Aging Parents Have Health Directives–(Health Care Proxy, DNR etc.) Now What?

Dentist’s vetting Aging Teeth-2 post not back in time. Thus, thoughts about Tuesday’s NY Times’ New Old Age Column “Where is That Advance Directive?” generates this replacement post.

Much time, thought, and energy–under the best of circumstances–go into planning end-of-life directives. In the olden days this no doubt consisted primarily of a will. Today, in our more complex society, additional important aspects of Estate Planning impact not only who is beneficiary of our worldly goods after death, but–on earth– our very life itself.

4 previous posts have addressed aspects of this subject: Health Care Proxies, Do Not Resuscitate orders, Power of Attorney, family disputes, remarriage to name some. The October 17, 2013 New Old Age column focuses on bringing one’s advance directives to the  hospital.

We never know when something serious could happen that sends us to the hospital; and I doubt any of us keep advance directives in our purses, wallets, or smartphones. Thus, this New Old Age column (which instructs us to give copies to our primary care doctor, “health care decision-makers” and keep copies for ourselves) is worth the quick read.

Check out the related posts below, especially noting the importance of adult children’s knowing where important end-of-life papers are (or–conversely–if parents don’t want adult children to have this information ahead of time, how to handle it).

Related: The Astors and Us
                12 Key Pieces of Information Children of Aging Parents Should Have
                Aging Parents, Adult Children: Control and End-of-Life Issues
                Aging Parents and Emergencies: First Responders, 911, Hospitals

                Acute and Critical Care Choices Guide to Advance Directives
(Am. Assn. of Critical Care Nurses) Excellent!
Copy and Google
(it downloads from Google much faster than linking from our blog)

Changing weekly: “Of Current Interest”(right sidebar). Links to timely information and research from top universities about cancer, dementia, Parkinson’s, plus some free and some fun stuff–to help parents age well.



Aging Parents and Emergencies: 911 Responders, DNR and Hospitals

When Mother Almost Died

In our attempts to help parents age well, one may wonder why Eloise (last post), who was living alone after her husband died, placed DNR post-it notes (see last post) throughout her home. The answer:

Advance directives do not take effect in 911 emergency situations. All 911 responders are legally bound to exercise every life-support measure possible unless there is a legally valid, state-recognized do-not-resuscitate (DNR) order completed and presented to the 911 responders….(Once the patient is in the hospital, 911 procedures are no longer in place and advance directives can take effect.) Courtesy “Acute and Critical Care Choices Guide” see link below.

I wasn’t aware of the above and how it plays out, especially in old people, until an incident with Mother required us to call 911.  Mother ended up in Emergency.  Likewise I wouldn’t have understood the reasons for Eloise’s DNR post-it notes–so deliberately placed neither you nor a responder with much less than 20/20 vision could miss them.

In Mother’s case, she almost died due to a heart valve issue we were unaware of. After calling 911 we quickly followed the ambulance to EMERGENCY. It took time to park our car. By the time we were ushered to one of the emergency room’s little rooms, they were “working on” Mother and whispered they weren’t certain she would “make it.” The next hour would tell.

She did “make it” and was flown 100 miles to Los Angeles to a heart valve–or something akin to that– top surgeon. Should I add that the ambulance, driving Mother from the plane at LA’s airport to the hospital, was hit by a car, causing a small accident? Dad and I–driving– arrived at the hospital before Mother. “They’ve lost Mom!” I remember exclaiming to Dad as I’d run (ahead of Dad) to the desk to find out what room she was in, only to learn she hadn’t arrived.

When we all reconnected–approximately an anguished hour later–the nurse assigned to the ambulance had stayed temporarily with mother. She was extraordinary. She not only kept Mother safe and comfortable but Mother, who was evidently conscious throughout, was noticeably stronger and– surprisingly–engaged in what was going on.

We spoke with the surgeon, understood the odds of success and agreed he should perform the procedure. When the subject of DNR was introduced, I was clueless. So was Dad. Were we dooming Mother to death if the DNR order was in effect and the surgery didn’t go as hoped? Would it be worse if she lived in a diminished state, kept alive by modern medicine, as a result of the surgery and no DNR?

DNR was a new term– never discussed before–creating an especially difficult decision at a time of major stress. If surgery was to be undertaken, it had to be asap. A quick decision was in order. Thankfully we never had to use the DNR.

For those who aren’t knowledgeable about advance directives (living will, medical power of attorney)

There’s a wealth of information available, suitable for beginners. The Acute and Critical Care Choices Guide to Advance Directives from the American Association of Critical-Care Nurses.  (Note: Link’s download from our blog is very slow. It’s faster to copy title and paste into Google and link from there.) Written in 2005, it’s easy to read, and has simple chapter headings ie.”What Are Advance Directives,” “Emergency Medical Response 911,” “Frequently Asked Questions About Advance Directives,” and “Key Points” which links to state-specific information.

The guide is instructive and simplifies complex information.  Check out the short chapters that are of interest. In our endeavor to help parents age well until the end, having this information–and making certain that the elderly we care about have advance directives–can save major emotional upset at a time when sound reasoning is called for.