Care home has suggested 'DNR'

Discussion in 'End of life care' started by anon36, Jan 7, 2016.

  1. anon36

    anon36 Registered User

    Jul 24, 2014
    Hi all,

    My family today had to make a decision with regards to my Mum who was admitted to a care home at the end of summer 2014. She has recently been refusing to eat and now needs assistance getting around which wasn't the case when she turned 70 last September. It's really frightening how quickly things are progressing and the home suggested that would be the case. The advice was that if she was resuscitated that she would be in a much worse state.
    I feel so bad as it feels like agreeing with that idea is giving up on her. I feel like there should be more hope and more they can do. It's a really bad feeling thinking at any minute we could now lose her and based on the agreement made they won't do anything to help.
    As recently as a month or so ago she could recognise people and respond to things. We did have adverse reactions at times and unpleasant responses as expected.
    Is she really that close to the end of her life? I really don't know what to think...
    I've seen people who are very much chairbound and non responsive but still there, would she be likely to go to that. I don't know whether to expect months a year or more or even just weeks.
  2. nitram

    nitram Registered User

    Apr 6, 2011
    North Manchester
    Some homes ask about a DNR as part of their admission procedure, it only applies when the heart has stopped. The success rate with older people with co-morbidities is very low. Some clinicians regard it as a defence against them being sued for lack of care.

    Their is another more difficult aspect that can be helpful to agree in advance.
    An advanced care plan can be drawn up as to when you would like the person to be sent to A&E, phrases like 'any reversible condition that cannot be treated in the care home' are useful always remembering that dehydration is reversible but unless the basic cause is removed multiple admissions may not be desired.

    The care home staff should be able to help you draw up an advanced care plan if you decide you would like one.
  3. fizzie

    fizzie Registered User

    Jul 20, 2011
    It is a difficult decision but it is a question which really does need to be asked - for the person's sake more than anything else. I knew my Mother did not want to be kept alive from many conversations we had had over the years and I have started those conversations with my older teens too. It meant that when the time came the decision had really already been made and so the path was no less painful but smoother. Some people have very clear ideas that when quality of life ends that is when they would wish to die with dignity but there are so many different thoughts and the day that you have to consider it is probably one of the most difficult days of your life - so sorry you have had to face that one today x

    Care homes are encouraged to ask about DNAR and end of life care and that is no bad thing. It isn't necessarily a signal that they think your Mother is close to death, just that they are being caring and mindful of everyones' needs and wishes (and as Nitram says no-one these days wants to get sued) and that when the time comes everyone will have a clear plan.
  4. anon36

    anon36 Registered User

    Jul 24, 2014
    Many thanks both, appreciate the reassuring comments. It's nice to think it's more of a preparatory measure and not signalling that it's very close to the end. I'm going to stay prepared for bad news at some point as I know it's inevitable, I just hope it's not for a while yet and I can still see her a few more times (200 miles away).
    I'll relay the other ideas on to my Dad as I just didn't want it to seem like we'd given up all hope and would lose her sooner than we should. She is still eating liquid food and I did wonder if the reduced eating might be affecting her strength and mobility.
    I might be able to see her on Sunday, it's always pot luck as to what reaction I get. If I can get a quick one-sided hug before she walks off or just a smile or something at some point it'll be worth the journey.
  5. Dimelza

    Dimelza Registered User

    May 28, 2013
    Hi there. I suggested a DNACPR for my dad quite recently when he suffered two strokes in a week. I simply want him to be allowed to go when his time is here, not be subjected to the relative brutality of CPR. He's going through enough now with constant UTI and pain. He's on pain relief but he's no longer looking happy or settled and it's heartbreaking.
    It felt very very odd walking into the CH to hand over the DNACPR document from dads GP, I was quite emotional but I know it's the right decision. In my mind when dads heart stops, that's him saying enough now.
  6. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    North West
    Whether your mum should have a DNR and whether she is close to the end are two separate issues.

    I was wondering if you felt she was close to the end? I think the priority at the moment is that she is 'refusing food'. Is she persistently doing so? Is anyone getting her to take any food? Is she being offered food she likes? Have fortified drink been tried? Does she have an infection? Could the meds she is on be causing problems? These are questions you might ask.

    People often deteriorate rapidly in care homes. There can be many different reasons for this.
  7. JXPW

    JXPW Registered User

    Feb 24, 2012
    #7 JXPW, Jan 8, 2016
    Last edited: Jan 8, 2016
    My dad went into a care home and for the 3 years he was there he hated it from day 1. To be honest He made it clear he wanted to die anyway rather than living in care, so when the question of a DNR came up for me, although I hated the idea of my dad not being around anymore, I just knew it was the right thing to do. I signed the document with a heavy heart, but knew his pain. During the three years in care, many times my dad tried to kill himself. He used to wrap his dressing gown cord around his neck, and then all hell would break loose. Dementia crisis teams called in, extra staff needed to watch over him, etc, etc. He was miserable so he said, when he could actually speak.. Nothing I could do or say was going to make him change his mind. We never actually had that conversation before he got that dreaded dementia, and now looking back we should have. Would my dad, dementia, and all his other medical issues, want to be resuscitated and live longer in the place that he never called home, only a prison - his words not mine No, never. I knew I definitely did the right thing.

    If it was me, I would choose one for myself. I'm going to actually write that down somewhere, so my daughter and husband never have to make that hideous decision.....

    Good luck.
  8. CHEZA27

    CHEZA27 Registered User

    Jan 8, 2015
    My mum has a DNR in place as ages extremely poorly ATM. It was a heart renching decision to come to for my family and I. The doctors gave us all the Information as to why resuscitating wouldn't give mum a quality off life. She would be reliant on machines and they said it's likely that we would have to make a decision to turn off life support anyway. We have to go with mums wishes as well as medical opinion. It's a hard thing to think about and I'm questioning every decision I'm having to make. Keep strong xx
  9. anon36

    anon36 Registered User

    Jul 24, 2014
    Thanks for the updates everyone, sorry to hear you're in the same boat CHEZA and Dimelza. It's really hard also seeing the emotional impact on my Dad who is at home on his own surrounded by things reminding him of my Mum. It's been said a million times how much of a horrible disease it is as it seems to affect so many really nice people, my Mum was no exception - she was very loving and nice to everyone, always willing to help others etc. I retain all those memories of here and know that's who she really is despite any adverse reactions received.
    Stanley - thanks for the interest, I got to see my family and Mum this weekend making the 400 mile round trip pretty much just for a day. I've been told she is taking food in liquid form but unsure exactly how often. When we arrived she was asleep (apparently often the case) but stirring a bit so the staff woke her up and helped her into a private room for us. We sat there with her but only received hard concentrating stares for about 20 seconds at a time each. There was no negative responses apart from a No when asking if she wanted the tea brought in for her. She did eat half a biscuit whilst we were there and smiled a little at my niece. We like to take her grandchildren in as she loved children and they often result in a smile. I showed her a couple of animal videos on my phone and played some songs she really liked, she watched them but no response at all. Unsure if it was a bit of an uncomfortable feeling for her being surrounded by people she didn't recognise or if she'd only just been woken up but in September she was still quite mobile. This time she seemed very much unable to get around by herself.
    With regards to medical issues she has frequently been affected by heartburn/indigestion (I think the former mostly) but it can be difficult getting her to take any pills. She has a negative response to taking any medication at all. We suspect the heartburn may contribute to her difficulty in eating possibly?
  10. Dimelza

    Dimelza Registered User

    May 28, 2013
    How are things going? My dad has dissolvable lansoprazole which they then mix with his thickened squash to drink. Would that work?
  11. anon36

    anon36 Registered User

    Jul 24, 2014
    Thanks Dimelza, I did think a subtle route for getting her to take something would be the answer. I've suggested it to my Dad as he sees her every couple of days. I've had something like that before for my indigestion and it seems quite good. I think she does receive small doses of gaviscon from time to time.
    The last few visits by people have been better than my visit. She's been more responsive and interactive, laughing and joking etc. which is nice. It's quite a contrast to when I saw her and she didn't seem to know who any of us were and just stared at each of us in turn as mentioned. She also ate a few biscuits on the last few visits.
    It did seem quite sad how now she has to be carried into a room by the staff when only last Summer she was confidently walking around by herself.

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