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After my mom's stroke last year, she said she did not want a DNR. I am her proxy and I haven't asked her about it lately, but I see that she's starting to decline and I really want the DNR. How do I make this happen?

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Those are really tough decisions to have on your shoulders. I know. I was MPOA for my late mother and I have no medical training! Check with the Hospitalist.
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You have the Doctor sign a new form. It may not be a D.N.R. any longer most are using a P.O.L.S.T. that stands for Physicians Order for Life Sustaining Treatment. It is much more detailed than a D.N.R. you can select the type and aggressiveness of care you wish.
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My husband and I many years ago had DNR's on our Health Directives. He had heart problems and slight dementia and finally one year ago he had to be put in the hospital at age 91 and after a week had to go to a nursing home. He had difficulty in eating and the nurses suggested he have a feeding tube put in. My daughter looked up the consequences of that and wondered if he would survive the surgery to do that. In our hearts we really didn't want that, but because there was some pressure about it we were considering having it done. On a Saturday when the doctor wasn't readily available, I went home so I could try to contact her and discuss the matter. Before I even got in the door my phone rang. It was the NH calling to tell me his heart had stopped and they had tried to revive him and he didn't make it. I was told that because I was considering the feeding tube they had ignored the DNR. If I had still been there I wouldn't have allowed it. I don't know how you get the DNR reinstated, but I think you should do anything and everything to get it reinstated. I don't think my husband at that point would have been able to make a decision regarding a feeding tube or resuscitation and that the nurses should not have gone against the DNA order even though I was looking into artificial feeding. Looking back I just wish I hadn't even considered the possibility and knowing how near death he already was we did feel sure he wouldn't have survived the surgery.
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This is the second part of my post on DNR. In Alberta, any patient can have what is knows as a “Green Sleeve”. It is a plastic pocket that contains documents and that patients take with them to every medical visit. At home, it is kept on or near the fridge which is where health responders are trained to look in an emergency. Unless they see a written, signed DNR order, they are legally obliged to start CPR until the patient gets to the hospital, where the physician decides whether to continue with or stop CPR. A copy of the forms in the Green Sleeve should be given to your agent, family, and healthcare provider.

The Green Sleeve contains Advanced Care Planning documents and is the property of the patient. Before it is issued there is a discussion between medical staff and the patient called “Conversations that matter: Goals of Care." I will cut and paste some of the document provided by Alberta Health Services. There are three levels of care:

“Medical Care (M) – Medical tests and interventions are used to cure or manage an illness as well as possible but don’t use resuscitative or life support measures. This is appropriate when resuscitative and life support measures won’t work or when the person chooses not to have these treatments. Medical care can be given in many locations, depending on the person’s wishes and values as well as if it’s appropriate medically.

Resuscitative Care (R) – The focus is to extend or preserve life using any medical or surgical means. This includes, if needed, resuscitation and admission to the intensive care unit. Talk to your healthcare team about which Goal of Care designation best reflects your health circumstances and your wishes and values.

Comfort Care (C) – The focus of care is to provide comfort to ease a person’s symptoms without trying to control the underlying illness. This is for people who have a life-limiting illness, when treatments can’t influence the course of that illness. This care can be given in any setting.

Within these three main approaches to care (Resuscitation, Medical, and Comfort Care), there are sub-categories. These are used to further define and communicate your Goals of Care designation to healthcare providers.” (AHS website, April 11, 2017)

I would highly recommend that you access the Advanced Care Planning website devised by Alberta Health Care, the provincial (as opposed to federal) government department that is responsible for providing (free) health care to Albertans, and gives wonderful information about Advanced Care Planning. It is available in eight different languages including Punjabi, Vietnamese and Chinese.

https://myhealth.alberta.ca/Alberta/Pages/advance-care-planning-conversation-matters.aspx

In the “Other Places to get help” click on PREPARE. PREPARE is a program helps you make medical decisions for yourself and others, talk with your doctors, and get the medical care that’s right for you.

I hope this posting is of some help to all of you. Even though the AHS website is Canadian and there may be some differences, the basic concept remains the same.
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Thanks, all. I spoke to our elder lawyer, and it turns out this was all taken care of after all.
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Although I am responding Xinabess’s thread about DNR I see that the situation has been resolved. It is not an easy decision but an important one, nevertheless. I ask your patience while I share my experience with CPR, both as a recipient and as a Nurse CRP Instructor.

First may I compare my situation with that of a young man called Ben. Although there was more than 30 years between our respective experiences but very similar circumstances, there was a huge difference in the outcome. We both, at 14 years of age, went underwater in a swimming pool. In my case, the pool was almost empty, someone realized immediately that I was in trouble, got me out of the pool and started CPR. Within 10 minutes I was sitting up asking what happened.

Ben was not so fortunate. He got caught under a piece of pool equipment and it was only when the pool was cleared that he was found. CPR was started immediately and, to the relief of everyone, his heart started to beat and he started to breathe on his own. It was a municipal pool and he got several million dollars in compensation—which is just as well— because he will need every cent he can get for his caregiving needs—now a healthy 19-year-old –but with a severe brain damage because his brain was deprived of oxygen too long. He can no longer walk, talk or see. He is confined to his bed or the chance of a change in his environment in his wheelchair. His lifespan is largely unaffected by his brain injury and he could, barring accident or injury, live for another 40-50 years.

As a CPR instructor, I taught my students that the first four minutes were imperative. After that the chances of a successful resuscitation diminished. Some institutions have an unspoken agreement to have a “slow code” i.e. no breakneck rush to get to the patient to start CPR but, instead, a “time wasting” period to delay the start of CRP, thus increasing the chances of a negative outcome. I, personally, believe that this is totally unethical but usually happens when the person who needs CPR should have had a DNR order in place—but didn’t. However, a slow code goes against the wishes of the patient/family and we, as health caregivers, need to respect those wishes no matter how much we disagree.

Incidentally, other than me, and although I am aware that it does happen,I have never attended a successful resuscitation--on young or old.

This post is getting a bit long so I will add another sharing what we do about resuscitation in Alberta, Canada.
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I agree with Dontask. if you have to jump through hoops to get her to sign a DNR something is wrong even if she doesn't want to sign it. Please don't have someone talk to her who is prejudiced against life and please don't have a talk with her to talk her into a DNR. She wants to live. Do everything you can to make her quality of life the best it can be given whatever state of her existence. Please be observant and creative to add to the time of her life.
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For instructions at home and away, you should look into signing a MOLST (or POLST): Medical (or Physician's) Orders for Life-Sustaining Treatment. It's not something you or a lawyer can do. She will need to have the counseling from a medical professional, but it is something that she signs herself. (My understand is that a DNR order is different: it is signed by a doctor and placed in her chart, typically in a hospital.)

She has previously told you and perhaps others differently (rejected her DNR), so you may have difficulty now in overriding her decisions without petitioning for guardianship, which you should really try to avoid. Remember that as her health care proxy, you are supposed to do what she would want to do herself. If you don't know that, you are supposed to use substituted judgment: knowing what you know about her, what she has said in the past, her values, you are supposed to step into her shoes and do what you THINK she would want you to do. This may be different than what you yourself would do if YOU were in that situation.

Going through the process of signing a MOLST should make her wishes clear, and take the burden off of you.
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I just went through a process to make sure I would not be brought back if I was very ill. I want to die in peace when the time comes. I was offered a form to fill out. However, my doctor said sometimes DNR's are open to interpretation by the doctor on hand. She said the best way is to have family or other legally appointed persons tell the doctors what they should and should not do. In other words, humans SPEAKING carry more weight than forms. Please discuss this with your doctor. But as a daughter, I think your wishes and instructions should be followed.
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I'm sorry I didn't read the question vary carefully and I should of put my glasses on. It's true every facility has you sign or not sign for a DNR they got to the point they didn't ask me or the family they asked him. Of course he said he wanted it. But than we must have different dr cuz they kept pushing for the DNR so he finally agreed to it. I'm sorry I didn't read yours better I pray your doctors come to there senses and talk to you and your family or someone like hospice or palliative care gets involved to help explain. I'm sorry again for not putting on my glasses I pray the best for you
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With or without the DNR, case by case - you still get a choice.

My mother didn't have a living will or anything but the Doctor advised against using life support but we all had to agree. I had to talk to my dad and sister and get them to see reason. If you're put on life support, you don't get to choose a time-frame and this is what my sister and father didn't understand.
You can talk to Clergy, someone in Hospice - there are plenty of people you can talk with. It isn't all DNR or nothing.
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Xinabess does your mom have a living will? I know you have a proxy but the will states what they want. I have been here I had there living wills drawn up while they were in good health just in case. I didn't want to be the one making there life choice I wanted it to be there's. I am power of attorney for them to help if needed but by no means take control. I will try to make this short. My dad had a fall last February had a non displaced fracture in his femur and a slight brain bleed. What we thought would be a simple over night observation became our worst nightmare. I do know that fentanol and the elderly do not go hand in hand they gave my dad some and he went crazy shot his blood pressure so high and they did nothing to bring it down and with a brain bleed it must stay low. That lead to aspiration and a slight stroke. He went up to ICU and things got worse. He got stable for a little while than he couldn't breath it took 3 minutes of me screaming and watching my dad die before they responded a code blue. They revived him but like I said things got worse we were in and out of hospitals rehab and home for a year and the things my father endured I would never ask anyone to have to do that let alone my dad. So his last visit home for a month and a half he took a turn for the worse and even I knew he wouldn't come home again. At the hospital they couldn't explain what happened just his blood sugars were high and no explanation why. He wasn't diabetic so I had him taken to a skilled nursing facility and hospice brought in. He was there a week and he passed a few minutes before I walked in the building. So all I can say is after all my dad endured I wanted him here too and I still do but that is selfish on my part cuz I don't have a say on when it's his time to go home. And after they revived him in the hospital when all this started just caused more problems. You need to find out when all is entailed when some one is revived and think if that is what you really want your mom to go through. Or let her go peacefully the way she wants to. Please consider what she wants. I don't want you to have regrets it's her decision and as hard as it is please reconsider. I have regrets and wonder if I hadn't had them revive him he would not have had to go through h*ll to get to heaven. I pray you think hard on this it's never easy either way.
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My mother is 95 with Afib and CHF. They asked her in thd hospital about a DNR and she said no way. She wants everything done to keep her going.
When she was in hospital my siblings and I discussed the DNR. They all thought she should have one. I explained what would happen if she didn't have one to her. Besides cracked ribs, the intubation and likely never returning home. She just said I want to live, not die. If I try and talk to her about DNR I feel she is seeing it as I want her to die.
She has lived with me 10 years. I know she wouldn't want intubation. She may change her mind down the line. When the idea of death isn't so close as it was at hospital stay. Then I fear it will be too late and her save at all costs plan would go in to affect.
If down the line something happened and paramedics came. Would they ask me about her wishes or just proceed with a full on CPR etc?
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as her proxy, definitely speak to her about it. If she does not want the DNR, don't force it on her if she's not ready to die. If she wants to live, then proper treatment to prevent future strokes must be done. Meanwhile, she's going to have to make lifestyle changes on her own to also help herself because just medications alone won't help if a person is not willing to stick to a healthy lifestyle
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Sorry, didn't read all the posts. In NJ a doctor has to sign the DNR. Mom didn't because she has Dementia. I have POA. Recently, she had a hospital stay and rehab. I had a DNR in place but the attending at each place had to sign one for that facility. Maybe her primary can talk with her and explain that a DNR is really a good thing. I really doubt if she would want to be kept alive if her body was naturally shutting down. And believe me, facilities will do whatever they can to keep someone alive. Families will hold on. My daughter sees it everyday. Not saying this is u, but some families rely on that SS check and if the loved one dies, that income is lost.
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Veronica, Yes she is living at home. Thanks for the advice.
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Is Mom living at home? You do need two types of DNR, there is a separate on for in hospital. When you have the necessary documents make several copies and be sure you have one with you and if she is at home one in a prominent place if it does not upset Mom on the back of the front door is a good place. That way there is no problem with over zealous EMTs. If she is in a facility make sure there is a copy in her chart.
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I visited my mother today and brought it up. She said she would not want to be put through resuscitation, etc. She doesn't remember saying otherwise. I am going to ask her elder lawyer how to make sure the DNR is in place.

I mean, she finds it hard to sit in her wheelchair for more than 10 minutes lately, so the thought of her enduring anything as brutal as resuscitation is unbearable. Something is so very wrong with our culture that we can't accept the natural course of things and will do literally anything to change it.
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Can you talk to her doctor and the three of you talk about the DNR? I thought Proxy works the same as POA in that the POA only goes into effect when the patient is not of sound mind or is unable to communicate their wishes. I completely understand that you want to respect your mother's wishes because she is of sound mind, but does she truly understand what's involved in aggressive measures if she were to have a heart attack? Ask her if she wants broken ribs and be put on a ventilator and then spend up to six months to one year in rehabilitation after the medical team resuscitates her - because this is a serious possible outcome if the men, women will have to go full force on her chest to jumpstart her heart. As a bystander, I've seen this done on someone else in the hospital and it's horrifying to witness, actually. It's not pretty like it's on television; the patient doesn't wake-up talking, smiling after their ribs have been cracked all over. My mother is suffering/has been suffering slowly from complications of vascular dementia - and is homebound as a result. It's awful to see her slowly deteriorate. I have a DNR in place for the very reason that you're wanting one. My father absolutely refused to be a DNR and wanted everything thrown at him because he didn't want to leave us - but we were traumatized by watching him suffer. It was so difficult honoring his wishes and I'm still having nightmares from this experience. Knowing now what I know, I wish I could go back in time and get that DNR in place without telling him (just put it with all the other paperwork that's given to medical personnel before evaluation for medical treatment) so he didn't suffer like he did.
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Xina, is there a social worker at your mom's apartment complex? If yes, she might be a good person to talk to about this issue and how to approach it.
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I'm so sorry Xina. Its never easy to make these decisions. I hear you. When my dad had his first stroke, we had to talk about a DNR. My siblings all agreed that we didn't want my dad to be hooked up to tubes. And the doctor said CPR can be very violent resulting in broken ribs. I have to agree with cwillie and try to have an outsider talk to her about this decision. I'm sure your mom is afraid. Who wants to face the reality of death? I sure didn't. I hope your mom will come around.
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It's so hard, because even though she seems to be going downhill lately, if I ask her anything about dying, she acts like I'm crazy. I think when they asked her at the rehab place, she didn't give it much thought, but there is NO way that I'm going to let them do all kinds of crazy violent things to keep her alive. She's 84 and has had non-stop health crises in recent years. I absolutely cannot bear - truly cannot bear - to think of losing her, but any kind of invasive, heroic measures would be agony for both of us.
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It sounds as though she made her decision, but you don't like it! The trick is in presenting the options in a way that is more likely to get her to see your point of view, something I personally would not be good at.
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So she can still make her own decisions, kind of.
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OK, I'll try. She's still mentally on the ball and will NEVER say she is ready to die, but her body is clearly starting to wind down.
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As her proxy I believe if Mom can no longer make her own decisions you can tell the medical team what to do or not to do. Have a note put in her chart that extraordinary measures be taken in the event of.......and here list what you don't what to be done such as cardiac resuscitation, artificial feeding. You can ask the nurses and Drs what would be appropriate.
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With my own mother I made the initial enquiry about how to have it put in place when someone is in their own home and not in a hospital or facility, and our case manager brought the form and discussed it with mom. Having an outsider (nurse, doctor or other) made the discussion less emotional and when offered choices such as " if you had a heart attack, would you want them to bring you back or let you go" my mom easily chose the latter option and signed the DNR herself.
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