January 19

Dexter nursing home death highlights bigger issues

Nursing home staff failed to follow end-of-life directives of patient to administer CPR, spurring state’s largest fine of year and raising questions about policies regarding elder care.

By Matt Hongoltz-Hetling mhhetling@centralmaine.com
Staff Writer

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Nursing home comparisons available online

For the last couple of years, nursing home compliance information has been available online.

Medicare offers consumers who have Internet access an easy way to check out nursing homes at its Nursing Home Compare website, medicare.gov/nursinghomecompare.

On that site, people can enter a location or nursing home name, and get information including overall rating, which is measured by one to five stars.

Those who want to dig a bit deeper can read the star ratings in three specific categories — health inspections, quality measures and staffing levels.

They can also access the most recent health inspection reports themselves, which document every deficiency found over the past three years.

With the new inspection report factored in, Dexter Health Care’s overall rating is now two of five stars, or “below average.”

The nursing assistant asked if the resident was OK, she later told inspectors, and Resident 11 said yes.

Still, sensing that something was out of the ordinary, the assistant told the charge nurse that the resident’s right arm was “making a strange motion.”

Twelve minutes later, the charge nurse and the nursing assistant both went to the room, where they found Resident 11 unresponsive, with no pulse or other vital signs.

At this point, the charge nurse should have administered CPR, an instruction that was spelled out in the advance directives for that patient. A physician had signed an order Jan. 15, 2013, directing that CPR should be given to the patient. Furthermore, if a patient doesn’t have an advance directive, the default directive is to give CPR.

But she didn’t.

Resident 11 was declared dead, with no further efforts made to resuscitate.

Full code ignored

Not every patient in Resident 11’s position would choose to be revived with CPR.

Deciding how far one wants to go in extending one’s life in difficult circumstances can be an intensely personal decision, according to administrators at other area nursing homes.

Because many patients can’t communicate when the time for medical intervention comes, federal regulations require that every nursing home resident be given a chance to create a set of advance directives, written instructions used to guide health care decisions when a person is incapacitated.

Nursing homes routinely create advance directives for their patients, and review them every three months with patients and families to make sure they are up to date.

The directives are important, not just for nursing home residents, but for everyone, according to Carol Timberlake, administrator for both the Orchard Park and Edgewood rehabilitation and living centers in Farmington.

“If I can no longer speak for myself and I’m in a situation where there is no hope for me to regain my abilities, this is how I want to be managed,” Timberlake said. “Do I want to be given food or not? Do I want fluids or not?”

Another nursing home administrator, Carolyn Sawyer, said she understands why CPR is not always desirable.

“The chances of CPR working run low and it hurts,” she said.

She has seen it add unnecessary pain to the end of someone’s life at Somerset Rehabilitation and Living Center in Bingham and Heritage Rehab and Living Center in Winthrop, the two homes she oversees.

The right to fill out an advance directive is protected by federal law, according to John Martins, spokesman for the Maine Department of Health and Human Services, which oversees Maine’s nursing homes on behalf of the state.

Not every resident chooses to fill out an advance directive, but Resident 11 did, according to the state’s inspection report.

The advance directive of Resident 11 was clear.

In life-threatening situations, Resident 11 wanted to be taken to a hospital for treatment. Infections were to be treated with antibiotics.

Most importantly, if the resident’s heart stopped beating or lungs stopped breathing, the advance directive told staff that CPR should be used in an attempt at revival.

In January 2013, a doctor read and approved the advance directives, issuing Resident 11 a code status, which tells staff whether CPR should be given. Some patients are under a “do not resuscitate” order from a doctor, while others are full code, meaning they should be revived with CPR and other methods.

Resident 11 was given full code status.

Failures uncovered

A sampling of about 30 inspection reports from around the country show that many people, like Resident 11, have asked for CPR but died in a nursing home without it in recent years.

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