Why would a caregiver not honor my mom's POLST?

Doingitalone,
In regards to the ALF staff stating, "Don't worry, if she falls again, we'll call an ambulance like we always do" when you were at the ALF and found your mother trying to stand on her own. The ALF staff might have be quoting the policy and procedure for "What to do when a resident falls." Our ALF staff are NOT allowed to assist an resident off of the floor, the rescue squad has to be called every time and they have to assist the resident off of the floor. (Sounds stupid, right?) BUT that is what their POLICY is.

Talk to the Nursing Supervisor or Director and ask her what the policies and procedures are for assisting someone off of the floor after they have fallen. That way YOU will know WHAT TO EXPECT if your Mom ever does fall at the ALF.

Sometimes what we expect the nursing staff TO DO or NOT DO for our loved ones, is not the same as what the facility's Policies and Procedures are. As a result, the nursing staff is put in the middle between family members who want certain things done a certain way and the facility; because legally the nursing staff are required to follow the facility's Policies and Procedures (and if they do not, they can get into trouble with their State Board of Nursing for NOT following the P&P.) So how does the nursing staff serve "two masters" while also taking care of the resident??? Something to think about.

Thank you all for your thoughts on the original question, "Why would a caregiver not honor my mom's POLST?" A lot of insight on here, I appreciate your taking the time to share. My Mom is being discharged soon, she has been placed on hospice care, and is going to a new facility with private pay caregivers who will check in on her frequently. We have enough money for about a year of this care. They know what has happened and are assuring me this will never happen again. My brother wants to pursue legal action against the facility that allowed this to happen, but from many of these comments it sounds like it happens a lot and there will always be some way to justify it or excuse it. I did file a complaint with the State Licensing Board. Should have mentioned the MRSA issue during the process, maybe I can amend the complaint.

Sounds like there is some kind of practical disconnect, legalwise - 911 operators are told they must push CPR, BUT are they informed about rules when a DNR is in place? Do they know how to respond then? Are there in fact laws that cover this type of situation? My sister is a doctor and when my Dad was dying she told all of us: DO NOT CALL 911 - because legally they have to attempt to resuscitate . (Don't know what current law would be.) Call Hospice. Thing is, it is an emergency and most everyone thinks "do something!!, "call 911" - they want to call somebody but don't know what to do or who to call. Please don't blame the caregiver too much - it is hard to know what to do unless you have really been drilled in procedure and even then you would probably find yourself arguing with 911. And as for 911, what does the law say, do they have any choice in response? Sort of stuff you don't think about until the emergency happens.

MaryKathleen, I think a lot of people call 911 because it is so well advertised and how many people know who else to call? The ramifications of this are not well understood and to many people the idea that "my loved one is dying and please do not interfere" is alien. It may become harder and harder to "achieve death". (In a modern industrial society - in most of the world, this kind of thing hardly exists as a problem - the hard thing to do is to keep alive.)

No more calls to 911. She is under very competent hospice care as of today. 911 is out of the picture.

kwyattearp,
I am glad that you have made arrangements for your Mom to receive hospice care at a new facility with private pay caregivers and that you have arranged that the caregivers will NOT call 911 if something happens with your Mom.

I think that you need to focus on your Mom as she is today and not worry about what "might have been". You cannot change the past, but you can make your last days and weeks with your Mom as happy and memorable as possible. Look at old photos, ask her about the stories behind the photos. Do a audio or video history with your Mom. Ask her if there are special items or belongings that she wants to give to a specific person. Enjoy the time that you have with her.

rovana, my point is this person is a caregiver. I assume a professional person. If it was a family member who had never seen death before, that would be different. A caregiver should have knowledge of what to do in this situation.

First of all, anyone who was caring for your mother should have been aware of the DNR order. This is the same as a doctor's order and should be followed as such. As for the caregiver feeling like should have done something, she certainly could have. As a retired RN of 25 years in critical care, I participated in many codes. I did, however, have quite a few patients that were DNR. For those, as I could see that their time was getting close, I would go into the room, hold their hand and quietly speak to them, in an attempt to make the passing from their earthly life to their heavenly one a pleasant and peaceful experience. Remember hearing is the last sense to go. Often they can be in a coma or be nearing death and still hear what is being said. I hope that your mother can eventually have a peaceful passing into her eternal life.

Cause unless you are in that position of seeing someone you care about in that state you jump to save that person. My father had that also but I held him and for me it was horrific seeing it and I tried to save my father, I called 911 you panic you just do. Unless your a nurse or doctor.