Sometimes it’s What’s on the Refrigerator Door That Really Counts

Sleepless in Seattle?  No, this geriatric care manager was slightly sleepless in New Rochelle, New York. The reason? An elderly client’s Out of Hospital Do Not Resuscitate was about to expire and the newly signed document had not been received. The current one is taped to the front door of the refrigerator and each aide who cares for my client knows its exact purpose.

Depending on the circumstances, hospital personnel may ask the health care agent to consider signing a Do Not Resuscitate (DNR) for the duration of a patient’s hospital stay. Should the family wish for the continuation of the DNR upon discharge, an alternate form is used in the home: The Out of Hospital Do Not Resuscitate. The form is specific to New York State.

The Non Hospital or Out of Hospital DNR document informs the EMS providers that in the event of cardiac or respiratory arrest, no chest compressions, ventilation, defibrillation, intubation or medications will be provided to extend the life of the individual. If the person is not in cardiac or respiratory arrest, full treatment by EMS providers will be given.  Put another away, this form becomes effective if the heart and/or the lungs have stopped pumping.  Should these conditions exist without the presentation of this form, CPR will be initiated.

The document itself is quite simple. It states the name of the person, date of birth and expresses the wish not to be resuscitated.  It is signed and dated by the doctor along with his/her license number.  The form can be downloaded at: www.health.ny.gov/forms/doh-3474.pdf . While it should be reviewed every ninety days, as long as it remains posted it is considered in effect. Neither a living will or a health care proxy can take the place of the Out of Hospital Do Not Resuscitate.

Understandably, not all families are interested in having such a form in the home. And often, even with the form present, in a moment of panic a family member will chose to have a spouse or parent resuscitated. Nevertheless, for those families who are intent on limiting further treatment this document is essential.

When Elderly Parents Come Home…..To Your Home

Recently I was interviewed for an article about elderly parents moving in with their adult children.  An odd topic I thought, unless you live in Japan where such an arrangement is common place. But here in Westchester County, NY?  This geriatric care manager was perplexed. What did the journalist know that I didn’t?

The ah ha moment came quickly.  People are living longer.  Living longer means the chance of using up one’s assets becomes a greater possibility. Combine this with the current economic downturn and you have a compelling reason to write this article. Both adult children and their parents may be feeling the impact of this new economic frontier.

With this as background, I suggested to the writer that ten questions be posed. The answers will help to guide families in determining if such a move has the potential to succeed:

  1. Why are you as a family unit considering this move? Do you really want the move to occur?  Does your parent really want to move in? What are the obstacles that could prevent a successful transition?
  2. What is your parent’s current routine? How easy will it be for them to adapt to a new routine?  For you to adjust to their routine?
  3. Will their medical insurance be valid in a new state? What entitlements might they be eligible for?  Is there a waiting period? Are there local doctors accepting new Medicare patients?
  4. Are there community activities a parent can participate in? What if their personality or physical limitations do not allow for activities outside the home?
  5. What sort of respite is available to you if a parent cannot be left alone? Are other family members close by or willing to travel to give you a weekend away? Will your parents accept outside care?  Who will pay for it?
  6. Is your home handicapped accessible to the degree needed? If not, does the structure of your home allow for modification?
  7. If you have children at home, how will they deal with this new arrangement?
  8. What rules and boundaries have you and your parent mutually agreed to? Have payment arrangements been discussed?
  9. What are your parent’s medications?  Have you been able to connect with their physicians to obtain a full understanding of their medical conditions?
  10. If you are no longer able to care for your parent what are the local alternatives?

So what this geriatric care manager thought of as an unusual article, was really a very timely topic. The three generation household just may be returning. Hopefully, it will be one of generation enriching generation.