Why Many Hospices Require DNRs
When our time is coming, at end-of-life, if we have lived to a ripe-old-age and are well into our senior status, certain legal documents become a must have. Many hospices will require a patient, or their DPOA (Designated Power of Attorney), to sign a DNR order upon admission, and for good reason.
A DNR is a legal document that stands for "Do Not Resuscitate" and is typically only used for senior citizens, whose bodies and bones have weakened and are more susceptible to injury, illness, and death. DNR documents let certifiably trained medical professionals know that if your heart stops beating or you become unable to breath, you do not want them to perform CPR, cardiopulmonary resuscitation, in an attempt to save your life. Without a DNR, medical professionals are required to perform life-saving measures. When you are young and reasonably fit, performing the CPR chest compressions can double or even triple the chances of saving your life. For more frail seniors, however, CPR only works about 5% of the time and often results in broken ribs, a fractured sternum, and impaired cognitive functioning, such as memory loss or coma. If you can imagine being at end-of-life, wanting to have a peaceful death, your heart begins to stop and suddenly a medical professional is performing CPR as your final moment on Earth. It is a heart-breaking thought and goes against the hospice philosophy which is set in place to provide you with the most comfortable transition possible.
When a patient signs onto hospice, the hospice company's role is to provide them with a dignified plan of care based on their wishes including the resources and medical assistance they need so they can make the most of their time that is left. Hospice strives to offer the opportunity for patients to die in their home, wherever that may be. Many home caretakers and assisted living staff are not comfortable or educated enough to perform CPR on a senior. When a patient does not have a DNR and a medical emergency comes up, even though hospice is supposed to be the first call to avoid hospital trips, they are often sent to the hospital anyway because the staff or caretaker cannot perform CPR, which would be required. Hospice patients that become admitted to the hospital are automatically discharged from hospice services. Unfortunately, in these situations, the patient will often pass at the hospital, having had a traumatic life-saving attempted measure in their last days.
As the scenario indicates, the hospice company loses the patient in the end and cannot fulfill their honorable mission. Hospice companies may accept patients without DNRs because, even though they didn't have the patient at their most critical time, they were able to provide a number of invaluable resources up until that point. These resources include social worker and chaplain visits, a home health aide to help with bathing and eating, weekly nurse visits and a comprehensive plan to provide as much assistance as the patient requires.
A DNR provides the opportunity for patients to direct their own care and chose comfort over medical intervention. After all, most people don't want their death to be a medical event, they want the dignity of peace and comfort care, surrounded by the community that loves them the most.
