Resources for Family Caregivers of Older Adults
DNR & Other Advance Directives: What Families & Caregivers Need to Know (Part 2)

DNR & Other Advance Directives: What Families & Caregivers Need to Know (Part 2)

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You responded so positively to our post, Part 1: DNR & Other Advance Directives, asking for more information, that we knew we had to post Part 2 right away.

We know we can’t hope to provide the information everyone needs to answer your individual questions, so we hope to give you enough information to know what questions you need to ask and to determine which documents to consider further.

In Part 1 we listed the Advance Directives to introduce you to them.  Let’s look at each different document so that you will understand them better.

1. Do Not Resuscitate

Do Not Resuscitate is a directive in the form of an order to healthcare personnel, such as physicians, emergency medical personnel, nurses and others, who may need to save your loved one’s life if his heart should stop beating or he stops breathing.  This document can be written with your loved one and your family before it is needed and also with your senior’s physician during a hospital stay.  A DNR order involves refusing to allow someone to perform CPR with chest compressions and ventilation support in the event your senior stops breathing or has heart failure.

This is a traumatic process for your loved one and when dealing with an elderly person it can be dangerous.  The outcome may include having to receive life support after resuscitation is given using mechanical ventilation known as a breathing tube.  This life support could be needed for a short time or longer, depending on the situation. Caregivers who don’t have clear guidelines from their senior loved one should ask themselves “is that what my father would want”?  Fractured bones can also occur when a senior receives CPR, especially if he has fragile bones.  If the wish for or against a DNR is clear among the family members before an emergency occurs, it will make it easier and faster when the time comes to inform those who need to know, especially emergency personnel, so that the correct and desired action is taken.

2. Living Will

A living will is a document that spells out what medical treatment is desired by your senior loved one; it can cover a variety of specific wishes such as your senior’s desire to not be kept alive in a terminal condition if there is little hope for recovery; your senior loved ones desire to not want to be kept alive by artificial means such as a breathing machine or the desire to discontinue any life sustaining treatment when there is no hope for recovery. Your senior loved one can also decide if he wants a feeding tube placed which could keep him alive regardless of the prognosis for recovery. Some feeding tubes are needed temporarily, others are need lifelong. This document can help the caregiver or surrogate make decisions that were dictated directly by the senior and help the caregiver feel that they upheld their senior’s wishes. A living will can be overridden by the family at the time of the emergency if all parties are in agreement; however, this likely will go against the stated wishes of the senior.  The desire for or against organ donation can also be documented in the living will.

3. Healthcare Proxy

A healthcare proxy gives a specific, stated caregiver the power to make decisions for the senior in the case of emergency when the senior is unable to speak for him or herself. The healthcare proxy has the authority to make decisions for the senior that he feels the senior would make for himself if he was able. It is helpful for this caregiver to have a living will, DNR or a clear knowledge of what the senior would want when executing a power of attorney for healthcare decisions. If no clear path has been determined prior to an emergency, it will be up to the caregiver to make a decision that all family members can agree upon. Unfortunately, this decision often needs to happen within minutes when tragedy strikes and often results in disagreement in the family when all parties aren’t involved. The more communication occurring before a tragic event, the better

4. Durable Power of Attorney

A durable power of attorney usually allows a designated caregiver to make both healthcare and financial decisions for a senior loved one such as completing banking, applying for Medicaid, cashing Social Security checks, selling property or assets, paying bills and other legal transactions while the senior is incapacitated as well as the healthcare decisions needed in the event of an emergency. This caregiver needs to know not only what the healthcare treatment desires are, but also where to find paperwork and records necessary to carry out their personal duties.

Next Steps

Knowing the documents and what needs to be done are only the first steps.  The big steps can be tough but are the keys:

  • learn the wishes of your senior loved ones;
  • put them in writing;
  • keep all advance directives in a place where all caregivers and family members have access in an emergency; and,
  • give a copy to the primary doctor so he or she will be ready as needed and bring a copy when you have a scheduled hospital procedure.

We hope this helps you prepare in advance for some of the most difficult times to make them less difficult for your senior loved one, your family and you.

4 Responses to DNR & Other Advance Directives: What Families & Caregivers Need to Know (Part 2)

  1. Yes, these are very important, but I have not done any of them as yet. I have a situation where my husband’s moods are unpredictible and although on a good day he might do what is best for me or what I wish, on any other day he would ignore my wishes and only think of himself. If I were to name someone else on the forms he would try to make me feel guilty for valuing someone else over him. I don’t know what to do.

    • Grace, we applaud you for getting these important documents together. You do have options when preparing advance directives. Of course naming another person instead of your spouse who you can depend on to make these decisions on your behalf is one option but we would suggest this be part of a discussion with your spouse to avoid future problems. Is there someone you can name to work with him as co-proxy that he trusts and could share the burden of these decisions with? If so, this may be a solution you can all handle. Another option is to set up a healthcare proxy who is unrelated to you such as a lawyer who can follow your directives without the emotional toll it might cause your spouse. You may want to talk with an advisor such as a lawyer or spiritual leader to help you complete these documents. Good luck!

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