My 94-year old mom is in AL and has had a DNR order for the past 4 years, obtained when her mental faculties were sharper and she knew what the DNR was and its purpose. She always refused to wear her bracelet, so it was placed in her purse so it would be available if she left the facility for an outing with family or facility sponsored event. Recently I checked the purse for her, it was missing, and I found it in her jewelry tray. I told her it is her ID bracelet and she should wear it all the time, just like she wears her wedding ring. Ever since, she has been wearing it all the time.
Another family member thinks this is wrong because I am not being fully honest with her about the bracelet and its purpose. My opinion is that, given her current situation, she would not comprehend, and calling it an ID bracelet is something simple that she understands and can relate to. Am I wrong here?
Imho, the bigger issue is that your mother must wear the bracelet AT ALL TIMES as it's useless being in a purse or jewelry box.
Not how you may think today I assure you . Life is precious , death is forever .
You said your mom got it when her faculties were better…do you have any proof of this, like a receipt for the bracelet showing date it was purchased or a cancelled check from your moms bank? Or records from the place she bought it from. That’s going to extremes, but if it’ll appease the family member, do it.
Let your mom think whatever she wants and don’t give a second thought to the family member. If that family member is so concerned, give them Alz.org hotline number and see if they can explain “therapeutic fibbing” to them. The number is 1-800-272-3900. It’s open 24/7.
You tell her whatever works - whatever will get her to want to wear it.
I don't even know what ... Oh ... Do Not Resuscitate.
Keep a copy of that information in her purse or on the back of her door (POLST goes there with this information on that form).
"The Physician Orders for Life Sustaining Treatment (POLST) form is a written medical order from a physician, nurse practitioner or physician assistant that helps give people with serious illnesses more control over their own care by specifying the types of medical treatment they want to receive during serious illness."
Since she is in an AL, staff should be well aware of this information already so what is the necessity of her having the information on her body / wrist?
Gena / Touch Matters
So it is an " ID" bracelet just as one would wear if diabetic or other medical conditions existed so that responders would know what to do.
Too often the " paperwork" that people have prepared about their EOL wishes never are available and, the exact opposite of their " expressed wishes" happen.
So.....as long as you are confident that the bracelet expresses her ( your mother's) EOL wishes, then it is actually helping her to wear it.
If you have any doubt about her wishes or feel you may have any " guilt" experience and, she is still cognitively able to express her wishes, then by all means revisit the decision with her....people can and do change their minds about things at times...
Otherwise, as long as you are her POA go forward with her wearing the bracelet.....ignore what " others" say as there will always be " opinions" driven by many different factors....
In my experience DNRs are done when a person is terminal. Hospice requires one. My Mom had one because she had Dementia and was 89. My Aunt 80, had it because of terminal lung cancer. My Dad, he was dying from years of heart desease.
Me, when I get around to doing my POAs, my Medical Directive will say "No extreme measures" My daughter, RN, will determine what those extreme measures are. A DNR is not something I am ready for at 73. That will come later when being resuscitated will not mean I will have a good or better quality of life.
As to planning for every single contingency for our elders, or even our YOUNGERS, we simply can't, short of attaching at their hips cover every possible contingency.
I agree with you, JoAnn. Get things done when and as well as you can and then let go of it.
And other people's opinion about what we should and should not do? Well, that's ALWAYS a given. Just ignore them. Just say "Thanks for the suggestion" and move on. Our OP was well and satisfied with her course of action until she made the mistake of listening to someone with input she didn't need. Hee hee, and now she has so much MORE of it.
moving my mom to another state , she needed another DNR , at first she didn’t want it until myself and NP explained to her , that she would never be the same as before the event….
If Mom is going out alone, unsupervised, still independant, then I would expect the decision to wear a safety alert bracelet is up to her.
Does Mom go out alone?
"if she left the facility for an outing with family or facility sponsored event".
OK, so she is supervised. Either with staff or family. If she was to have a sudden collapse, or a fall, WITH STAFF, what would happen? My guess is.. Staff alert their Manager & the facility Doctor. EMS may be called too. Ambulance transport arranged if necessary for transfer to hospital. DNR status is part of handover at each stage.
What if the event happened on FAMILY watch? What would they do? Stay calm? Panic? Would they stand around watching her lay on the floor doing nothing? No of course not.
Yes, people do have sudden collapse or be found unconcsious on the floor with no signs of life. Someone would have to KNOW about the DNR status & the conditions of it & also be prepared to take authority of it. Eg Attempt resus from a major heart attack? Attempt reus from choking on food swalled the wrong way?
More OFTEN (I would guess) people are found fallen or collapsed but CONSCIOUS. In no need of resus. No-one leaves a person lying on the floor unil the end of their time because they wear a DNR bracelet. The cause & damage is unknown... suspected hip, leg fracture, internal injuries, head strike or just a simple feint? Doctor or EMS are called to assess.
Disease, illness, injuries always present risk to our lives. Can bring a slow decline... how many leave by a sudden heart stop?
I get you don't want a chain of un-stoppable events to start that *may aim* to prolong life, but cause undue burden, pain, cost. I do get this. But consider the odds.
- Of a resus event being needed.
- That staff/family keep the DNR status in mind/check for it/see the braclet
- Staff/family could identify a resus/DNR situation
- Staff/family could act on it
Ask yourself if this is more about your anxiety about the unknown future. I'd let it go.
I'm thinking that even if a medically trained person finds someone unresponsive.. what the chance they know the wishes?(unless you are in a hospital)
eg Beach lifeguard finding an responsive person in the water... Attempts are made to save them.
Excuse me elderly Sir! We are trying to revive you! Can you hear me? Have you signed a DNR? Did you consider drowning to be a natural death? Or would intervention be accepted to you? 🤔
Never in a million years would I have left my home without her being safely buckled up.
She continued to fuss about buckling up and I had the thought of telling her that the car didn’t move until she was buckled up. Was I lying? Nope, because I wouldn’t have dared to drive to the playground without her being safe.
My dad would sometimes go with us to the playground. One day, he wasn’t buckling up. My daughter shouted from the backseat, “Grandpa, hurry up and buckle up. Mom’s car won’t move until we are all buckled. I want to go to the playground!” My dad looked at me slyly and whispered to me, “Is that what you told her? Wow! That’s smart.”
This family member sounds a bit ridiculous, don’t you think? It’s silly to quibble over something like this.
What difference does it make if your mom considers her bracelet jewelry? Technically, it’s jewelry and it’s also an I. D. bracelet because it is identifying an important medical issue.
You are a responsible daughter. You know this and anyone who has any common sense realizes this too. Some people like to stir the pot. Ignore them.
Or is this person be so terribly naive that they actually think it makes a difference how your mom views the bracelet? The only thing that matters is that she wears it daily for it’s intended purpose.
I would've moved heaven and earth to PREVENT my mother who suffered from advanced dementia from being resuscitated had the occasion arisen. Just saying.
If your mother is happy to wear it now, and especially if she is able to put it on and take it off by herself, that's more than good enough.
If the family member still has qualms, ask what bad thing or loss of dignity or other outcome opposed to your mother's wellbeing and best interests s/he thinks might happen as a result of not giving your mother more detailed information.
Is this a bracelet you yourself had made? Does it have room on it for further engraving on any side.
When out I, at 81, carry a DNR card with me and my Kaiser ID and number to call. If I get coded it will be, if not a "slow code" as some EMS personnel call it, at least a BRIEF code.
If there is room on this bracelet add the medical information to access no code status (MD number, or in my case the Kaiser number). Then if Mom asks at all you can HONESTLY and BRIEFLY explain it has her medical information on it.
It might spare your wondering and worrying and being further divided by other peoples' opinions. Sometimes, too many opinions just adds to all the confusion.
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I had a DNR paper on my frig so if the emts came, I would hand it to them. I had a file I carried to the hospital with copies of all Moms papers. Mom was never alone so no need for a bracelet. Mom had an Advanced directive that stated not to resusitate. When Mom entered the AL, I was told the State required a new form to be filled out. I was POA so I had authority to sign for Mom and of course her doctor. The form covered much more than the simple DNR Mom had. When Mom went to the Hospital, Rehab, and eventually LTC each facility wanted their own new DNR on file with their doctor signing.
So, a bracelet may make everyone aware that a DNR is in place, but that DNR needs to be on file so these facilities can cover their tails. So if you have a hospital u frequent you need to have a DNR in file. Any doctors Mom goes to, DNR on file.
The truth is that a 94 year old is very unlikely to come round from CPR, and in most the chest wall will cave from normal CPR, complicating things further.
Many medical personnel do what is called privately a "slow code" in circumstances where a very fragile and aged senior is found down.
We can argue it till the cows come home, but this is a good message to get our polsts done, carry medical info (I have my Kaiser number listed and DNR in big red letters in case of collapse in street, much good THAT will do). Hoping a call to Kaiser will result in a BRIEF resuscitation, if not a slow one. That's about the best we can do.
Best wishes to you and your mom.
I have spoken about this at length with my friend who is a hospice doctor, with my therapist, and with other professionals about lying to people with dementia, ALZ and the like.
They ALL said it’s perfectly fine and morally justifiable. LOs don’t have reasoning skills anymore and have lost cognitive abilities. You tell them whatever you need to tell them that settles their mind and allows them to let that topic go or that changes their fixation or focus to something nicer and where you can redirect her.
TBH, if something did happen and a first responder found her, they’re is still (my guess) like a 50/50 chance they are going to do interventions until they see the paperwork or whatnot. This is in no way condemning your mother to death etc.
It is somewhat of an ID bracelet and it more or less really only serves as a heads up to the hospital when she gets there that she might have a legal DNR. Ok. Gotta run
SO, I AGREE WITH YOU.. It actually is somewhat of an ID... You are okay.
And hope your mom is too...