March 10, 2013
CPR Incident Prompts Policy Reviews on LI
Featuring: Rosemarie Ennis, Director, Emergency Cardiac Care Training, North Shore-LIJ
While staff at independent-living and assisted-living facilities in New York are not legally required to perform CPR on residents, Long Island facilities said they would come to the aid of any ailing resident until emergency help arrived.
The issue came to national attention after the death an 87-year-old woman who on Feb. 26 collapsed in the dining room of an independent-living facility in Bakersfield, Calif., from apparent cardiac arrest.
The woman, who did not have a "do not resuscitate" order, died after a woman identified as a nurse refused a 911 dispatcher's pleas to perform cardiopulmonary resuscitation, or CPR, saying she was not permitted to do so. The family of the woman who died later said that she did not want "any kind of life-prolonging intervention."
Under New York law, nursing homes are required to have someone able to perform CPR on each unit for all shifts and they must perform lifesaving maneuvers unless the resident has a do not resuscitate order.
But assisted-living facilities, which can provide an array of services for residents who do not require 24-hour care, and independent-living facilities, which are usually apartments for seniors, are not required by state law to do so.
Nevertheless, facilities contacted said their policy is to have staff able to perform CPR if needed.
Karen Brannen, chief executive of Jefferson's Ferry in South Setauket, which offers a continuum of care from independent living to skilled nursing, said a licensed practical nurse is always available to respond to any resident's emergency medical needs at the facility, and security guards are also trained in CPR.
"I can't imagine someone in my organization not trying to help," she said.
Amy Schuster, a vice president at Atria Senior Living of Louisville, Ky., which has 10 independent- and assisted-living facilities on Long Island, said, "We do have staff in our buildings 24 hours a day. So, if and when needed, and as appropriate, Atria employees can and will perform CPR."
The Amsterdam at Harborside in Port Washington, which offers independent housing, assisted living and skilled nursing care, has a similar policy: "If any resident needs emergency CPR, we have a number of associates who have been trained by the American Heart Association and are required to administer CPR," said Sam Guedouar, executive director of The Amsterdam.
Ginger Lynch Landy, director of the New York chapter of the Assisted Living Federation of America, which represents 54 assisted-living communities statewide, said that policies can vary from facility to facility and that it's important for families to fully understand the care being provided, including emergency care. "That requires a lot of discussion and disclosure about how they are staffed," she said.
Jim Clyne, chief executive of LeadingAge New York, which represents 600 not-for-profit long-term facilities at all levels of care, said that many members are "going back to look at their policies" regarding CPR after the California incident. But, he said, "it's a complex issue . . . You don't want to inject untrained staff."
And the CPR survival rate is low, especially for those over 80, he said. A 2000 study in the journal Academic Emergency Medicine found that 10 percent of 40- to 59-year-olds survived cardiac arrest outside a hospital after CPR, while only 3.3 percent of those 80 and older lived after it was given.
New Yorkers -- except for medical workers "rendering professional services in the normal and ordinary course of his or her practice" -- who aid in an emergency are protected from lawsuits under the state's Good Samaritan law. The Federal Cardiac Arrest Survival Act passed in 2000 also offers immunity from civil suits to people giving CPR or using an automated external defibrillator.
Medical experts and elder-care advocates maintained that no policy -- except a DNR -- should prevent someone from helping another while emergency help is on the way.
Rosemarie Ennis, director of the American Heart Association's emergency cardiac care training center at North Shore-Long Island Jewish Health System, said that while it may not be a legal requirement to perform CPR if one is able, "most people would feel it is a moral duty."
Richard Mollot, executive director of the Long Term Community Care Coalition in Manhattan, said that "it's very troubling that this would even be an issue."