Full code status in LTC

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    What do you all think of full code status in LTC. I am not talking about alert short term residents in for rehab, but like a 97 year old man with end stage alzheimers who absolutly has no quality of life. the families tend to think cpr will make grampa all better. No matter how we educate families, some wont budge. They dont bother ever coming to visit either. I wish we had a video tape to show them of ribs cracking and such, then would they really want that for grandpa? It seems like the elderly who have there mind, choose to die pain free with dignity and no cpr, but the confused bedridden ones who have been in the ltc for years are full codes. And its usually the residents who have no visitors ever, even though all the family lives within 20 minutes. But thats a whole different subject!!! Thanks in advance for your opinions on this!! Have a great day!
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    Sometimes I'll talk to the family, but if the situation looks bleak and I see they're not looking at the big picture realistically, I make a social services consult and they can pursue the subject more in-depth than I can.

    i think what's worse are docs that have a terminal and obviously dying pt on their hands who refuse to put in a hospice consult, because that way the family can get counseling for a year after the pt passes on. really ticks me off, yanno?
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    My facility was taken to court a few years ago for allegedly refusing to allow a man with end-stage parkinson's to be full code. Makes me shake my head.


    Most people are cognizant of the realities, but it seems like the only people that are ever granted full code status are the ones with severe osteoporosis and brittle health. I work on a special care unit and it makes no sense to me.
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    Isn't it a shame that most of these family members wouldn't let their family pets suffer in the way we see some of our residents suffer. I really think these Docs need to be more active in educating the families on terminal or end stage diagnosis, even though this is 2003, they still believe everything the doctor says and not much of what we think.
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    Latest from Michigan: Unless the patient has it in writing when they were fully competent that he/she does not want CPR, a DPOA or guardian can not make that decision. AND..to top that off, Michigan does not recognize living wills. It's starting to get really sticky. Sooo....basically everyone in my facility has to go back to being full code.
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    WHAT THE HECK IS GOING ON IN MICHIGAN!?!?!? That's awful! How sad for the patients who deserve to die surrounded by a praying family and the staff who've been caring for them, not paramedics beating on them and shoving tubes into them and shocking them!!! I'm horrified.
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    Originally posted by ChainedChaosRN
    Latest from Michigan: Unless the patient has it in writing when they were fully competent that he/she does not want CPR, a DPOA or guardian can not make that decision. AND..to top that off, Michigan does not recognize living wills. It's starting to get really sticky. Sooo....basically everyone in my facility has to go back to being full code.
    Sort of the same in Washington...however they allowed the grandfathering of previous DNRs and the person does not have to be compitent just alert enough to put a mark on the papers that can be witnessed. I also believe a court appointed gardian (and has to have been appointed by a WA State court)can sign for them...but only if that gardian is ONLY for medical decisions and has no connection to financial issues.

    Worse yet...patient can be a DNR with every I dotted and T crossed in a SNF/NH but they have to have a seperate directive for EMS or they will be coded (by EMS).
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    No CPR should mean no CPR. What if the person arrests while still in the nursing home bed, but with EMS on scene?
    That law is ridiculous. Who makes up these things? The person doesn't have to be competent, just has to be able to make a mark on a paper? Does the family have to sit helplessly at the bedside, trying to accept the immenent death, with the support of health care providers, while concurrently the health care providers have to do CPR when the heart stops? How awful is that? How do you extubate people and let them die? Who are these laws protecting?
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    We have 70 y/o end stage alzheimer's who are full code by the family simply so they can receive their disability money. That in my opinion has got to be the lowest form of abuse. To let someone suffer with bed sores, a trach, getting pneumonia at least three times a year and whatnot just so you can get some money out of him/her is just plain cruel in my book. One of our residents has paid for his neice and nephew's college education, but in the meantime had to suffer for it. No one comes to visit him but maybe once a year and they stay a whole 10 minutes! I hope these people suffer just like him one day.
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    Originally posted by ChainedChaosRN
    Latest from Michigan: Unless the patient has it in writing when they were fully competent that he/she does not want CPR, a DPOA or guardian can not make that decision. AND..to top that off, Michigan does not recognize living wills. It's starting to get really sticky. Sooo....basically everyone in my facility has to go back to being full code.
    Do you have a link to show the statute on this? So far as I knew, medical personnel were still honoring a DNR signed by family for a patient who was obviously not competent.


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