Blanket order on all care homes to place Do Not Resuscitate orders on all residents

When our dear consultant told me there was nothing more he could do for DH he said he had already signed off the DNR ecause he thought he had been through enough and the last thing he needed was someone jumping on his chest and trying to restart his heart . The children and I were in complete agreement with him.

that is true love <3

A family member - who is a community nurse - was told to only offer palliative care to care home residents suffering from coronavirus. No hospital admissions.

Makes sense.

Been there, done that, got the t shirt.
Paw had signed a DNR during his penultimate hospitalisation after discussion with me and with the girls. It was clear his body would not survive any attempts to “bring him back” were he to suffer a cardiac arrest -this time
When the end came and he suffered multiple organ failure after a massive internal haemorrhage, nevertheless, ITU were prepared to support his organs in the hope that one or more might show signs of recovery - no rush, no pressure.
When after 18 hours of no change, the consultant and I had “the conversation“ and over the next few hours he was allowed to gradually slip away - allowing us time for the family to be together with him at the end.
There was never any pressure and I could have had him for another 12/24 hours if we had felt it served any real purpose.
He received the Last Rites and it was the most peaceful, kindest gentlest passing you could have wished for - if pass he must.
I wish people would be less histrionic about DNR’s - why prolong suffering, why hang on to a life which is ready to go?

Some Care Home residents who died as a result of Covid may possibly have benefited from treatment in hospital and recovered. Those in Care Homes were/are not necessarily at death’s door.
I suspect some ill people, often elderly, in the community, were discouraged from going to hospital. It’s not surprising that the Nightingale wards were under utilised.

MawB2 that was so moving. It was very similar with my Dad. The care home he was in were brilliant both with him and the family giving my Dad dignity at the end.

MawB2 - so true - 'glad' you got to be with him and that it was all peaceful in the end x

Katek, that is why we need the enquiry. No-one would want to try and resuscitate a frail elderly person, but a younger care home resident might well benefit from oxygen in a hospital setting, if not necessarily ventilation, and make a good recovery. Discussing DNR questions with the family is good practice. A blanket instruction to put all residents on DNR orders without talking to them or their families is not.

To deny all care home residents access to any hospital care, including not covid related, just because of where they live, is unkind to them and their families. Some areas sadly did take this approach. There have been reports of the same approach being tried with those in care homes because of severe learning difficulties or autism.

Agreed.

mawb an uplifting post.

Thank you.

Truly it is becoming a Brave New World

@agnurse, I didn’t know the official categories, but the C2 equivalent was what we’d agreed with my mother’s care home a few years before she died (at 97 with advanced dementia).

Hospital only if absolutely necessary, e.g. in the case of a 2nd broken hip. Hospital is usually a terrible place for anyone with dementia anyway.
So with the above exception, palliative care only.

IMO it would have been positively cruel to try to prolong her life, given the most pitiful state she was in.
I know 100% it’s what her former self would have wanted, too.

sparklingsilver28

Well Trisher, I would like to have your confidence, and/or naivety. Long before Covid 19, DNR known to have been placed on some hospital patient records without patient or family knowledge or consent. My opinion for what it is worth, euthanasia through the back-door. Just as failing to protect care home residents in this epidemic. I am sure Dr Shipman believed he was delivering a public service. So little regard is placed on human life. The next generation need to be aware, because if they fail to address this issue their turn is to come and "too late to close the door when the horse has bolted".

I can only comment about family experiences. My mother aged 95 spent 3 months in hospital being treated for a fractured pelvis. She developed and was treated for a number of other complaints whilst there including a bleeding stomach ulcer. The staff all treated her with care and hope. She wanted to die and asked for a DNR which I discussed with the doctor and he discussed seperately with her. Whilst her discharge was being planned she suddenly developed pneumonia and died the same night. The doctor who was treating her was in tears about it. The staff on the ward were all upset. To imagine that Shipman was anything but a very strange exception is insulting to the medical staff who do their best for all patients regardless of age. I don't think my mum was the exception I think they show the same care to all patients.

Its the blanket approach that is very very questionable because a DNR decision is categorically about individual circumstances, rather than generalised policy.

A DNR is in place for the patient. It is not to save money. It is the kindest thing to do

I think many have an overly optimistic view of the results of CPR etc as well. It doesn't save that many lives. Also it can result in a person being left needing 24 hour care.

This comment from MawB2 sums it up so well

I wish people would be less histrionic about DNR’s - why prolong suffering, why hang on to a life which is ready to go?

Nobody pressured my mother into a DNR. In fact when we had meetings with the staff involved in her care it was me who asked the question "Are we looking at end of life care here?" and the staff always answered "No" and promised if it ever came to that they would discuss it with me. When she was on a drip after having her stomach bleed cauterised the veins in her arms began to collapse, and that was when we discussed DNR. She actually recovered from that episode but died very suddenly and unexpectedly. When I asked about DNR one of the nurses said to me it was what she would have done if it was her mother. I think people sometimes forget that medical staff have elderly family and often treat their patients as they would their own. In 3 months visiting the ward my mother was in I watched staff deal with all sorts of illnesses, their care and patience always impressed me. I remember the ward sister following one patient with dementia along the corridor as she pushed her walking aid, and announced loudly that she was leaving (the ward was locked anyway), and patiently explaining to her that she wouldn't get out that way because it was the door to the store cupboard. Staff on geriatric wards really aren't there to get rid of as many patients as they can, they care about them.

A good care home will have these things dealt with very promptly after a person comes to live there, so it is noted down and there can be no mistakes or people doing the wrong thing.

I'm a bit disturbed that posters, are still responding to the misleading headline of this post and, indeed, that the headline has been allowed to stand.

There was no blanket order on all care homes

The Op based her post on a survey of 128 care homes. At a recent survey there were 21,782 care homes in Great Britain.

Of those 128 surveyed 1 in 10, that's 13 homes said they had placed new DNRs on residents, some without consultation. Not all residents.

I am repeating myself. But I can't let the "blanket" statement continue.

Owners of care homes and care workers have said that the government has totally let them down with regard to testing.

The test have simply not been forthcoming which means that apart from controlling the spread within the care home relatives are still unable to visit.

Blimey that seems inordinately cruel.

Illte

I'm a bit disturbed that posters, are still responding to the misleading headline of this post and, indeed, that the headline has been allowed to stand.

There was no blanket order on all care homes

The Op based her post on a survey of 128 care homes. At a recent survey there were 21,782 care homes in Great Britain.

Of those 128 surveyed 1 in 10, that's 13 homes said they had placed new DNRs on residents, some without consultation. Not all residents.

I am repeating myself. But I can't let the "blanket" statement continue.

Absolutely.
This is another example of Chinese Whispers!
Have you reported it to GNHQ as “fake news” ?

It is issues like this that worry me, surely you can't be happy about these?

www.mirror.co.uk/news/uk-news/vulnerable-kids-parents-covid-coronavirus-21852510

Appalling, I agree. And needs to be brought into the open.
But that was dated April - when treatment for Covid19 was still very rudimentary, few even among doctors had any idea of the effects on organs as it was thought to be a respiratory disease.
Added to which, very few children have caught it as it turned out.
5 months on both the medical profession and the health authorities know so much more about transmission, treatment and outcomes.

But that was dated April And it wasn't in fact an order to put DNR on the notes of every care home patient - it was a reminder to review and check that the question of DNR had been considered, in the light of the seriousness of the possible effect of CoVid on their vulnerable patients.

If I were in a care home, unable to breathe unaided, with no heartbeat or likelihood of my heart spontaneously restarting, and about to be certified dead, I would not be grateful for having my ribs broken and other damage done to my tired old body by vigorous attempts to force my heart into beating again. I'd be knocking at the pearly gates by then, and stepping through them happily.

That doesn't mean I wouldn't want treatment for conditions and illnesses.