Carol Hart, who is 88, was disturbed when a California woman died after a nurse at an independent living facility refused to administer CPR, citing company policy.
“I think it’s wrong,” said Hart, who resides in the independent living section of the Renaissance on Peachtree in Atlanta, which offers both independent and assisted living.
Hart would like to believe that if she collapsed, the staff would attempt to resuscitate her. “If they got there quick enough they could save my life,” she said.
Management at Renaissance said their policy is to call 911 and perform CPR in both the independent living and assisted living areas.
In Georgia, assisted living and independent living operate in two different worlds. Assisted living facilities are required to have staff trained in CPR; independent living facilities are not.
In fact, independent living facilities, which do not include medical care among their amenities, are not regulated by any health agency in Georgia. When it comes to handling medical emergencies, it is up to each operator to decide how staff should respond — a matter fraught with all the tangled and conflicting impulses individuals and families confront as life draws to its close.
Those issues were brought into sharp focus by the recent death of 87-year-old Lorraine Bayless of Bakersfield, Calif. Within the world of elder care, the incident — captured on a harrowing 7-minute, 16-second call to police — has outraged advocates, spurred discussion at training seminars and online forums, and led some residents of facilities to start asking questions.
During the Feb. 26 call, the nurse asks for paramedics to respond, and then the dispatcher urges the nurse to begin CPR. She declines.
“I understand if your boss is telling you you can’t do it,” the dispatcher says. “But … as a human being … is there anybody that’s willing to help this lady and not let her die?”
“Not at this time,” the nurse replies.
The incident outraged some Georgia advocates.
“I can’t for the life of me understand a policy that would prohibit emergency care,” said Pat Puckett, executive director of the Statewide Independent Living Council of Georgia, an education and advocacy group for people with disabilities. “Why would you just sit there and watch this lady die?”
At Holiday Retirement, which has independent living communities in Decatur and Lawrenceville, a company spokeswoman said its emergency medical policies are aligned with most public facilities such as shopping centers and movie theaters. That policy is that staff should call 911. After that, the employee decides how much aid to render.
“Our associates then follow directions to the level they may individually feel comfortable or capable,” said spokeswoman Chelsea Henkel. “There is nothing in our policy that prevents associates from following directions of emergency services personnel.”
Sharon McNair, executive administrator of Gwinnett Christian Terrace, where she has been for 27 years, said the policy there is “to provide comfort and support.”
“We would do whatever the 911 operator instructs us to do,” she said. But she noted that her facility, which houses 140 people, has no CPR-trained staff.
And she’s not sure reviving someone is always the right thing to do. “I know most of my residents would not want to be resuscitated,” she said.
Beyond that, she worries she would injure the patient. “What if a person has osteoporosis and I do CPR and break their ribs and puncture a lung?” she said. “I might not be legally responsible, but that wouldn’t make me feel any less responsible.”
It’s a dilemma that’s likely to occur more and more often.
Although demand for senior living facilities fell off during the recession and its hangover, occupancy rates are rising again. With the tidal wave of baby boomers surging toward retirement, housing options geared to seniors are expected to find a ready market, at least among those who managed to retain a sufficient portion of their retirement savings.
Metro Atlanta is in the thick of the trend, with a population is aging more rapidly than the nation’s as a whole. Between 2000 and 2010, the number of people aged 65 and older grew by 145,000, or 44 percent, across the 28-county census region, according to census figures.
Amid the pressure of rising costs, the trend in the industry is to keep residents in the least intensive setting they can manage, according to various industry publications. Prices vary widely from region to region and facility to facility, but the national average for a private room in a nursing home is about $7,500 a month, compared to $3,350 for assisted living and $2,750 for independent living, according to industry surveys by insurance providers MetLife and Genworth.
Because independent living facilities aren’t licensed, there is no way to get a precise fix on how many exist. An online search for “senior independent living Atlanta” turns up dozens of places offering a range of amenities, spread throughout the metro area. Some run the gamut from independent living through assisted living and memory care to skilled nursing care.
Walter Coffey, president of LeadingAge Georgia, a trade group for companies that provide senior citizen housing and services, said people choose independent living because they may need a little help but not the range of medical services at more expensive facilities. Often alone after a spouse’s death, they also like the camaraderie of people with similar interests. Many of these place provide meals, entertainment and transportation.
Coffey said the woman’s death in California created a lot of discussion during a training seminar in Atlanta this week. The takeaway was that independent living facilities need to have clear policies and that residents and their families need to know them.
The owners of the California facility, Brookdale Senior Living, initially had said the nurse was following company protocol in calling 911 and awaiting assistance, but on Tuesday it said the employee had not understood the policy and it was reviewing the incident.
No charges have been filed.
Hart, who has lived at Renaissance for three years, likes living there. She appreciates the fact that the staff has ways to check on her daily, as well as provide her with meals and transportation to shopping and doctors.
“Last night we went to the symphony,” she said.
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