Should a medically-trained staff member at a senior living facility watch an elderly woman pass out and do nothing to revive her?
This is a question the entire elder care community has grappled with in the years since the shocking death of 87-year-old Lorraine Bayless. She collapsed in the dining room at Glenwood Gardens, an independent living facility in Bakersfield, California.
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 question was no. No one performed CPR on Bayless. Emergency medical personnel took her to the hospital, 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 in certain states (California being one of them) are not licensed 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.
Jeffrey Toomer, executive director of Glenwood Gardens, released a public statement defending the actions of the employee. “Our practice is to immediately call emergency medical personal for assistance and to wait with the individual needing attention until such personnel arrives,”
says Toomer. “That is the protocol we followed.”
Glenwood Gardens conducted 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 sparked controversy and left medical ethicists and long-term care experts 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 that a woman with medical training 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, she did not want to undergo CPR.
But, even if CPR had been performed, her chances of surviving the ordeal were probably slim. “CPR is unlikely to restore the patient to their 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 a loved one’s future care.
The following articles can help guide you through the process of setting up advanced care directives:
- What are Advance Care Directives?
- Avoid the #1 Mistake Elders Make with Healthcare Directives
- 3 Must-Have Legal Documents for Elderly Healthcare
This incident also highlights the need for seniors and their caregivers to ensure that they are fully aware of a senior living community’s policies and ability to provide emergency medical care before signing a contract.
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 familiar with the regulations.