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After Glenwood Gardens: What Would Your Loved One's Residence Have Done?

A harrowing reminder to learn all you can about emergency policies at senior residences

posted by Gary Drevitch, March 11, 2013 More by this author

Deaths in elder care facilities require you to know their emergency policies.

Gary Drevitch is senior Web editor for Next Avenue's Caregiving and Health & Well-Being channels. Follow Gary on Twitter @GaryDrevitch.


Deaths in elder care facilities require you to know their emergency policies.
Ryan McVay/Digital Vision/Thinkstock
The story has shocked and outraged millions. On Feb. 26, 87-year-old Lorraine Bayless lost consciousness in the dining hall of Glenwood Gardens, a senior residence in Bakersfield, Calif. A staffer who identified herself as a nurse called 911 for an ambulance. The dispatcher asked the woman to perform CPR on Bayless as rescue workers rushed to the scene — but she refused, citing what she said was the facility's policy against performing such care.
 
"I understand if your facility is not willing to do that," the dispatcher said during the seven-minute conversation, which has since been released to the public. "Give the phone to a passer-by. This woman is not breathing enough. She is going to die if we don’t get this started, do you understand?

The dispatcher later implored, "Is there anybody that's willing to help this lady and not let her die?"
 
(MORE: Why Caregivers Need to Plan for the Worst)

"Not at this time," the staffer replied. Bayless stopped breathing before rescue workers arrived.
 
In the days following the incident, Brookdale Senior Living, the Tennessee-based company that owns and operates the residence, has been widely criticized in media reports that were overheated and, in some cases, erroneous. Many articles, for example, called Glenwood Gardens a "nursing home," when in fact it is an independent living facility. Brookdale released a statement that said if the incident had occurred in one of the nursing homes it operates (involving a patient who did not have a "do not resuscitate" order), qualified nursing staffers would have acted quickly to try to save the woman.
 
Only in the past couple of days have the company and the family offered more insight on what really happened. Brookdale now says that the worker who called 911 was a resident services director, not a nurse, even though she identified herself as such. Further, the company says the staffer did not abide by its procedures for emergency situations and could have followed the instructions of the dispatcher, who had offered to talk her through the steps of cardio-pulmonary resuscitation over the phone.

Brookdale pointed out that it is "not licensed to provide medical care to any of its residents," but that it would review its policies so workers could be more responsive in future emergencies.
 
In a statement released to The Associated Press, Bayless' family members said they had no plans to sue Brookdale, nor did they have any complaints about the attention she received at Glenwood Gardens. Bayless, the family said, wished to die naturally, although it is still not clear whether she had a DNR order on file. Bayless was also aware that her facility did not provide full-time trained medical staff. "Mom had full knowledge of the limitations of Glenwood Gardens and is at peace," the family said.
 
State law generally governs policies in nursing homes and senior residences. In the wake of the incident, local police are considering whether the apparent refusal to provide care constituted a crime. Members of the California State Assembly said they might consider new legislation to avoid a repeat of the incident.

What We Can Learn From Glenwood Gardens
 
Leaders in the field of senior care told Next Avenue that while the incident at Glenwood Gardens was most likely avoidable, it was also a powerful reminder to families that they need to know exactly what services a facility will and won't provide.

Leah Eskenazi, director of operations and planning at the Family Caregiver Alliance, fears that reports of Bayless' death will complicate essential long-term care conversations in families nationwide. Most seniors want to stay in their own homes as long as possible, she says. But when it becomes clear that a senior living alone is insecure or lacking in social support, children or other loved ones need to initiate a difficult talk about moving.

Unfortunately, Eskenazi says, Glenwood Gardens appeared to provide neither security nor social support in Bayless' last moments. "When you help mom move into a retirement living community, you expect that there are people there who have compassion for older adults," she says. "Staff working with seniors, whether they be nurses or not, should make sure that seniors feel safe, secure, comfortable and welcome."

(MORE: How to Find the Best Residential Care)

"But if there's actually a policy against providing CPR – an intervention that they might expect to receive from a stranger in their home or out in the neighborhood," she adds, "it strikes me as not security-focused or socially supportive, especially when you think about the other people in the dining room watching this person die."

Coverage of the case may even make some seniors more resistant to moving. "I could see a senior saying now, 'You want me to move? You want to get rid of me now?'" Eskenazi says. For adult children, she adds, "Trying to convince someone to move is a delicate dance. This unfortunately adds to the guilt side of it."

If a move is imminent, Eskenazi urges family members to get critical answers from facilities about their emergency procedures. She says she would ask: "How is your staff trained to react in a crisis? And how is your staff drilled on these policies?"

Eskenazi expects that after this week, many administrators will be sure to have clearer answers for families asking these questions. People who run senior residences will need to review their policies and determine whether declining to perform CPR is really the best practice. "I would guess that it's not going to be," she says.

Larry Minnix, president and chief executive of Leading Age, an international network of aging services organizations, agrees that facilities are likely to launch major reviews of their emergency policies in the wake of the incident at Glenwood Gardens.

In general, he believes, families should not find it less likely that loved ones would have access to CPR in an independent living facility than they would in, say, an office building. "I would think that in any place that serves seniors, the staff is going to be trained in CPR and be able to administer it until 911 gets there," Minnix says. "That's sort of common sense."

The situation would be different if a resident had a DNR order on file, of course, and Minnix urges families to initiate or revisit conversations about advanced directives. Sometimes, a senior will want to have the talk and adult children will find it uncomfortable or depressing, Minnix says. Sometimes it's the other way around. "But responsible planning around these issues is where everybody needs to start," he says.

(MORE: How Strong Is Your Living Will?)

Every family member should have copies of essential documents, like health care proxies and living wills, that clearly indicate who is authorized to make decisions in emergencies. "What families tell me over and over again is that when the day arrives, they want to be able to look in the mirror and say, 'I have no regrets,'" Minnix says. "When there are regrets, you carry them with you the rest of your life  — and sometimes your family piles them on you. And if you don't blame each other, sometimes you blame the institution where someone died."

It should be noted that performing CPR on someone like Bayless may have been risky, and the success rate on patients her age is less than 50 percent. Still, even though guidelines for senior facilities vary from state to state, most legal experts commenting on the case have agreed that a senior residence would be unlikely to face legal liability had a staffer attempted CPR; most states have "Good Samaritan" laws relieving people of liability when they attempt to help others in an emergency.

(MORE: How to Save a Life and Make Sure Someone Can Save Yours)

Given all of this, what went wrong at Glenwood Gardens may have been a case of insufficient staff training or inadequate communication of emergency policies to workers, Minnix says. "This should be a wake-up call to any organization: Look at what your policies are, disclose them and make sure you're training your people to respond," he says. "If you don't do that, your staff members are going to feel uncomfortable in an emergency situation."


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