To Resuscitate or Not to Resuscitate, What is the Policy?

In recent years, aging individuals have more and more options for how to live, depending on their healthcare needs, social desires, financial health, and other factors.  However, when communities are targeting the older population to become residents, should the community be obligated to provide emergency care to its residents?  The question was raised by a dramatic 911 call from Glenwood Gardens, a Senior Living facility in Bakersfield, CA and highlights the importance of doing adequate research when choosing living quarters and care providers and creating and updating Advance Healthcare Directives.

In the Glenwood Gardens case, an 87 year old woman collapsed in distress in the dining room of the home.  A woman, who identified herself as a nurse at the facility, called 911 in order to get an ambulance to help the distressed woman.  During the call, the 911 operator pleaded with the caller to perform CPR or, if unwilling to do so, find someone who would perform CPR while awaiting the ambulance.  The caller repeatedly refused, saying that she was not allowed to do that.  Subsequently, the elderly woman died.  It is unknown whether the woman had any documents in place indicating her care preferences, but Glenwood Gardens has relied on a policy of non-intervention to explain the caller’s actions.

Levels of care vary among facilities from independent living or some basic in-home care, up to assisted living, and then skilled nursing.  Glenwood Gardens was the type of facility that provides services at each level of care, but allegedly makes clear to incoming residents that no medical care will be provided to seniors who live in the independent living portion of the home.  Apparently, even seniors who wish to receive heroic efforts for life-saving treatment will not be aided by the staff as a matter of policy; they must await an ambulance for emergency care.  Some other facilities have similar policies, and it is important to recognize if you are moving into such a place.
However, it is also important to recognize that the law presumes that you want any and all possible care that may save your life unless you have indicated otherwise.  At higher levels of care, more regulation exists to require intervention when possible.  Had the elderly woman been moved to the Assisted Living or Skilled Nursing areas of the facility, or if the ambulance had arrived in time to administer life-saving treatment, the woman may have been subjected to uncomfortable and invasive treatments she did not want.  The family has indicated they knew she did not want treatment to artificially prolong life, but there is no indication that the care providers knew of her wishes.

This story has made headlines around the country due to the disturbing nature of the 911 call.  However, it should bring to light a more pressing issue: creating an Advance Healthcare Directive to outline your preferences and locating a facility that will honor it will ensure that your healthcare preferences are carried out, without the need to rely on policy.  Once created, your Directive should be shared and updated with your care providers and agents as much as reasonably possible.

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