Nursing Home Abuse Advocate : Idaho Nursing Home Abuse Lawyers & Attorneys : Kormanik Hallam & Sneed Law Firm : ID Assisted Living Neglect, Nursing Home Injuries : Boise, Nampa, Caldwell

In a recent article in the Wall Street Journal, Katherine Hobson discusses a Center for Disease Control (CDC) survey of nursing home and hospice residents' files. Specifically, the CDC survey looked to how many residents had an "end of life care plan" or "advanced directive" on file at the time of discharge.

The CDC's numbers were not good:

• Overall, 28% of home health care patients, 65% of nursing home residents, and 88% of discharged hospice care patients had at least one advance directive (AD) on record.
• The most common types of ADs among home health care patients, nursing home residents, and discharged hospice care patients were living wills and do not resuscitate orders.
• Care recipients under age 65 years were less likely to have any AD than those aged 85 and over; black care recipients were less likely than white care recipients to have any AD in all three populations. These age and racial differences were larger in the home health care and nursing home populations than in the hospice care population.

Twenty years ago, Congress passed the Patient Self-Determination Act (PSDA) requiring most health care facilities to inform adult patients about their rights to execute an AD. I have previously written about the importance of "getting your affairs in order," which, in part, means having a living will or advanced directive. Don't be one of the 35% of nursing home residents or 72% of home health care patients without one.

It's important to make your wishes known in writing so that your loved ones will not be left to wonder what those wishes are. It is equally important to make sure your caregivers know what your wishes for end of life care are. Tell them! Make a living will or advanced directive today; don't wait another minute.

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I have previously written about "getting your affairs in order" in the form of a living will. A story by Jane Friedmann in yesterday's Minneapolis Star Tribune brought to mind an important topic concerning living wills or, as they are sometimes known, "advanced directives for health care." These are formal documents which tell your healthcare providers whether, or to what extent, you would like "heroic measures" such as CPR should your heart stop beating. Idaho Code §§ 39-4501 through -4515 govern these documents in Idaho and, in fact, the law sets forth the specific requirements of such a document.

Instead of boring you with a lot of "law," however, the story brought to light an issue of training and procedures for the Pine Medical Health Care Center. You see, a resident there did, in fact, have a valid living will. The problem was the staff could not locate the document when the resident's heart stopped beating. The nurse, instead of immediately starting CPR, "called her manager who told her where to find the documents and to start CPR." When the nurse who should have performed CPR on the resident was interviewed by the appropriate authorities, she apparently told them she "froze and was unable" to perform CPR even though that was the resident's wishes. Although the article does not state what happened to the resident; it can be safely presumed, however, a needless death occurred. The nurse faces "disqualification by the state and inclusion on an abuse registry."

It goes without saying, if a resident's living will is not placed in an obvious place, the delay in the staff locating it can lead to truly deadly consequences. Additionally, it would seem to me Pine Medical Health Care Center could have, and should have, developed a system to help staff readily identify whether its residents wish to have CPR performed or not. Finally, adequate training of facility staff would have resulted in an ability to properly perform CPR on the resident. Such a system and training could have prevented this needless catastrophe.

Does your facility have such procedures and training in place? You should check! If it does not, it could be your life that is needlessly lost.

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Let's face it: No one wants to think about the end of their life. Because of this, many of us do not have end of life plans to ensure our affairs are in order. Making sure your wishes are followed as your life nears its end is important; after all, they are your wishes!

Melissa Healy, in a recent Los Angeles Times "booster shots" blog, tackled the difficult subject of "getting your affairs in order."  The post links to a Guide Book for those with a serious illness to help get their affairs in order. The guide book was published by the American Bar Association Commission on Law and Aging for the National Hospice and Palliative Care Organization. Although Ms. Healy's entry is based upon receiving bad news from a health care provider, it contains good information for all of us to consider as the new year approaches.

The Guide Book discusses, in fairly good detail, step-by-step instructions on the following areas: 

• Planning how you will pay for the healthcare you need;
• Making a plan for the management of your health and personal decisions during your illness;
• Making a plan for the management of your money and property;
• Planning for the care of dependents;Knowing your rights as a patient;
• Knowing your rights as an employee; and
• Getting your legal documents in order.

Although all of these areas are important, for nursing home residents, perhaps the most important area is that of making a plan for the management of your health and personal decisions. If you cannot make your wishes known, you want to make certain they have been previously documented or someone who knows your wishes is legally able to make them known for you.

In Idaho, there is a specific law governing "living wills and durable powers of attorney for health care." This is just the document to make sure your desires are known and a the appropriate person is able to legally make decisions about your health care when you cannot. Such decisions include, for example, the level of care desired, including whether a "do not resuscitate" or "DNR" is properly carried out.

End of life decisions are difficult things to think about, let alone put on paper. Carefully considering the care you wish to receive, with input from, among others, family, friends, medical care providers and, perhaps, clergy, is critical. If you do not plan, and put your wishes to paper in a legally enforceable document, your wishes may not be followed. That would be a tragedy.

Take the turning of the year to decide what you want concerning your health care. Make a plan and make your wishes known. There is no better time to do so.

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