Ask the Expert: Legal and Ethical Question Regarding Refusal of CPR

Published: Fri, 05/03/13



Ask the Expert- Your Elder Law Questions Answered by Evan H. Farr, CELA

Ask the Expert: Legal and Ethical Question Regarding Refusal of CPR

*This is from the call the nurse from Glenwood Gardens made to 911.

Q: My parents are in an independent living home in Virginia. I recently read a story about a nurse who refused to give CPR to a dying woman at a California independent living home. Was she legally right to refuse giving CPR and could this happen in Virginia?

A: The unfortunate story that occurred at Glenwood Gardens in California is disturbing on many levels and raises important legal and ethical questions for debate and review.

Starting with the issue of the facility type first, Glenwood Gardens and the place where your parents are staying are Independent Living facilities. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.

In Virginia, Independent Living facilities are not licensed and not subject to any of the licensing regulations that apply to assisted living facilities. The facilities are therefore free to create their own policies regarding handling of emergencies.

In the Glenwood Gardens situation, there is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.

Virginia, like many states, does have "Good Samaritan" laws (Code of Virginia - Section 8.01-225) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.

This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident's and family's expectations. When choosing a facility it is important to understand the facility's policies on emergency management.

Also, before you decide on the best living situation for yourself or a loved one, make sure your Advance Medical Directives are complete and available when needed. This will ensure, in most cases, that your loved ones desires are communicated to physicians and loved ones, and that they take your preferred course of action regarding all forms of medical treatment.

An Advance Medical Directive (also called a Medical Power of Attorney or a Health Care Power of Attorney) authorizes another person (called your "Medical Agent"), to make decisions with respect to your medical care in the event that you are physically or mentally unable to do so. This document includes provisions that used allow you to indicate your wishes concerning the use of artificial or extraordinary measures to prolong your life artificially in the event of a terminal illness or injury. You will also use this document to indicate your wishes with regard to organ donation, disposition of bodily remains, and funeral arrangements. Your Advance Medical Directive should also set forth your preferences with regard to organ donation, funeral arrangements, and disposition of remains. Our proprietary Four Needs Advance Medical Directive^(TM) contains all of these elements plus our proprietary Long-Term Care Directive, which addresses a host of issues that might arise if you wind up needing Long-Term Care.

In order to be easily accessible when needed, your Advance Medical Directive should be registered with an electronic archive service that can immediately fax the document to any desired destination. This firm will provide such registration service to you at no charge unless you would prefer that the document not be registered.
Don't have a Advance Medical Directive or planning in place? Call The Fairfax Elder Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.

Critter Corner- Featuring Saki and Alley

Dear Saki and Alley,

I am a caregiver for my 80 year-old widowed dad with dementia and sometimes it can be quite challenging. What are some tips for staying sane?

Thanks,
Karen Ford-Addie
------
Dear Karen,

One of the most challenging things a person can experience is taking care of an elderly parent. These are some ideas we learned from clients of our daddy who are caregivers. Hopefully these tips help you in your situation:

Give them their autonomy. Offer your parent options instead of orders. It's important for them to continue to feel as if they, and not you, are running their lives. Let them decide everything they can about their own care and situation.
Take care of yourself. It's so easy to surrender more of your life than you should. Take walks, exercise, eat right, and make sure you spend quality time away from them. Taking time to rejuvenate yourself is as critical a part of your care routine for your parents as cooking their meals or making sure they take their meds. Your life still needs to be about you, or else you might wind up suffering from Caregiver Burnout, which is a very real medical syndrome.
Talk to a friend. If you have a friend with whom you can regularly meet and talk, or even chat with on the phone, do it. When caring for aging parents, the input and love of a friend is invaluable to you. As soon as you get involved with tending to your parent, call your best friend, and tell them that you're going to be depending upon them to do what friends do best: care, and listen. If you don't have this type of friend, then look into joining a local support group. There are caregiver support groups almost everywhere that you can find by calling or visiting the web site of your local Area Agency on Aging or one of the associations dealing with the illness your parent is suffering from, such as the Alzheimer's Association or the National Parkinson Foundation.
Have fun. One of the things we most need in life is the one thing we often forget once we begin caring for an elderly parent: fun. Whenever, wherever and however you can - take some time for yourself to truly enjoy life.
Pray or meditate. Caring for an aging parent is one of the most emotionally complex and physically draining things you can do. Accordingly, open yourself up to God, whatever that might mean to you, and/or take some time to meditate. Sit comfortably in a quiet, peaceful place; close your eyes; breathe deeply and slowly; and take a few minutes to feel calmness and peace.

Family members are a major provider of long-term care, but research has shown that caregiving exacts a heavy emotional, physical and financial toll. Almost half of all caregivers are over age 50, making them more vulnerable to a decline in their own health, and one-third describe their own health as fair to poor.

Are you a family caregiver, who is in need of information or assistance? Learn more about the programs and services that may be of assistance to you or your loved ones on the U.S. Administration on Aging website.

Caregiving can be rewarding, but it can also physically and emotionally demanding. The Fairfax Elder Law Firm of Evan H. Farr advises that if you are a caregiver, don't let your own needs or your health take a back seat. Many caregivers are at the age when they are developing their own chronic issues. Be sure to take good care of the person you are caring for ¬and yourself too!

Do you have a loved one who is suffering from dementia? Persons with dementia and their families face special legal and financial needs. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect the family's hard-earned assets while maintaining your loved one's comfort, dignity, and quality of life by ensuring eligibility for critical government benefits. Call us today at 703-691-1888 to make an appointment for a complimentary consultation.

Purrs,

Saki and Alley

About Saki and Alley: Saki and Alley are nine year old Siamese cats that belong to Evan and Jeannie Farr and live here at the Farr Law Firm. They are very sweet and smart and love all the attention they get from staff and friendly clients at the firm. We encourage you to visit us and meet these extraordinary Siamese cats!

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Correction to "Ask the Expert: Why is Autism So Common Now?"

In last Friday's newsletter, there is an error in the sentence "However, once the income of a person with special needs exceeds $2,000 a year, he or she is no longer eligible for SSI or Medicaid." Please note that the $2,000 is a resource test, NOT an income test. Sorry about any inconvenience this error may have caused.