Should a medically-trained staff member at a senior living facility watch an elderly woman pass out, and not do anything to revive her?
This is the question facing the entire elder care community in the wake of the shocking death of 87-year-old Lorraine Bayless, who collapsed at Glenwood Gardens, an independent living facility in Bakersfield, California.
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After Bayless lost consciousness, a staff member called 911 and was connected with emergency dispatcher, Tracey Halvorson.
For seven minutes and 16 seconds, Halvorson pleaded with the employee, who was also a nurse, to begin CPR to keep Bayless breathing.
"She's going to die if we don't get this started. Do you understand?" Halvorson says to the nurse after being told, "We don't do CPR at this facility."
"Can we flag someone down on the street? And get them to help this lady?" Halvorson asks in desperation, offering to teach anyone willing to help how to perform CPR.
"As a human being I don't…you know…is there anybody that's willing to help this lady and not let her die?"
The answer to Halvorson's plaintive question was no. No one performed CPR on Bayless, who was eventually taken to the hospital by emergency medical personnel, where she was later pronounced dead.
Senior living facilities don't have to offer medical care
It may sound surprising to some, but the nurse's claim that her facility wasn't required to perform CPR on Bayless was perfectly legitimate—from a legal standpoint at least.
Independent living facilities certain states (California being one of them) are not required to provide medical care to elderly residents. Glenwood Gardens is one such facility. Residents and their families are supposed to be informed about such policies before they agree to live there.
Jefferey Toomer, executive director of Glenwood Gardens, released a public statement defending the actions of the employee saying, "Our practice is to immediately call emergency medical personal for assistance and to wait with the individual needing attention until such personnel arrives. That is the protocol we followed."
Glenwood Gardens has said that they plan on conducting a full internal review of the case surrounding Bayless' death.
But Bayless' daughter, herself a nurse, has reportedly said that she is satisfied with how the independent living facility responded to her mother's collapse.
Drawing the line between policy and compassion
The incident at Glenwood Gardens has lit a powder keg of controversy, leaving medical ethicists deeply divided.
"It is totally unethical for anyone, no less medical personnel, to stand by and watch a person die," says Carole Lieberman, M.D., psychiatrist and best-selling author of, "Coping with Terrorism: Dreams Interrupted."
"I think the nurse who let her [Bayless] die should be fired and criminally charged, along with a civil suit being filed against the home," Liebermann continues. "This is incredibly unethical and disturbing."
Many agree with Lieberman's stance—proclaiming their incredulity and disgust that a medically-trained woman was willing to stand by and watch someone die.
Others are taking a different stance.
Reports vary as to whether or not Bayless had a Do Not Resuscitate order (DNR), stating that, in the event that her heart stopped or she ceased to be able to breathe on her own, that she did not want to undergo CPR.
But, even if CPR had been performed on the older woman, her chances of surviving the ordeal were likely very slim. "CPR is unlikely to restore the patient to her pre-arrest condition and unlikely to be successful at all," notes Kathleen Powderly, C.N.M., Ph.D., director of the John Conley Division of Medical Ethics and Humanities at SUNY Downstate Medical Center.
Only about 5 percent of people who undergo CPR for a cardiac arrest outside of the hospital survive. Those are not very promising odds, and they get even smaller if the person is older and frail.
According to Powderly, for a patient who has expressed the desire to not be resuscitated, dying after a failed CPR attempt constitutes a loss of dignity.
She also says that the medical community (and the public as a whole) should avoid finger pointing, as many of the extenuating circumstances surrounding Bayless' death are still unknown.
Powderly does question why emergency medical personnel were called by Glenwood's nurse if no emergency response was desired. "If that was the case, it seems to me that a licensed health care professional is obligated to use their skills," she says.
Ultimately, Powderly feels that this sad story underscores the vital importance of having advance directives in place for elderly family members. "It is important to know what a person would want us to do and that's what should drive the emergency response," she says.
Setting up advance care directives (i.e. living will, power of attorney, DNR) represents an important step in planning for your elderly loved one's future care.
The following articles can help guide you through the process of setting up advanced care directives:
This unbelievable incident also highlights the need for seniors and their caregivers to ensure that they are fully aware of a senior living community's policies, preferably before they sign on the dotted line.
The following printable checklist can tell you what to look for and what questions to ask when visiting a senior living facility:
If your loved one is already residing in a facility and you aren't quite sure of the rules regarding emergency resuscitation and other forms of medical intervention, be sure to call and get your questions answered by a staff member who is well-versed in the center's regulations.