It was the 911 call heard around the world. An employee at an independent living facility in Bakersfield, Calif. refused to give CPR to a resident after being urged to do so by a 911 operator. Lorraine Bayless, who did have a Do Not Resuscitate Order in place, 87, died at a local hospital after medical workers attempted CPR after she had collapsed in the dining room of Glenwood Gardens where she lived.
The 911 dispatchers pleaded with the person on the other line, who identified herself as a nurse initially, to give Bayless CPR. Here’s a transcript of the call between dispatcher Tracey Halverson and women identified as Colleen, as reported by CNN:
“I understand if your boss is telling you can’t do it,” the dispatcher said. “But … as a human being … you know … is there anybody that’s willing to help this lady and not let her die?”
“Not at this time,” Colleen answered.
In the last three minutes of the call, Halvorson said, “OK. I don’t understand why you’re not willing to help this patient.”
Colleen: “I am but, I’m just saying that …”
Dispatcher: “OK, I’ll walk you through it all. We, EMS take the liability for this, Colleen. I’m happy to help you. This is EMS protocol.”
Colleen is then heard asking someone nearby to call a supervisor. ”Can you get (unintelligible) … right away,” Colleen said. “I don’t know where he is. But she’s yelling at me and saying we have to have one of our other residents perform CPR. I’m feeling stressed and I’m not going to do that, make that call.”
The nurse asked the dispatcher when the fire department would arrive.
“They’re coming as quick … they’ve been on the way all this time. But we can’t wait. This lady is going to die,” the dispatcher answers.
Colleen replies, “Yeah.”
Despite the public outcry, Bayless’ family said they do not plan to sue. They issued a statement to the Associated Press after the story went international. They said that Bayless had a Do Not Resuscitate Order, or DNR as it is commonly called. That means she did want to be revived if she was in distress.
Second, the facility was an independent living facility. According to Jeffery Toomer, the president of Glenwood Gardens, their policy is not to offer medical help but to wait until medical officials arrive. It is not clear whether Bayless’ children knew this was the policy. The Bakersfield Police Department conducted an investigation and no criminal charges were filed.
Even though the family is not upset, the incident has lead many people across the country to question the care their loved ones are receiving or the care they will receive in the future. What if you family member has a heart attack or other life threatening emergency where CPR is needed? Do you know if your mother, father or other loved has a DNR? What is the policy at their nursing home or independent living facility?
As the population continues to age, more options are available for older adults looking for an assisted or independent living solution Here are a few of the most common options available to seniors:
Independent Living
Independent living does not mean that mom or dad stays home. This term refers to retirement communities or any kind of senior housing. These centers give seniors a place to call home without the headache of routine maintenance such as cutting the lawn or general maintenance on their residency. Some of these facilities offer homes that are in a neighborhood while others are apartment complexes or condominiums. Most are near bus lines or are accessible to other forms of transportation.
For recreation, there may be a center or clubhouse nearby or onsite. This gives older adults a chance to socialize with people in their peer group.
Who is a good candidate for independent living?
• An older adult that is relatively healthy and may only need minor assistance with daily activities
• Someone who loves to socialize with others
• Someone who wants a home but doesn’t want the hassle of maintaining one
Assisted Living
Assisted living facilities give older adults a sense of independence even though they need help with daily activities. Assisted living facilities have a staff that is available around the clock to help with those activities and in some cases they monitor the older adult’s medication.
Assisted living facilities have different living arrangements. Some older adults live in an apartment and may even have their own kitchen. Others may share a room with another older adult. Most of the facilities have a dining room and recreational area that is shared by the residents. How much you pay for the assisted living facility will vary. A good candidate for an assistant living facility is someone who needs personal care services but doesn’t need 24-hour supervision.
Continuing-Care Retirement Community
Some of the larger companies that provide care for older adults are offering more options for families. Continuing-Care Retirement Facilities, called CCRCs, have several options for senior care in one location. These communities may include apartments for independent living and a nursing home nearby. These are a popular option for many seniors who want to settle in one place and not have to move. For example, an older adult may move into an assisted living apartment but find he or she needs more care they may have to transfer to the nursing home. The costs of care may increase as the need for care increases.
CCRCs offer several options for spouses. In some cases, one may need a nursing home while the other spouse is still able to function independently. The spouses can receive the care they need and live close to each other.
Nursing Homes
Nursing homes provide the highest level of care and are the most familiar form of care for older adults. Nursing homes are overseen by a doctor that sees each resident. Nurses and medical professionals are on staff to help the older adult deal with aging issues. Some nursing homes offer occupational or physical therapy.
Putting an older loved one in a nursing home can be a difficult decision in some cases. Here are some reasons why a high level of care may be needed:
• The older adult is having difficulty completing day to day activities.
• Their medical needs are too much to handle in a home setting, either independently or with a relative or friend.
• A recent illness has led to a decline in their health and they need care.
Sometimes a nursing home is needed for an older adult temporarily. Many nursing homes also have rehabilitation centers. These centers offer therapies such as occupational or physical therapy that will help the older adult so that he or she can return home once the doctor says they are able to function in a home setting again.
Aging In Place
Older adults who live in their home are considered to be “aging in place.” This is preferred by some, especially those who have lived in their home and neighborhood for several years. Even though an older adult continues to live at home, he or she can still receive assistance with daily activities. Home health care agencies have staff that provides help. Private home care assistants may also be employed to help with household duties and basic daily activities.
Not every older adult can age in place. Several factors need to be considered:
• Is there a support system that is close by, including family, friends and neighbors?
• How will the older adult get around? Is it still safe for him or her to drive? Is there public transportation nearby?
• Can the home be modified if needed to meet mobility needs?
• Is there someone available to help with maintaining the home?
• Will the older adult ask for help when needed?
There are a few downsides to aging in place. Some seniors may feel isolated and become depressed, especially if they are widowed. And many are afraid to ask for help and feel they are a burden. Family members and friends need to keep an eye on the older adult to make sure they are living healthy, active lives.
Understanding Do Not Resuscitate Orders & Living Options
Some families find it hard to have a conversation about care for their older adults. It is difficult to think about mom, dad, grandpa or grandma getting older and needing care. But we all age and putting off these discussions can lead to misunderstandings and complications later.
While Bayless’ family said they knew about her DNR (Do Not Resuscitate Order) and they type of care she was receiving, many families don’t ask the right questions when choosing care. Here are some things you need to know about the facility and the wishes of the older adult:
• What type of facility is it? Is it an independent living facility, assisted living or nursing home?
• Is there staff on hand 24 hours a day?
• If there is staff, what are their qualifications (and history with the company)? Are there nurses available in case of a medical emergency? Is there a physician that oversees the facility?
• What kind of care does the facility provide? Do they offer medication monitoring? Will they help the older adult get dressed or bathe?
• If you are in an assisted living or independent living facility, can you be asked to leave if you health worsens? What are the criteria?
• What are the wishes of your loved one if they are faced with a life-threatening situation? Do they want to be revived or do they have a DNR?
• Does the older adult have a living will?
New options for care for older adults
The Baby Boomer generation is presenting new challenges for those who provide care for older adults. According to U.S. News and World Report, there will be twice as many seniors ages 65 and older in 2050. Today, 39 million people are over 65. That number is expected to be 89 million in 2050.
As the population has become older, new concepts for care have emerged.
Retirement Villages
In the past decade, many “villages” have been created across the United States. Seniors who live in “villages” actually don’t move from their homes. They have access to all of the things they need including grocery stores and medical facilities. What is offered depends on the village.
Advantages of villages include:
• Older adults can stay in their own homes.
• They don’t have to rely exclusively on family and friends.
• They have easy access to the things they need.
• They have a social network.
Membership fees vary and in some cases they can be expensive. Some are more than $500 a year.
Naturally Occurring Retirement Communities (NORC)
A report issued by the United States Senate in 2007 by the Congressional Research Service defines a naturally occurring retirement community as “communities with a large proportion of older persons residing within a specified geographic area. NORCs differ from purpose-built housing for the elderly, such as assisted living facilities or board and care homes, in that NORC residences were not designed with the provision of services to older persons in mind.” An NORC can be an apartment complex or a neighborhood.
The advantages to an NORC include:
• Residents can continue to live independently in a residential setting. Most of them live in their own homes.
• Recreational facilities are made available so that residents can socialize.
• It’s easier to determine the needs of residents who may be at risk and may need government resources or support services.
These communities have been recognized since the late 80s and federal funding has been available for certain communities. As more people continue to age in place, more of these communities will be identified across the country.
Conclusion
The death of Lorraine Bayless was a tragedy, but it has revived discussions about the housing, medical and social needs of older adults. Families need to discuss the wishes of their loved ones so that they will know what they want to do if a life threatening emergency should occur. They should investigate the facility and know if the staff will honor their wishes.
