an apartment complex.  For the various levels of care for assisted and nursing care in Florida, you can check out our overview of Florida Assisted Living Definitions.

Guide to Choosing the Right Assisted Living Community for You

Florida Department of Health Information about D.N.R.: Top Questions about Do Not Resuscitate Orders such as who should have one, the legal requirements, and the differences between a living will and do not resuscitate order.

Family Caregiver Alliance offers a helpful overview regarding end-of-life choices regarding C.P.R. and D.N.R.  It is useful to read some information about C.P.R. and the elderly and talk to experienced professionals, as many people have misperceptions about the process of resuscitation (and the realities of it for frail elders).  This is one of the issues our care managers often talk through with clients and families, to help gain a fully informed perspective.