Learn how to talk about when to stop life saving treatment.
https://knowledge-for-caregivers.simplecast.com/episodes/legal-papers-needed
https://knowledge-for-caregivers.simplecast.com/episodes/myths-about-hospice
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Welcome to knowledge for caregivers. My name is Kathy, the host of this podcast. Since I have been a geriatric nurse for almost 10 years helping seniors age in place, I'm going to give you the knowledge that I used to help my own family, so you can help your famiW
Welcome back to this episode, and I want to talk to you about something that can be a little bit difficult to talk about and that is death. When our parents or our loved ones are aging, it's something I think we think about but a lot of times we're like, how do I talk about this with the healthcare professionals. Believe it or not having a hard time talking about it with their clients because we go into the medical field to save lives. We have begun to recognize that helping people die with dignity is something that is also part of the medical field. If you have questions about hospice, I have done an episode on that.
This time, I'm not really talking about hospice. What I'm talking about, is an order that is many times written by a doctor in which we say Do Not Resuscitate. A Do Not Resuscitate order can sometimes be very misunderstood. The do not resuscitate order will mean that a person will not be put on a respirator, and they will not have their heart shocked or CPR done to bring them back if their heart stops. I remember one of the first ladies I walked into, to do a long term care assessment. She was about 90 years old. And I could imagine that she was at one time a feisty individual. And she looked at me and she goes, I passed out. I was seeing the pearly gates and the light and peace. And then they brought me back. And now I can't walk and I live in this bed. And she was upset. She goes I even had a piece of paper.
So the important thing is to know the difference between a living will and Do Not Resuscitate. And I cover a little bit of that on legal papers. But the question that I come back to is when do you do a Do Not Resuscitate order. Sometimes those happen when a person is in the hospital, let's take an older person who has multiple health problems, let's say that their heart is already bad, their lungs are bad, they get a very bad disease even has happened with people have gotten COVID. And the family members are said you know, they don't have much chance of survival. But at this point, we need to put them on a respirator machine and people go oh, I don't know. And so they can decide at that moment when a person's in the hospital, hey, I don't want extreme life saving treatment done. So many times that is when people are approached about a Do Not Resuscitate order.
The one thing that people often misunderstand on a Do Not Resuscitate order, is it does not mean do not treat. For instance, if somebody has a bladder infection that we can give simple antibiotics that Do Not Resuscitate order does not mean that we do not treat their bladder infection. If somebody has pneumonia, it doesn't mean we don't give them antibiotics. If somebody has a broken bone, it doesn't mean we don't set the bone and try to straighten their limb and get them out of pain. The Do Not Resuscitate order only means that if a person's heart stops, or they stop breathing, we're not going to try to bring that person back. As I said, when you are dealing with being in a hospital, sometimes it's like Okay, the next level that we're going to need to take to help this person is to put them on a respirator. And that's when a lot of times families will begin to have that conversation of I don't know if I want to do that. Then, of course, a lot of times when people go on hospice and they're deemed that they are terminal, they will usually sign a Do Not Resuscitate order for those individuals.
But then we deal with the community people. I know of a client who has a bad heart valve. She's not a candidate for surgery. When the heart valve goes she knows that her heart will stop. There's really nothing they can do if her heart stops at that point. So even though she is awake, alert moving around, not something that you think of as being a terminal person. She has made the decision to have a Do Not Resuscitate order. Therefore, we often have to say, when do we want to have that Do Not Resuscitate order? I met with a gentleman whose mother is still living with them, but she has fairly significant dementia and somebody is having to come in every day to make sure she eats, make sure she's clean, make sure she takes her medication. And as I'm going through the intake form, I'm like, does she have a living will or Do Not Resuscitate? And he began to ask me all kinds of questions like, well, what is a Do Not Resuscitate? When should I have a Do Not Resuscitate on my mother, she looks fairly healthy. To me, she looks like she still has quite a bit of life left in her. When do I make that decision?
That's kind of some things I also want to talk about in this episode. do understand that I'm just giving my opinion. And there's no hard and fast rule this is the time to have a Do Not Resuscitate order. A do not resuscitate order means that if you have a caregiver in the home or the family in the home, usually you have a piece of paper that you put on your refrigerator so that if they call 911, then they can hand that to the individual. So they are still going to provide care. But if it comes down to something like having to put them on a respirator or resuscitating their heart, they will not do it. It's hard for people to know when do I do that? Again, this is something that definitely don't be afraid to bring up to your doctor, when you're taking your loved one to the doctor. They're less likely to bring it up if the person you know, they're still walking around. Maybe they have quite a bit of dementia. They're on. I don't know, do I bring this up to somebody I've had people actually threaten me when I brought it up. A lot of times we're like, we don't know what to say they're like, do you mean you're not gonna treat my mother?
understand a Do Not Resuscitate means putting a person on a breathing treatment or bringing their heart back? Those are the two main things that the medical personnel do. That's a good time to always have a family meeting and sit down and talk and say, okay, mom and dad now have dementia. Mom and Dad now have significant Parkinson's disease. Mom and Dad now are dealing with extreme frailty. Do we want to talk to either mom and dad if they are still Cognizant, of course, they should make the decision themselves. But it's okay to bring that decision up of how much life saving treatment Do you want us to do? Especially as someone is getting frailer. The other thing to look at is if they don't, you know, if they have dementia, and they're not able to make their own decisions, then that's a good time to have a family meeting and say, before something happens, we need to sit down and talk about what type of treatments Do we want.
My dad would tell me that when my mother was in ICU, they put her on the respirator, she was alert but she was in a lot of pain. He said he could see tears in her eyes. It just tore him up to see that. And after kind of going back and forth on the respirator, he called me and he said I don't want any more done, you know, she can't stay off the respirator. This time. I'm not going to put her back on. And I totally supported my dad's decision. But my mom actually did pull through. And I remember asking her, what do you want. So like I said, this is the time that we want to have these conversations before they're in the hospital before they're in crisis. And say, if there is little chance of your recovery, or if doing so much, putting somebody on a respirator, putting them in ICU for 10 days, they may survive. But I'm going to tell you, if they're 90 years old, and they're already frailer, the likelihood of them being mobile walking around on their own is going to be greatly diminished. A 90 year old who is put in intensive care unit bed bound, their muscles will waste away much quicker and it's harder to get them back. Therefore, we have to make that decision before that happens.
So if they're 90 and they're looking frailer, that's the time to sit down and talk to the family and go How much do we want to do so that if somebody's out of the country, I had that happen to me, some children had planned and paid for a very expensive European vacation, one child was left behind. And about two weeks before the family was to go, their father began to become very frail, developed all kinds of health problems. And they're texting me from Europe, and I'm trying to give them my opinion, and I'm seeing this person go downhill very quickly. They're trying to enjoy their European vacation and trying to decide that and then the one son that's left at home is like, I don't know why they left all these decisions to me and went off on their vacation. Well, I understand if you've invested 10 to $15,000 on a vacation. At what point do you pull the plug on that. I hope that this has begun to make A little sense to you on the Do Not Resuscitate. I wish I had this hard and fast answer. This is when you should have a Do Not Resuscitate. I just think it's important as family members to talk to your loved ones before they have dementia. At what level Do you want a Do Not Resuscitate order. And then to talk to family members when the loved one cannot make their own decision? What do we want to do in different situations? For instance, in my family, I have somebody with dementia, I would probably not want extreme measures taken for him. But if he was to fall and break a bone, I'm going to want that bone fixed, because otherwise he's going to be in pain, and is definitely not going to have a chance to recover. If he has a mild pneumonia, that he can take some IV antibiotics and get better. Yes, I'm going to want that treated. There's no way to really look at all the scenarios if you are not a medical person. But it is good to know when do we make the decision? Who can make that decision? If somebody is out of town who's going to be the primary decision maker and if that primary decision maker is gone, who's going to be the next decision maker. I hope this is helpful. If you have any questions, reach out to me and I will be more than happy to answer them.
Thank you for listening to this podcast. The information that I am giving is meant for informational or educational purposes. They are not meant to replace the advice and consent of a person's primary care doctor or physician. If you wish to send me an email, you can do it at info inf o at symbol Cathy's consulting KTHYSCO en su lting.com. Or you can check out my website at Cathy's consulting.com I would love to hear from you. Thank you for going on this caregiving journey with me