Every time I am in a client’s home I have to talk to them about things they don’t like to talk about. It just happens most people don’t like to talk about having to go to the hospital, or worse, dying. So as I go about creating or reviewing their emergency procedures, I end up having to make them uncomfortable. Since I don’t like making people uncomfortable I have created my own way of asking these questions.
The most important of these questions being, “Do you have a DNR, Do Not Resuscitate, order or would you like us to do CPR, Cardio Pulmonary Resuscitation?” Most people are intimidated by such a question. They start talking about their living will or Medical Durable Power of Attorney. I usually thank them for sharing this information, note it on my tablet, then I redirect them to a simpler question.
I don’t use big words or mention what is legal or not legal without a doctor’s order. I simply ask what they would want us to do. It goes like this, “What would you want my Home Care Aide to do if you fell and were hurt?” Unfortunately, many of the people I meet have experienced falling and being hurt. This is often the reason they call Care N Assist and ask for help.
Most, are quick to say they want us to call 911, or press their Emergency Pendant. They will pull the pendant out of their shirt or show me the base unit sitting on their counter. Once in awhile I will have someone say they want their son or daughter called first.
If they haven’t thought about this question before and don’t have a firm answer, this gets the ball rolling in the right direction. If they say “call family” I know they are less likely to want aggressive treatment. If they say emphatically to “call 911” I know that they are probably going to agree with a majority of my clients who want as much help as is possible.
So I proceed with the real question, “What if something else happened? What if you stopped breathing or your heart stopped and you collapsed?” I have gotten such a variety of answers from this question. Most will tell me they want our Home Care Aide to help if they can. If they say this “Yes 911, and Yes CPR” is what I write on their Care Plan.
Having just sat through another CPR training class with our Home Care Aide’s, I’m happy to say they are ready to help if needed. As our CPR trainer, Mike Bussing, always says, ”You can give that person one more Thanksgiving or Christmas with their family.”
Some of our clients will respond, “No. I don’t want CPR,” or “I have a DNR Order.” They usually have a good reason for having this opinion. For some it is a practical reason like having osteoporosis and a small frame, which would make recovering after CPR very painful. Others choose this because of illness or they believe they have lived a full life. In this case I document in our Care Plan, “Yes 911, and No CPR.”
If this is the case, I explain how it will work. We will not perform life saving CPR, but we will have to notify the proper authorities which means calling 911. Simply put, Emergency Medical Services, EMS, will show up and will be obligated to do CPR when they arrive unless they are shown a copy of a DNR order. Having this posted on the refrigerator makes it easy to find in an emergency.
Sometimes when family members are present during the consultation, they will question their loved one’s decision regarding CPR or DNR. This can be a good thing because what my client wants or prefers should be clarified before a situation happens. I am a strong advocate for my clients’ wishes to be written in the Care Plan and ensuring it will be carried out by my Home Care Aide. Having said that, I remind the client and family that I update Care Plans every 3 months or so to give them an opportunity to discuss things further.
Last, I do have clients who want “No 911, and No CPR” documented in their Care Plan. Usually this means Hospice is involved in their care. In place of calling 911 we will call the hospice nurse. This can be a great support service since everything is planned and organized to be taken care of without fail.
I enter every house knowing I have to ask these questions. I never know what a new client will say. A few of them will surprise me. Most of them are happy to hear we have regular CPR trainings with our employees. My job is to keep things simple and document clearly what their wishes are. It will be our Home Care Aide that will be responsible to help when that time comes.