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Advanced Directives, Living Wills, and DNR - Documents for End of Life

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What is a DNR?  What is an Advanced Directive or Living Will?  If I have an Advanced Directive or Living Will do I need a DNR?

These are questions we get all the time while helping people take care of their loved ones, or even because the questions come up while putting a loved one’s affairs in order.  So, let’s look at these different documents.

An advanced directive, or living will, is a document by which someone makes provisions for health care decisions if, in the future, he/she becomes unable to make those decisions. An advanced directive or living will is not intended to be used in an emergency situation.  In this document someone can make clear their desire regarding treatment in the event they have a terminal illness. Decisions involving artificial hydration and nutrition, being placed on a machine that breathes for them, and other measures to prolong life, can be outlined. A health care proxy, or health care power of attorney, is usually appointed as part of this document. The advantage of having an advanced directive, or living will, is that it makes it very clear what someone wants and relieves the health care proxy, or health care power of attorney, of the responsibility of making those decisions. Their job then becomes making sure the wishes already outlined are being carried out.

DNR literally means Do Not Resuscitate. This document covers the use of Cardiopulmonary Resuscitation (CPR) in an emergency situation. CPR uses mouth-to-mouth or machine breathing and chest compressions to restore the work of the heart and lungs when someone's heart or breathing has stopped. It is an emergency rescue technique that was developed to save the life of people who are generally in good health. Each state has different requirements for the administration of CPR and DNRs. In the state of Oklahoma, if a healthcare worker does not have the document from the Oklahoma Department of Human Services that is specific for DNR, copy HERE, then they MUST initiate CPR. The law works a bit differently in Texas, as senior care facilities are not required to administer CPR in Texas. Having a DNR on file, however, ensures that one's wishes related to CPR are honored. 

When someone has Alzheimer's, Lewy Body Dementia, or other kind of dementia that significantly impairs their health, discussions about end of life are very important. If the individual with the diagnosis is still able to make their wishes known and is competent to sign documents, ask them to consider completing an advanced directive. Also introduce the topic of CPR and discuss their wishes. This discussion can be difficult - emotionally, as well as confusing if you are not familiar with medical procedures and terminology. Physicians and nurses are trained in discussions such as these. A primary care physician should be able and willing to help facilitate this discussion. If the individual living with dementia is no longer able to make their wishes known, it is important that all family members discuss these issues before decisions have to be made. Making sure you are all on the same page before there is a crisis is very helpful with managing the stress when said crisis happens. And unfortunately, the path of caring for someone with dementia is filled with tough situations that force tough decisions. 

If your loved one is a resident of Iris Memory Care, the Director of Wellness will be more than happy to answer any questions you might have related to these matters. Let us know how we can help! 


 

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