March 7, 2013

Why some facilities are OK with 'no CPR'

Daily Briefing

Senior living communities are explaining their medical policies after the death of a resident at a community in California and the controversy over whether staff did enough to try and save her.

Background on the California death

Last week, a woman who identified herself as a nurse at Glenwood Gardens phoned 9-1-1 to request emergency assistance for an 87-year-old resident who had passed out in the facility's dining room and was "barely breathing." During that 9-1-1 call, the dispatcher pleaded with the nurse to provide CPR to the resident or find someone who would. However, the nurse said it was against the facility's policy and declined to do so.

The 87-year-old woman—who did not have a do-not-resuscitate order—subsequently died at the hospital.

The executive director of Glennwood Gardens said the employee followed the facility's policies. "In the event of a health emergency at this independent living community, our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives," according to a statement. The facility also will conduct an internal investigation into the incident.

In a statement, the resident's family said, "We understand that the 9-1-1 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace."

Medical care requirements depend on the facility type

Independent living communities like Glenwood Gardens often do not provide medical care, which means they are not regulated by the state.

Paul Williams, senior government relations director at the Assisted Living Federation of America, explained to The Tennessean that senior housing facilities are "like renting a senior apartment, with meals and social activities included. There is no care provided."

In contrast, nursing homes and assisted living communities—which are regulated by states—are generally required to hire employees who are certified in first aid and CPR. The only times that these facilities can refuse to provide CPR is if a resident has a do-not-resuscitate order or a pre-existing directive.

"This heartbreaking situation in California absolutely points to the need to get as much information as possible about facilities and what their policies are," says AARP Tennessee spokesperson Karin Miller. She adds that residents and their families must understand the distinctions between the different types of facilities.

When facilities choose to provide emergency care

Some independent living communities do opt to provide medical care, according to the Seattle Times.

For example, Louisville, Ky.-based  Elmcroft Senior Living would require staff to perform CPR after calling 9-1-1 "to the extent allowed under state law." Bob Goyette, Elmcroft's senior operations vice president, says, "Performing CPR at independent facilities—it's up to the facility."

Similarly, Emeritus Senior Living in Washington State allows staff members certified in CPR to administer the procedure on residents after they have called 9-1-1. According to Deb Murphy, CEO of LeadingAge Washington, laws in the Northwestern state allow independent living facilities to provide emergency care without having to acquire a higher license (Graham, "New Old Age," New York Times, 3/6; Ostrom, Seattle Times, 3/4; Marsteller, The Tennessean, 3/6).

More from today's Daily Briefing
  1. Current ArticleWhy some facilities are OK with 'no CPR'

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