Policy and Practice of Nursing Home CPR and Do Not Resuscitate (DNR) Orders
Understanding Nursing Home Staff Responsibility with Residents and Do Not Resuscitate (DNR) Orders
While all healthcare providers, including nursing home staff, take an oath to heal patients and perform life-saving measures, there are some exceptions which are common in nursing homes. A common exception is a type of advance health directive known as a Do Not Resuscitate order, or DNR. According to government definition, a DNR is a medical order written by a physician which instructs healthcare providers to not perform cardiopulmonary resuscitation (CPR) on a patient if the patient’s breathing or heart stops. Thus, even though a Missouri nursing home staff member may have an obligation and oath to save residents, heal residents, and to perform life-saving measures on residents, a DNR order creates an obligation on that same healthcare provider to not perform any CPR or life-saving measures.
It is important to remember that when a Missouri nursing home resident has a Do Not Resuscitate order, that is not an excuse for nursing homes to provide bad care or to ignore providing care to that resident. If a resident with a DNR is suffering from a urinary tract infection, for example, the DNR does not give the nursing home an excuse to ignore providing treatment to the resident. Many nursing homes use the DNR status of a resident as a shield against claims of providing negligent care to a resident when, in fact, the DNR status of a resident has no bearing on whether a resident suffers from multiple falls or develops bed sores as a result of bad care. The DNR should only come into play when a resident is found deceased. At that point the question is whether to provide CPR or not.
Even though many nursing home residents may have a DNR, it is important for nursing home employees to realize that if a patient does not have a DNR the nursing home staff must perform CPR. This can become tricky in a nursing home if employees are not provided information on which residents have DNR status and which are not DNR status. When nursing homes don’t provide that information, it can confuse employees. Because a DNR may be more common than not, uninformed staff members may find themselves unwittingly in a situation where nursing home staff members perform CPR when it is against a DNR order, or even worse, fail to perform CPR thinking that there is a DNR order when there is none. Either way, it is a serious problem and it can be nursing home abuse, neglect, or medical malpractice.
Unfortunate Example in Joplin
This is exactly what happened recently in a Joplin, Missouri nursing home known as NHC Healthcare, Joplin which is located at 2700 East 34th Street, Joplin, Missouri 64803. According to news sources, two residents died within a single week after nursing home staff decided not to perform CPR, even though both residents had chosen to have life-saving measures implemented if necessary. In short, neither resident had chosen Do Not Resuscitate status, yet when resuscitation measures became necessary, staff members treated them as though they they had elected DNR status. This means that staff literally neglected medical care and treatment under a mistaken belief that residents did not want it—when the residents desperately did.
Missouri law requires medical staff to perform life-saving measures on all patients and residents, unless there is a DNR. That is the standard and default rule, a DNR is the exception to the rule. The nursing home’s policy also appears to require life-saving measures to be performed when there are not DNR or other advanced directives dictating otherwise. Subsequent investigations labeled the deaths as “unexpected” and a “statement of deficiencies” was issued to the nursing home facility.
According to the Nursing Home Compare section of Medicare.gov, NHC Healthcare, Joplin is an overall average facility with below average staffing levels. Residents at NHC Healthcare, Joplin receive on average just 22 minutes of RN care each day compared to the national average of 41 minutes. Similarly, residents at NHC Healthcare, Joplin receive 1 hour and 50 minutes of care from certified nursing assistants (also known as nurse aides) whereas the Missouri average is 2 hours and 17 minutes and the national average is 2 hours at 19 minutes. Medicare.gov also reports that the quality of resident care at NHC Healthcare, Joplin is below average and the facility has been fined twice in the last three years, $7,150 on August 11, 2017 and $77,365 on November 10, 2016.
Important Points to Know Regarding Life-Saving Measures in a Missouri Nursing Home
The recent events at NHC Healthcare, Joplin are horrible and it is literally the opposite of what we except for our loved ones at Missouri nursing homes. We place our loved ones in nursing homes for these life-saving measures and protections that are provided there. When staff members fail to perform life-saving measures—which is what we are paying them to do—it is not just a breach of trust, it is potentially medical malpractice and nursing home abuse and neglect.
Why Get a DNR: Choosing to have a do not resuscitate order is a very important decision and it should not be done lightly. Residents who elect to have a DNR may do so based on several factors such as the following:
- They are terminally ill;
- They are elderly and CPR measures may be less effective or cause more damage to them;
- They feel their quality of life will be greatly diminished considering the present conditions and the added damage from a medical emergency.
Nursing Home Staff Do Not Decide Who Lives or Dies, Missouri Law and a Do Not Resuscitate Order Always Governs
Nursing home staff members cannot choose who they perform life-saving measures on and who they do not perform life-saving measures on; they must comply with the wishes of the residents. If a resident does not have a do not resuscitate order, nursing home staff must always attempt life-saving measures. If a resident does have a DNR, nursing home staff will not perform life-saving measures in situations where residents have simply passed away. As stated earlier, DNR status is not a license to provide bad care and use the DNR as an excuse for a death that should not have happened.
If you lost a loved one in a Missouri nursing home because staff members failed to perform life-saving measures, or if nursing home staff mistakenly believed that your loved one had a DNR and that is not true, call the Terry Law Firm to learn how to protect your rights by dialing (314) 878-9797. We offer FREE consultations and can help you and your family get the answers you deserve.