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My Mom has been a resident in a nursing home since March. Today the head nurse caring for my Mom called me to update me on how my Mom was doing. She told me that an infectious disease doctor was called in to run some tests on my Mom as she’s had an infection in her stool for more then 2 weeks now. She’s been quarantined and on antibiotics when she was first diagnosed with this infection. Since it’s been 2 weeks an infectious disease doctor had to be called in to run further testing. Another thing the nurse told me was that my Mom is considered a code patient. She wanted to know if my Mom has ever spoken to me about this. I was a bit confused because the nurse went from your Mom is doing well considering her other medical issues to my Mom is a code patient. Can someone please help me understand this? I’d appreciate any information anyone can give me. Thank you in advance.

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It sounds like they are asking if you want her to be "full code" or DNR if something happens. Has your mom ever expressed her wishes on this?
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If your mom does not have a DNR or POLST then she is a "Code patient" this means without the document instructing them what measures to take they have to, by law, respond with full chest compression, and any other means to get a pulse back.
If your mom does not have a DNR or POLST I strongly urge you to get one and if she is aware go over it with her and if she wishes sign the document.
Chest compression's WILL break ribs and most likely the sternum this will be very painful, if she survives and the recovery is difficult.
CPR works great on TV and on healthy younger people (frail bones and CPR do not mix)
If your mom is not cognizant it would be up to you or the person that is her Health Care Advocate.
And the DNR or POLST should go with her everywhere she goes. If something happened while she was out and 911 is called without the document present they still must do all that they can do.
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It means that should her heart stop and she goes into cardiac arrest they will work a full code on her in an effort to get her heard going again, this includes CPR, Defibrilation, medications to attemp to recover a heart rythum. Personally I feel anyone of advanced enough age in need of permanent nursing home care is better off with a DNR but that is of course a personal decision and can include various reasons for and against having one. I’m surprised this wasn’t addressed very specifically and clearly when she entered the nursing home, maybe it was and she decided no on the DNR but I think they typically urge residents to have them.
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Generally elderly people, and almost always residents of a nursing home have an Advanced Health Care directive putting a family member in charge of making decisions for them. If the person is unable to do this themselves their Health Care Proxy is generally the next of kin. If there are no instructions then a FULL CODE BLUE will be run in the event of death. That means that someone will come and do chest compression on the chest (generally, as a nurse all my life I can tell you that in a fragile elder I have never seen this do anything but fracture the ribs; it takes a decent amount of pressure), and use an "air bag" to try to administer air. If the patient makes it through the code (unlikely in the elderly) they will be placed on a ventilator in the hospital. If a patient is a NO CODE that means that, should they die unexpectedly, their body will not be treated in this manner. Are you POA or guardian for your mother? If not, who is. That person should speak with your mother's doctor at once. Have you ever, during your mother's lifetime, discussed with her what her wishes would be. Most people have at the least seen a movie or TV where a code is being done and most parents will at some time have said "I don't ever want that done to ME" with conversations ensuing as to what they would want. The Nursing home Nurse will discuss this in detail with you. She is the best one to go to. She can arrange your putting your Mom's wishes as you understand they would be in writing.
A NO CODE BLUE order may also be called DNR or "Do not resuscitate" order, meaning do not try to bring my Mom back if she dies. Generally these orders are asked for by ANY hospital or nursing facility on entry. They all, today, no matter the condition want to know who will make decisions for you if you cannot, and whether or not you are a DNR.
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Nothing in your previous posts suggests that your mother has dementia so they should not becoming to you with this, the choice is completely up to her.
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I just read your profile. (I should have done so earlier) You state your mom is 55 years old. You do not indicate any other health issues. Due to her age, if 55 is correct and if she does not have any major health issues I can see why a DNR or POLST has not been completed.
This is something to discuss with your mom as well as her doctor. And if she is cognizant this is a decision she can make.
edit...I just saw another post and you state your mom is in her 90’s. Given that I stand by the suggestion that she have a DNR or POLST.
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Rosie, at 90 years old and lots of medical conditions I think that the nurse is asking you to really think about what you want to have happen if your mom dies. Others have explained what full code means and I have personally seen my 300# dad go through this treatment. He had fractured ribs and he was a 69 year old, big guy. I can't imagine what it would do to a frail 90 year old.

Does your mom have her mental capacity? If yes, this is solely her decision. If no, it is something that you should research and decide if you want her to go through the "treatment" of full code.

Is her infection C-diff? That is tremendously hard to clear up and the antibiotics are brutal on frail systems.

I think taking her future quality of life into consideration is very important when deciding whether to resuscitate or not.

Best of luck making the decision, it is soooooo difficult to have to make for another.
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anonymous999770 Aug 2020
Thank you for your response. In all honesty, I would choose a DNR given my Mom’s current medical situation. The problem here is that she was considered of sound mind to make her own decisions. The other problem is that my Mom is not one to discuss death wishes. She’d rather bury her head in the sand (so to speak) then discuss anything regarding death. My husband and I have already paid for her funeral arrangements because we are realists and know what the inevitable will be. Not to sound morbid or cold but we handled all the funeral arrangements however haven’t told my Mom. It’s just something we knew we were going to do regardless of the situation as my Mom owns no property, has no assets, no income other then SS and nothing to declare as far as personal possessions other then what she had in her apartment. We also cleared out her apartment and turned it back over to the renter as we knew my Mom was not leaving the nursing home because of her condition and age. Again we didn’t tell her that she no longer has the apartment because it would do more damage emotionally then help. She never wanted to be placed in a nursing home and fought against it. Unfortunately given her health and the doctor’s orders she had no other choice. She is 90 and lived alone because she chose to. She didn’t want help from anyone. Yet I paid her utilities for her apartment and her expenses because it’s what I’m used to doing as her daughter. She paid the rent but it was only $200 in an income controlled housing apartment. My Mom has never been one to discuss these kind of issues. Never has. I always told her there are only 2 things guaranteed in life. 1) Life and 2) Death. She would get her feathers all ruffled (again so to speak) and just say let’s change the subject. With that said, I think from everyone’s response that I’m getting asked about my Mom being a code is because this subject has not been discussed with my Mom. Quite possibly it was brought up but my Mom didn’t want to talk about it. This is the difficult situation I’m in. Yesterday the social worker called me to discuss the advanced directive issue and advised me that a FaceTime conference between myself, my Mom, herself (social worker) and a psychiatrist should be done to discuss it. My Mom has always been a difficult person and now her stubbornness falls into my lap as the one having to deal with everything. I do not have POA because my Mom is of sound mind as per the psychiatrist’s evaluation.
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Thank you everyone who responded. Your responses have helped me better understand and know that what I initially felt what was best for my Mom is the choice to be made. I felt that a DNR would be the choice to make. At her age and given her medical issues it would be cruel and I did not want my Mom to suffer. Quality of life is important and in my heart I know she wouldn’t want to live like that. My Mom never discussed these kind of issues. It’s like some sort of taboo for her. It’s just not realistic because we all die at some point. She always avoided that type of conversation and would ask us to change the subject.
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RosieT...Unless you can convince your mom that it would be in her best interest to sign a DNR or POLST (and a POLST might be better in her situation it is more detailed and has more options that she might find a better choice)
And if she is as you say of sound mind then it is her decision to sign or not either document.
She should know though that signed or not most likely she will die when it comes to a point in time when she needs CPR or other "life saving measure"
My Husband was much like your mom he never wanted to discuss what he wanted. And this was LONG before he was diagnosed with Alzheimer's I would kid about it when we first met and he would just say..I don't want to talk about it and that would end the (one sided) discussion. Luckily his sister mentioned to me one day what he had told her, he wanted to be buried next to his mom. DONE!
You can not do any more for her than what she wants done. So you have done the best you can do try not to let it drive you to distraction.
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anonymous999770 Aug 2020
Thank you. I appreciate your post and your advise. It’s not been easy since my Mom was put in the nursing home. She never wanted to be put into one. The only reason she went (fighting it tooth and nail though) is because her doctor told her and signed the forms to have her admitted. Truth be told, she lived alone at 90 years old because she chose to. I live in Florida and she lives in NJ. I moved to Florida when I was 23. I needed to start a new life after I had a near fatal car accident. A drunk driver hit my car head on and all the doctors says I’m a miracle because I survived. I was left in critical condition and am here by the grace of God. As for my Mom, she was living a relatively active life for her age. She was still going across the street to buy her groceries and going to her visit her friends within her apartment building. Her mobility was a bit of an issue because her ankles were swollen due to one her medical issues (diabetes) but she was a stubborn and strong woman. I had been after her for over a year to accept help from a home health care worker but she wouldn’t have it. She wouldn’t accept any help. I saw her way of living was lacking a bit when I had gone back to NJ for Christmas. I was there for a week and I saw her apartment wasn’t as clean as it used to be and her general health wasn’t great. As a result I began trying to convince her to allow me to have a home health nurse to come out and help her. She’d tell me if I had a home health care nurse come to her apartment that she wouldn’t let her in. She was dead set against any sort of help down to refusing to use a cane to walk. Stubborn is putting it mildly. I don’t know if it was ego or a sense of accepting her age however my Mom was always it’s my way or the highway type of person. I’ve dealt with her way of being my entire life. So now back in March her neighbor checked on her and found her on the floor. She had fallen and was most likely on the floor for several hours because the neighbor told me she was covered in her own urine. The neighbor called an ambulance and my Mom was against being taken to the hospital. So she obviously was dehydrated and in serious medical distress. She went from a week hospital stay to being put in a rehabilitation facility for therapy for 2 weeks to becoming a permanent resident. Had my Mom accepted the help I wanted to get her she wouldn’t have gotten to this point. Her regular doctor hadn’t seen my Mom for her refill medications for probably 6 months past due. The neighbor told me that my Mom wouldn’t let her take her to the doctor because she said she was fine. So I get the phone call telling me all this because my OWN Mom would never tell me anything and felt I didn’t need to know. She felt she could take care of herself and she was fine. She relied more on faith then being realistic. I’d always tell her that God helps those who help themselves and she wasn’t doing that. So she’d laugh it off and I had no say in the matter. Now this is the point where she’s at. A nursing home resident with a laundry list of medical issues because she felt everything was ok and I didn’t need to know all this. All this and I still get stressed because I feel helpless. Throw in COVID and not being able to visit her is the icing on the cake. If I was to fly to NJ where she lives I’d have to spend a mandatory 14 day in self quarantine and I still wouldn’t be permitted to see her. Nursing homes will not permit any visitors whether family or family friends because of COVID. My hands are tied. Forget phone calls. My Mom doesn’t always answer the phone in her room. The nurse said it’s the rebellion phase. She argues with the nurses, the physical therapist, the occupational therapist and the staff. When she has a good day the staff tell me that’s she’s a lovely woman. When she’s not wanting to cooperate it’s hell on wheels. Nothing physical but she will not do what she’s supposed to. She’s not mobile but she gives everyone a hard time.
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Lordy -- get a DNR or advance medical directive ASAP. I'm amazed her nursing home didn't require one when she moved in. Both the places my mother has been in required a POLST when she moved in.

A nurse had that conversation with me when my grandfather was dying in a hospital in 1983! That was before people routinely had a directive, and my step-grandmother hadn't even thought he would die (even at 88 years old). The nurse took me aside and told me that in the absence of any other instructions he was a code patient, and if he started to die, they'd have to do CPR on him and would likely break his ribs.

I was horrified and talked to my grandmother immediately. It was very difficult for her to make that decision so quickly, but thank goodness we did, because he died peacefully an hour later.
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Oh Rosie, I am so sorry to hear that it is c-diff. That could be a death sentence for a frail senior.

Hopefully, hopefully the specialist can get this under control. I would talk to them about adding probiotics to the meds. The c-diff antibiotics are brutal on the gut and can make her feel worse than the infection. Adding a good probiotic can help her feel better.

I have to say that you are really blessed that your mom was independent enough to keep on keeping on. She is of an age where not much is going to help what ails her, so sucking it up and depending on her faith is actually an awesome testimony. Believe me when I say that it is far better than hearing every little thing that is going on as though the next breath could be their last.

Can I recommend sending her a card every couple of days that has scriptural verses in them. That should help her calm down a bit.

My heart goes out to you for the suddenness of all this. It can't be easy for any of you. Great big warm hug!🤗

Praise The Lord for saving your life!
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anonymous999770 Aug 2020
Thank you very much for your kind words! I sincerely appreciate it! This is such a difficult time and throw in the state we’re in with COVID it makes the weight even heavier. I try my best to stay in touch with my Mom with phone calls and speaking to the staff at the nursing home. Even though there have been times when I call her and she just brushes me off and tells me she didn’t feel like talking and hangs up on me. Still I continue to call her so she knows I’m there for her. I just don’t want my Mom to feel like she’s alone. She’s not able to have visitors because of the COVID situation and we’ve actually been blessed enough to have her in a non COVID designated facility. I’ve had trying times in the relationship with my Mom because of the kind of person she is but she is my Mom and I love her regardless. I only want the best care for her and for her not to suffer.
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My 94 year old dad has a POLST and is full-code. He filled it out 4 years ago and wants to be resusitated. The skilled nursing facility he is in was a bit surprised by this, as was my attorney for the guardianship. The attorney suggested seeing if they could get him to complete a new POLST. I passed that along, but have not heard a thing
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MichaelEzekiel Aug 2020
Babs, he's afraid to die; most people are, even some who know the Lord.
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