Nursing Home report on RTE

aloyisious

I heard with a bit of disquiet e report on RTE about the closure of a Nursing Home that had been left without a person in charge for some weeks. The report also said that documents found at the home (apparently referring to some residents) included the wording "do not resusitate". The report said that it seemed patients relatives may not have been aware or informed of the issue. The patients were transferred elsewhere by HIQA.

seven_eleven

DNR - Do not resussitate is common in nearly every nursing home. Nobody is going to resuss a high dependency elderly person for many reason which I'm not qualified to outline. It probably would do them more harm than good.

kneemos

seven_eleven wrote: »

DNR - Do not resussitate is common in nearly every nursing home. Nobody is going to resuss a high dependency elderly person for many reason which I'm not qualified to outline. It probably would do them more harm than good.

With the persons or relatives consent which was apparently lacking.

mikom

aloyisious wrote: »

The report also said that documents found at the home included the wording "do not resusitate".

The documents were apparently FG's plan for the economy.

baaah

mikom wrote: »

The documents were apparently FG's plan for the economy.

A bit flippant that comment, considering the topic of this thread.

There have been too many reports on the poor standards of some nursing homes in this country over the last few years.

Wacker The Attacker

seven_eleven wrote: »

DNR - Do not resussitate is common in nearly every nursing home. Nobody is going to resuss a high dependency elderly person for many reason which I'm not qualified to outline. It probably would do them more harm than good.

Does the hippocratic oath apply?


That question is from someone who has absolutely no idea how the medical system works so it may appear silly

ITS_A_BADGER

If they had DNR on someones file without the familys consultation thats disgraceful, did they say on the report if the families were asked?

mikom

baaah wrote: »

A bit flippant that comment, considering the topic of this thread.

There have been too many reports on the poor standards of some nursing homes in this country over the last few years.

Yeah......... reports.
I wonder what home carers think of reports.

Larianne

ITS_A_BADGER wrote: »

If they had DNR on someones file without the familys consultation thats disgraceful, did they say on the report if the families were asked?

I heard it on the radio news report that in some cases neither patients nor family members had given consent of DNR of the patient. It was found the case in a number of residents at the home.

What the hell is going on in these homes?!

My name is URL

How independent are HIQA? They seem more interested in shutting places down than bringing about improvements. I wonder which costs less and brings a bigger yield to sub-standard state care facilities.

Munstermissy

On the positive side of things, my elderly uncle is in a nursing home in Co. Galway and the care is second to none. He is well looked after, the place is spotless and the staff are brilliant. We are contacted immediately if there are any issues with his health. We are an hour and a half drive away so we are happy he is being well cared for.

Kristopherus

My name is URL wrote: »

How independent are HIQA? They seem more interested in shutting places down than bringing about improvements. I wonder which costs less and brings a bigger yield to sub-standard state care facilities.

This place was a private NH. Built/Opened in 1987 iirc.

ITS_A_BADGER

Larianne wrote: »

I heard it on the radio news report that in some cases neither patients nor family members had given consent of DNR of the patient. It was found the case in a number of residents at the home.

What the hell is going on in these homes?!

Thats outrageous that someone in the nursing home made the decision to not resuscitate some patients without consulting anyone, The families pay enough money to have them in the homes to be let die by their so called carers

seven_eleven

Honestly its not a disgrace really. If there is a person living their final years, have a list of medical problems longer their arm, physically and sometimes mentally disabled, frail and weak, trying to resuscitate them is not in their best interest. It will only end up damaging them even more! you cant just keep trying to resuss every elderly person when their time comes, because they HAVE to die eventually. And a lot of the time these people dont have any relatives, family, or friends.

As I said above, I'm not qualified to say for sure, but I'm not sure if you NEED the families permission to DNR them. Most nursing homes wont do it. I hate when people start slating services for something they deem morally wrong, when infact its the opposite.

If only you knew what they did with your body after you die, or hell even during resuscitation, some of you would be quick to ridicule that too.

Its very hard to do a job working with people, when every joe-soaps eyes are on you, waiting for you to do something they deem "wrong", so they can mouth about it and complain to joe-duffy and every old biddy down at the shop.

My name is URL

seven_eleven wrote: »

Its very hard to do a job working with people, when every joe-soaps eyes are on you, waiting for you to do something they deem "wrong", so they can mouth about it and complain to joe-duffy and every old biddy down at the shop.

+1 for the Priests.. poor feckers can't even cop a feel these days because they were caught too many times.

ITS_A_BADGER

seven_eleven wrote: »

Honestly its not a disgrace really. If there is a person living their final years, have a list of medical problems longer their arm, physically and sometimes mentally disabled, frail and weak, trying to resuscitate them is not in their best interest. It will only end up damaging them even more! you cant just keep trying to resuss every elderly person when their time comes, because they HAVE to die eventually. And a lot of the time these people dont have any relatives, family, or friends.

As I said above, I'm not qualified to say for sure, but I'm not sure if you NEED the families permission to DNR them. Most nursing homes wont do it. I hate when people start slating services for something they deem morally wrong, when infact its the opposite.

If only you knew what they did with your body after you die, or hell even during resuscitation, some of you would be quick to ridicule that too.

Its very hard to do a job working with people, when every joe-soaps eyes are on you, waiting for you to do something they deem "wrong", so they can mouth about it and complain to joe-duffy and every old biddy down at the shop.

Doesnt the family or patient have the right to say if they want to be revived or not? If its true that they had DNR on someones file without asking them how they feel about it, THATS the part i have a problem with, Not that it might cause them more damage to revive them, The home took the decision themselves to revive or not, do you not find something wrong with that?

kneemos

ITS_A_BADGER wrote: »

Doesnt the family or patient have the right to say if they want to be revived or not? If its true that they had DNR on someones file without asking them how they feel about it, THATS the part i have a problem with, Not that it might cause them more damage to revive them, The home took the decision themselves to revive or not, do you not find something wrong with that?

The patient or relations need to give consent.

ITS_A_BADGER

kneemos wrote: »

The patient or relations need to give consent.

Then whoever took these decisions to put DNR on patients files with no consent of either patient or family should have their role as a carer examined

Rasheed

A doctor can order a Do Not Resuscitate order without family's or patients consent.

kneemos

Rasheed wrote: »

A doctor can order a Do Not Resuscitate order without family's or patients consent.

Pretty sure your wrong.

Larianne

Rasheed wrote: »

A doctor can order a Do Not Resuscitate order without family's or patients consent.

Apologies I got the statement wrong.

But DNR is something that should be discussed with the patient and/or the family, and the MDT. Something which wasn't documented in being completed in that home.

Rasheed

kneemos wrote: »

Pretty sure your wrong.

I'm sure right.

It's not usual but it does happen. The problem with the said nursing home was there was a DNR order with any consultation from the family, multidisciplinary team or the patient. So it basically looks like a staff member wrote DNR on a chart.

mattjack

Rasheed wrote: »

A doctor can order a Do Not Resuscitate order without family's or patients consent.

There is nothing 'set in stone' about DNR in Ireland at the moment.Its based loosely on agreement with the family ,doctor and if possible the patient.I think if DNR is agreed , the exact reasons must be given for it.

My father has DNR instructions in his files.He lives in a care home.

Rasheed

Larianne wrote: »

Apologies I got the statement wrong.

But DNR is something that should be discussed with the patient and/or the family, and the MDT. Something which wasn't documented in being completed in that home.

Oh it should be, definitely. But sometimes it's not possible and the doctor will take it upon themselves to order it. There can be dozens of reasons for this.

kneemos

Rasheed wrote: »

Oh it should be, definitely. But sometimes it's not possible and the doctor will take it upon themselves to order it. There can be dozens of reasons for this.

Seems there is no legislation on it according to the RTE news.

Larianne

Rasheed wrote: »

Oh it should be, definitely. But sometimes it's not possible and the doctor will take it upon themselves to order it. There can be dozens of reasons for this.

Yes, in an acute hospital setting maybe, but a nursing home?

ITS_A_BADGER

If there was nothing strange about it, it wouldnt be on the news in the first place, They said on the news that no one was consulted neither MDT,families or patients.

Rasheed

kneemos wrote: »

Seems there is no legislation on it according to the RTE news.

Yeah exactly. It needs a doctor to sign it, one way or the other. So a doctor can sign it without having to consult the family or the patient.

Now it's not going to be done on a compos mentis person, but some patients can have no family and their faculties affected. So the doctor will sign it, taking the MDT's opinions into consideration.

For Paws

The question ' why would a nursing home benefit by noting a DNR notice on patient's files without consulting the patient's family ?' arises.

In the not uncommon situation where a resident in a nursing home is referred to a hospital, either on a family physician's orders, or by nursing home staff, the likelihood of an increasingly ill person being treated and thereafter returned to their nursing home is greater than it would be if that patients had a DNR notice.

In other words, no DNR & the now seriously ill resident is back in the home, taking up more care time & resources.

Stick a DNR on the patient's file & they'll probably die in hospital.

Very sad ...... and their bed in their home is free for the next customer.

In 'private' nursing homes it is not unusual to 'rent' beds to non-private, ie; GMS (Medical card holders) through the health authority. This bed doesn't generate the same income level as it would if a private patient was occupying it.

Would not be surprised to learn that the patients with the DNRs were GMS.

I am fully aware of the huge numbers of excellent & caring people who look after the residents in nursing homes countrywide, but these places are BUSINESSES first & care homes second.

Rasheed

ITS_A_BADGER wrote: »

If there was nothing strange about it, it wouldnt be on the news in the first place, They said on the news that no one was consulted neither MDT,families or patients.

Yup so basically a nurse could have decided to themselves that they wanted Joe Bloggs to be DNR and wrote it in his cardex.

That's why it's in the news. There's no paper trail as to how the decision was made, ie. no family, patient or MDT involvement.

mattjack

For Paws wrote: »

The question ' why would a nursing home benefit by noting a DNR notice on patient's files without consulting the patient's family ?' arises.

In the not uncommon situation where a resident in a nursing home is referred to a hospital, either on a family physician's orders, or by nursing home staff, the likelihood of an increasingly ill person being treated and thereafter returned to their nursing home is greater than it would be if that patients had a DNR notice.

In other words, no DNR & the now seriously ill resident is back in the home, taking up more care time & resources.

Stick a DNR on the patient's file & they'll probably die in hospital.

Very sad ...... and their bed in their home is free for the next customer.

In 'private' nursing homes it is not unusual to 'rent' beds to non-private, ie; GMS (Medical card holders) through the health authority. This bed doesn't generate the same income level as it would if a private patient was occupying it.

Would not be surprised to learn that the patients with the DNRs were GMS.

I am fully aware of the huge numbers of excellent & caring people who look after the residents in nursing homes countrywide, but these places are BUSINESSES first & care homes second.

In private homes a percentage of the residents are under the Fair Deal, with medical cards , before that there was a system called subvention where you gave up your pension.

Rasheed

Larianne wrote: »

Yes, in an acute hospital setting maybe, but a nursing home?

It's actually more 'cut and dry' in a long stay facility than in an acute setting. Usually, in an acute setting, a persons prognosis might not be easily determined so doctors would be more wary of signing a DNR without complete family/ next of kin consent. Even then, they would need to be very sure of no recovery.

In a long stay facility, a person could be there for years, in a near vegetate state or in very poor health and without a near family member to give consent, the doctor will take it upon themselves to get everyone's opinion and go ahead with what everyone decides.

Micky Dolenz

I really don't get it. Surely it is in the best interest of the nursing home to keep people alive, from a business perspective if nothing else.

seven_eleven

Pippa Middleton's Arse wrote: »

I really don't get it. Surely it is in the best interest of the nursing home to keep people alive, from a business perspective if nothing else.

Theres only so much you can do to keep somebody alive when its their time to die. Its a waste of time and life. From a business perspective? There will never be a shortage of clients for these nursing homes.

Chorcai

I don't get how some people are all blaz'a about DNR files. Both of my maternal grand parents were in a nursing home I would be sick at the thought of a DNR file put into their records with out any discussion with our family. People saying ohh don't be taking the moral high ground, really?? This is how we are letting our eldery be treated in Ireland.

There were other issues mentioned such as diet/pain/medical, this place should have been closed down sooner, I hope the owner is prosecuted aswell.

Some medicines that were not suitable for crushing were crushed by staff and no maximum dose was identified for some pain killers, some of which were controlled drugs.

No temperature gauge was available in the medication fridge to control the temperature of certain drugs.

- There had been no person in charge of the home from September 2011 until May 2012

- Poor wound management, nutritional assessment and pain management

-A photograph of wounds could not be taken to monitor care due to a dead battery in the camera.

- A resident had a serious pressure sore that was not receiving suitable care

- Many residents had not been weighed recently even though they had been losing weight

- An incident of bruising to a resident was recorded in the care file but not documented in an incident report and was not investigated

- A failure to monitor a resident after they had an epileptic seizure