Why would a caregiver not honor my mom's POLST?

Why? Probably because it is confusing and traumatic to be in charge when someone is unresponsive, and the caregiver was following the direction to call 911 and then was following the direction she received there. She should have said, "I can't do that. There is a DNR on file for her. I'll wait with her until the EMTs arrive." But she simply followed their direction. I doubt this was in any way malicious, but whether it was a matter of insufficient training or a panic response would be hard to say based on what you've stated.

Chest compression on a frail 88 year old bedridden dementia patient with a DNR on file? Lordy, what was she thinking? How is your mother at this point?

I am glad the owner followed up and got back to you with the truth. Perhaps that is a good indicator that increased training will follow.

I am so sorry this happened to your mother, and that you are now having to deal with the consequences.

I feel incredibly sorry for that caregiver, and I hope she is being treated kindly.

First off, it is overwhelmingly unlikely that chest compressions carried out by a lone caregiver acting on the instructions of a 911 call handler would be enough to save a patient; CPR is rarely successful even in skilled hands. So the inference is that this was not, after all, your mother's time to go. I'm still sorry that your poor mother had to endure being thumped around like that, it's no way to treat a frail elderly lady.

Secondly, as a human being, let alone as a paid caregiver, one's instinct to seeing another human being in distress is to help. It is not to stand by and think 'rules is rules.' The caregiver responded instinctively.

What she needs is better training in taking a step back and following a protocol, rather than stepping in and intervening; and her employers ought to have seen to it. I hope the licensing board will follow that up effectively.

There was a huge uproar a couple of years ago when a 911 dispatcher instructed a caller from a California senior living facility to start CPR and the caller refused. All residents at the facility had signed DNR orders. The dispatcher was quoted as saying something to the effect of "If you are going to let this woman die, is there anyone there who will try to save her?" Her family said not performing CPR was in accordance with their mom's wishes, but that didn't help stem the outrage. Maybe the caregiver was aware of that event and was afraid the same thing would happen to them if he or she ignored the dispatcher.

My Dad collapsed with sudden cardiac arrest at 63. He and my Mom had discussed his not wanting life saving measures taken as he had had several heart surgeries, defibrillator, stents, etc. When he collapsed, my Mom, being an retired RN, knew that he was gone. She did call 911 and was bullied by the operator for not performing CPR. The operator was adamant that my Mom go out there and perform CPR. My Mom continued to refuse. Had my Mom not had an RN background, she probably would have started CPR based upon the insistence of the 911 operator. Its a no win situation because the operators are trained to "make" an unwilling caller try to take lifesaving measures. Otherwise they could be held liable for the death of the patient. Either way its a horrible situation no matter which end of the phone line you are on. You just don't know what you are going to do in a situation until you are there.

As an aside, my Dad's cardiologist said that my Dad was more than likely dead before he hit the ground and CPR would have been of no value and traumatic to my Mom.......

My mother, aged almost 98, was checked into a rehab facility this week following an "aortic hematoma." She has had a DNR on file in the past, but no one can find it now. At check in, the nurse asked her if she wanted CPR, etc., if something happened and she said "yes," so I've let the family know and we will, of course, abide by her wishes. However, I know she has no idea what it involves. Should the nurse have explained it to her in detail? Should we?

jeannegibbs, thank you for asking how my mom is doing. She has had an eating/swallowing evaluation and they are going to start giving her some food. She is in an isolation room with positive MRSA culture. She has a lot of bruising. She has answered correctly the number of her children, but everything else is incoherant. Doesn't want to wake up. This has caused my brother and I great grief, she was so ready to go to her husband and was praying for that daily. I am having a hard time inserting sympathy for the caregiver into this equation.

I guess I wondering, NOT why CPR was performed, but why 911 was called.

Is you mom on Hospice? Are you thinking about involving Hospice in her care at this point?

BarbBrooklyn, she will be on hospice upon discharge. I finally got a qualifying diagnosis after a few attempts.

When my mom started a day care program she was asked by the staff if she wanted life saving measures. Her reply? Of course. Why would I want to leave my wonderful family. UGH! She had a DNR in place but her verbal wishes overruled the document. Thank goodness life saving measures never had to be administer at day care or otherwise.

Kwy, even emergency responders will attempt to save a life, that is their job and what they are trained to do.

K watt, I am so sorry you had to experience this and your poor mom!
I hope she recovers soon and is able to return either to home or a SNF. I bet she is sore with bruising from going through the CPR and subsequent admission.
Will be thinking of you and she today...

KW, I'm glad that your mom will be receiving Hospice services. That will make it easier for the caregivers to know what to do. (((((Hugs))))))))).

maybe you should have made sure the caregiver knew t for sure ..around where your mother is have a big sign DNR & your polst maybe if it was to much to not DNR who ever it was put do not call 911 & dnr & polst .if to much just go out side for 10 minutes then call me = you to tell me what is going on ..but i do not know if that would agree with all there rules ..it might have been to much to handle to watch her go so going out side will get ?? ever mind off of it ..

My dad's renter, of the mobile home on dads property died in his recliner. I went to check on him and found him. I called 911 and the dispatcher tried to get me to take him out of the recliner and do CPR. I refused. He was obviously dead, had been. My husband touched him and he was cold. But boy, that dispatcher was adamant that I do cpr.

I have dnr instructions at the two hospitals in town. I have a tattoo. I also carry paperwork with me for when my husband and i go someplace away from here.

When i went to the er a couple years ago i told that to the emt who shrugged like ... so what.

Its a big yes/no decision ... no maybes. But i have heard stories like yours for years and want as good quality of life as possible not bad quality.

I sadly say to all of us ... good luck !

For all you who have elderly LO's: Atul Gawande's book, Being Mortal, goes into detail about CPR on old people. I think that chapter is available free on the internet for download. Maybe you could print it out, take it, and read it to your LO's. There is a form called 5 Wishes that is similar to an Advance Directive. Both are available online. Print them and take them along so you can have them with you when you are reading the chapter!! Get those filled out and signed, and make copies to give to every doctor and ER visited - and post on the wall of the facilitiy!

There was a good article about this issue on KaiserHealthNews.org.
khn.org/news/that-living-will-you-signed-at-the-er-it-could-be-open-to-interpretation/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=63756297&_hsenc=p2ANqtz--ZmuVv63bCRpuIZhYzBmdt1LfZON6Ihru2I9azdkajXFJjcUYvBw6GtdPJ0N-2CvMphRM1Byz3OOz1rNSj5_Kjvj0wUQ&_hsmi=63756297

I'm so sorry you had this happen to you and your mother.
Notes to others: I have found that every time my mother goes into a hospital, on and off hospice, you name it, her DNR needs to be examined, put in place with her caretakers, AL, doctors - really every six months it should be brought up and procedures gone over WHILE YOU ARE PRESENT. AL tends to go to my mother and ask her medical questions which she has not been in charge of for 3 years. It depends on how they ask the questions as to how she responds. This is one of the "being a pushy daughter" things I have realized I have to do for her care.

The 911 Operator's behavior is surprising and a wake-up call for all caregivers.

I had a different but related experience when my Mom went into cardiac arrest.

The senior nurse came up to me to ask me if I wanted to "override the DNR" to have them start CPR. It was an emotional, harried, time when I initially said "yes, go ahead". Fortunately, the doctor pulled me aside and explained the ramifications of compressions on a frail 87 year old woman. She let me rescind my request.

I could have handled the situation smoother if I had recently reviewed my Mom's Durable Power of Attorney for Health Care, or/and if I had a copy of the document with me in the hospital.

This situation led me to make some changes to my personal Durable Power of Attorney for Health Care. I added specific language on when NOT to administer CPR.

My situation also made me realize that having "the talk" about the intent and contents of my Durable Power of Attorney's for both Health Care and Finances.

BetsySue, A tattoo! What a great idea! Is there an established protocol for that which EMTs or anyone would look for or recognize? I'm thinking of a big "DNR" across the chest, which wouldn't be very attractive, maybe.

If a doctor has not written a DNR, there will be CPR. And if 911 is called, how can they be sure that there is truly a DNR document? You have to understand that in this day and age of so many lawsuits, disagreements between family members desires, that hospitals, facilities, 911 dispatchers must all protect themselves.

Anyone just filling out their wishes is not good enough. You have to have a DNR, and some states require 2 medical doctor signatures. So when the wishes - 5 Wishes Booklet or Living Will is completed and signed, you must then talk to the doctor when the time is appropriate to have a DNR. And then EVERYONE needs to know. In hospitals and other places, even at home with aides in and out, there is so much change in staffing that many times, someone could be covering for another nurse/aide while the one is on break, and I'm sure you could understand that in hectic areas communicating that someone is DNR can get missed. Sometimes death can occur quickly and unexpectedly so if someone is unsure whether there is a DNR, the mandate would be to perform CPR.

I recently got a call from my mom's facility begging me to let them send her to the hospital. My sister was not in Cell Phone range (they had tried to call her). I gave in. My sister convinced my I did the right thing (thank goodness we have agreed to go through this supporting each other). It's a new facility and they don't realize that the DNR is in her best interest. We moved her there because the memory care facility she was in kept calling 911. Now that the new place and doctor understand her condition better, we hope that this won't happen again.

I am not condoning anything by saying this, but it is quite possible that the caregiver didn't even know about the POLST---facilities that provide custodial care to elderly people are notoriously understaffed with minimally qualified people who may or may not know which patient is DNR & which are not. Furthermore, only doing chest compressions is not proper CPR & a person that is not CPR certified should not be doing ANYTHING like that in a facility like this.

I question why there isn't a nurse or other trained medical person at that facility that is called when a person is found unresponsive--doing chest compressions should only come after a proper assessment of breathing & the reality that one person can continue with CPR (not just chest compressions) until emergency services arrives. Your mother's heart apparently was beating, albeit weakly, likely due to the MRSA (which she got at that facility and should be a bigger gripe than the chest compressions, quite honestly--she would have lived with or without those chest compressions because she was still alive). How she contracted MRSA in a non-medical facility is a MAJOR issue---that means that someone else in that facility has untreated MRSA that has been spread to other people by caregiver(s) that have not washed their hands between touching the people there. I would have a much bigger concern about that issue much more than the chest compressions issue. It sounds like this "Board & Care" facility is taking in medically complicated people that they are not qualified or trained to handle. If someone there has MRSA that is not being treated, that is a MAJOR problem in my book. MRSA requires IV antibiotics, isolation rooms, gloves & gowns, very careful hand washing after contact, etc. Since you likely paid quite a bit of money for your mother to be there, you should be very angry about your mother getting MRSA there. That indicates totally inept care, poor housekeeping practices, lack of hand washing between contact with people. For the amount of money you were paying, that should not happen. If it were me, I would have scheduled a sit-down meeting with the administrator/owner of the place to discuss a refund of some of the money you paid---you paid for quality (non-medical) care, but they clearly admitted your mother when it is quite obvious that her needs exceeded what they were/are able to provide. To me, that is unacceptable. These places have money signs flashing in their eyes when they see somebody that can afford to pay to stay there and they will often take people that should not be there. "Assisted living" means that a person needs "assistance"---meal prep, laundry, social activities--someone that is 95% bedridden with severe dementia needs far more than "assistance", they need skilled nursing care.

I am not familiar with "Board & Care" facilities since I live on the east coast, so I looked it up & found that it is the same as what we call "Assisted Living". The way you describe your mother's condition--frail, severe dementia & basically bedridden--she did not belong in that type of facility to begin with. That type of facility cannot possibly have the type of care that she required/requires---just the fact that she is basically bedridden would require staff to turn & position her regularly to avoid bedsores. If she is incontinent, her underwear would require changing frequently.

I do hope that when she is discharged from the hospital that you don't put her back in that "Board & Care" facility. Try to get her into a hospice facility. If the "Board & Care" facility can't get CPR correctly, they damn sure can't get hospice care correctly either. Furthermore, unless she is in the care of family that would sign for responsibility of her care, I am not sure about the legalities of a non-medically trained person administering hospice medications like morphine to her, since that is considered medical treatment & "Board & Care" facilities do not provide any medical care. I would be very leery of any non-medical facility telling you that they can handle whatever hospice orders. People on hospice need more direct monitoring so that care can be provided. I don't think this "Board & Care" facility can meet her needs now.

Report the care facility to the proper authorities of licensing.
I just had to place both my Mother/Step-father with an assisted living group home.
They require this information and are legally bonded to follow the directive.
Your Mother is MOST LIKELY being taken to a hospital that the facility has contracted, so they're making money billing Medicare/Medicaid and any other health insurance you may have for your Mother.
You may want to find another facility. This one is being negligent to your Mother's wishes as well as scamming, but people are too afraid to stand up to facilities caring for a family member because that could create Elder Physical Abuse, not giving needed medication etc.

Go to the hospital where they are taking her. Go to the Director of Patient Welfare, give the Director a copy of the Directive. Then inform him/her that IF they do not follow this Directive they will be changing the name of the hospital because YOU as your Mother's agent have the right under HIPAA to SUE THEM.
I would also ask to see the records as to WHO has signed her into the hospital, the attending doctor(s) AND DEMAND A MEETING WITH THE DIRECTOR OF THE HOSPITAL NOW!
You'll get the run around, but screw that; go to his/her office start out politely to see the Director, do not take NO for an answer. As this goes back/forth become more agitated until you get what you want. Get the phone number of the Hospital Board Director and go to him/her. You may find that information in a brochure. It will provide you with the name, occupation AND the name of the company he/she works. Just go down that list.

TRUST ME....you'll get your answers.

My mother has late stage dementia and heart disease and is now in Hospice. In this very long battle I have made sure all involved have a copy of her DNR. At this stage, Hospice is in charge of any emergency and should be the only contact besides myself. When I came to the ALF recently and found my mother trying to stand on her own I was told: "Don't worry, if she falls again, we'll call an ambulance like we always do." My God, you have to stay on top of everything for your loved-one to get the care she deserves!

The answer to your question is held in the head and heart of the caregiver. During the time I have worked with families, only to have this same question come up I have found several answers some overlapping. Although I advocate very strongly for individual rights be upheld. The main reasons I have found for this behavior are, religious beliefs, feelings the individual was push into signing or did not understand what they were signing and a reaction to the situation. In the same situation this kind of reaction has been made by EMS, doctors, lawyers, judges and individual family members (not all families can agree on this question). Was this a proper answer/action, I do not believe so. However, there are so many questions you may never have an answer that will be satisfactory. You are now in a situation where your actions must be calculated to provide the care your mother desired. Give this very careful consideration and move ahead with your knowledge of your mother wishes. Do not try to come up with an answer for the why and how of the caregivers actions. You are in one of the most difficult transitions of your life. Move ahead with full believe in your heart the next actions are what your mother wanted. Focus on family and loved ones during this time. Take the caregiver's actions to to the garden and bury them, at this time. You will have plenty of time to reflect later.

The caregiver called 911 and the 911 Call Center personnel told the caregiver what to do regarding CPR: Hands--Only CPR.

The American Heart Association (AHA) developed "Hands--Only CPR" in response to people refusing to perform the mouth-to-mouth breathing portion of CPR because they are/were afraid of getting an infection or illness from the person who is lying on the ground. The American Heart Association along with fire departments and hospitals throughout the US are promoting this version of CPR.

According to the AHA website: "Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting (such as at home, at work or in a park). It consists of two easy steps:
1. Call 9-1-1 (or send someone to do that).
2. Push hard and fast in the center of the chest. "

See the American Heart Association website for more information: https://cpr.heart.org/idc/groups/ahaecc-public/@wcm/@ecc/documents/downloadable/ucm_493890.pdf

In regards to a tattoo that states "Do Not Resuscitate" or "DNR". IT might NOT be HONORED!! In the 1980's or 1990's, a RN got a tattoo on her chest that stated: "DNR" or "No CPR" (I don't remember which) with her signature copied onto her chest. She was told by the EMTs at the Fire Dept. and by the Hospital ER Dept., that if she collapsed and wasn't breathing and had no pulse, they would STILL HAVE TO DO CPR, because the TATTOO was NOT A LEGAL DOCUMENT--the tattoo had NOT been "Notarized"!

Your poor mother, CPR on an elderly person usually breaks ribs and the sternum. My heart goes out to you and her.

As has been discussed here. When you are under Hospice, you do not call 911, you call Hospice. When 911 is called, they have to try and save the person's life. It is the law. Otherwise, why call them? To me, this is why you want to get your loved one on hospice. If they are in a facility, get them at least on Palliative care. I just went through this with my Aunt. Thank God she was still coherent when she was admitted and she told them herself she did not want to be resuscitated, and get the oxygen mask off her face. She was admitted to Palliative Care and when she died, we held her hand as her heart stopped and she quit breathing.

My father died at my house back in 1974 before hospice. We knew he was terminal, when he died, we called his doctor who came out, pronounced him dead and we called the mortuary.

A POLST can oppose your wishes. Let's say you go into the hospital with a clear advanced directive that says you want to be resuscitated and you do not want nutrients withheld. You've made the decision after careful consideration and you went to great lengths to ensure that it is documented correctly. A POSLT, however, can override your directive and, even worse, the person who makes the decision (signs the POLST) can be someone you may not have ever wanted to do such.

realtime, your mother should have the discussion about CPR with her doctor. My mom, when first answering the question of CPR, said that medical personnel could try a little bit. The doctor explained that it didn't work that way, that they would likely use CPR techniques for a more extended period of time and that it often results in bruised and broken ribs, etc. When put that way, she then decided to decline CPR. In Massachusetts, a MOLST form must be signed by a doctor anyway, so having a doctor explain all the choices short and long-term is easy and it is clear that the patient is properly informed. It also helps to know that at any time in the future, a change can be made as long as a doctor signs, so if the patient's condition changes or they have a change of heart, it's easy to accommodate those changes.

Never mind CPR on the elderly, my brother required CPR when he was 53. He has a very high pain threshold and he said he suffered a lot of pain in his rib cage area for 6 months. It is no small thing. We need to get this right so that kwayttearp's mom or anyone else who chooses to forgo CPR do not suffer!