It's right there on the side of his refrigerator, in a little plastic sleeve.
Dr. Byron Oberst, a retired pediatrician, signed a form saying that he doesn't want CPR if his heart stops. If emergency medical crews come into his apartment in his west Omaha independent living center, they can find it along with his medical history, medications and emergency contacts.
A general name for any housing arrangement designed exclusively for seniors. Other terms include retirement communities, retirement homes, senior housing and senior apartments. These may be apartment complexes, condominiums or free-standing homes.
In general, the housing is friendlier for older adults — it’s more compact, easier to navigate and includes help with outside maintenance. Sometimes recreational centers or clubhouses are available.
Assisted living center
A housing option for those who need help with some activities of daily living, including minor help with medications.
Costs vary according to the level of help.
Staff is available 24 hours a day. May not employ specialized staff such as skilled nurses or physical therapists, but may make arrangements for such care visits. Some are apartment-style while others are just rooms, sometimes shared. Most facilities have common areas for dining and social and recreational activities.
The highest level of care for older adults outside of a hospital. They provide assistance in activities of daily living as well as a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care and medical professionals such as occupational or physical therapists also are available.
Sources: Helpguide.org, AssistedLivingFacilities.org
The importance of such information was reinforced last week in Bakersfield, Calif., where an employee of an independent nursing center told a 911 dispatcher that she couldn't perform CPR on an 87-year-old resident who collapsed there. She said doing so would be against her employer's policy.
This flustered the 911 dispatcher, who pleaded during the seven-minute call: “(I)s there anybody that's willing to help this lady and not let her die?”
“Not at this time,” the woman replied.
The resident, Lorraine Bayless, later died.
Police said Thursday that investigators looked into whether the incident constituted elder abuse and found no criminal wrongdoing.
Fire officials in Bakersfield say Bayless did not have a “do not resuscitate” order on file at the home.
As it turns out, her family said it was Bayless' wish “to die naturally and without any kind of life-prolonging intervention.” They said that she knew the center didn't offer trained medical staff.
That's usually the case with independent living centers, said Heath Boddy, president and CEO of the Nebraska Health Care Association, which represents Nebraska nursing homes, assisted living centers and hospice care centers and advises independent living centers.
“There isn't a facility license for independent living,” he said. “It's just senior housing. It's not something covered under Medicare. It's not a skilled nursing facility or even assisted living.”
Assisted living centers offer more care than an independent living center, he said. “They would need to have a nurse consultant but not necessarily a nurse on staff.” In a skilled care center, he said, a nurse must be on duty throughout the day.
The Bakersfield center's parent company said the employee who spoke to the 911 dispatcher was employed as a resident services director, although she identified herself as a nurse. Company officials said the incident “resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents.”
It's unclear whether CPR would have worked in the California case. The American Heart Association says survival rates for out-of-hospital cardiac arrest vary widely in the United States. For every 30 bystanders who do perform CPR, one life is saved, the association said.
Joyce Black, an associate professor in the University of Nebraska Medical Center College of Nursing, said the dispatcher assumed “a modest effort of CPR is going to bring this patient back. I'm not sure that's a reasonable assumption. The outcomes of community or bystander CPR are not good.”
In a long-term care facility, Black said, the likelihood of surviving CPR is low. Residents who do survive, she said, often are left with broken ribs or neurological problems.
The woman's death may have been “the right thing” for her, Black said. “But it scares you if you put yourself in the patient's position and it's not the right thing for you.”
Independent living centers can forestall any confusion about residents' wishes for lifesaving care by having them write down their preferences, said Roxann Rogers-Meyer, a spokeswoman for Omaha-based Immanuel Communities. Lakeside Village, where Oberst lives, is one of its properties.
When people move into one of Immanuel's independent living centers, she said, they are asked to fill out a CPR/Do Not Resuscitate form that is kept in the office. A copy is included in what's called a File of Life, which is what Oberst has on his refrigerator.
Residents are asked to update the forms once a year, Rogers-Meyer said. They're also encouraged to discuss the directives with their families, a talk she said can be difficult for everyone.
“So many families don't want to talk about advance directives,” she said. “But if you don't know the wishes of your mom or dad, it makes it difficult if something happens.”
Some states have what are called Physician Orders for Life-Sustaining Treatment forms, said Helen Chapple, an assistant professor in the Creighton University School of Nursing. Such forms are a complement to advance directives and are more specific, outlining preferred medical interventions and artificially administered nutrition options. The person's physician then signs off on the orders.
Chapple said a group at Creighton is trying to come up with a standardized form that could be used statewide. People also can review the online “starter kit” of questions put together by the Conversation Project, an effort to get people to talk about their end-of-life wishes.
Oberst, who turns 90 next week, said he had the conversation with his sons about 10 years ago. “I told my three boys that if I have a debilitating stroke or heart attack, leave me alone. ... Let me slip away.”
In the meantime, Oberst, the grandfather of musician Conor Oberst, is staying busy writing his third book. The first two were about his medical career and his family, he said, and this one is about the medical miracles he has witnessed. He said he's happy to be living at Lakeside Village. He said the staff is friendly and keeps track of him. He enjoys eating meals with a group of buddies in the dining room.
If he needs to, he said, he could move into an assisted living apartment in the same complex.
And if he dies, he dies.
“I've lived long and hard and done enough,” he said. “I'm ready to go join my wife anytime.”
This report includes material from the Associated Press.
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