industry & reform
A good death
On resuscitation and dying
in aged care.
By Sarah Russell
T
he Royal Commission into Aged
Care Quality and Safety recently
addressed dying in an aged care
home. It is clear that a good death in
an aged care home requires a sufficient
number of competent and qualified staff.
A friend’s mother died in excruciating pain
because there was not a registered nurse
on duty overnight. Without a registered
nurse on duty, there was no one qualified
to administer morphine. My friend was so
traumatised by her mother’s agony that she
could not remain at the bedside to hold her
mother’s hand.
Towards the end of my mum’s life, only
the most experienced staff were able
to provide adequate care. Personal care
attendants (PCAs) with minimal training
did not have the required clinical skills to
provide care for a dying woman. For two
months, I sat at my mother’s bedside to
protect her from inflexible routines and
policies. I ensured she slept as long as she
needed, and ate when (and if) she wanted.
12 agedcareinsite.com.au
Some PCAs, many of whom were caring
people, provided thoughtless task-oriented
care. On one occasion, a PCA came to
Mum’s room around 8am to change her
night incontinence pad. Mum was sound
asleep. I asked the PCA to let her sleep
and to change the incontinence pad when
she woke up. She replied: “It is policy. She
must have a day incontinence pad because
it is daytime.”
I questioned this so-called policy, and
the PCA replied: “I just work here. I do what
I am told.”
Soon after this incident, I received an
email from the manager. She asked me
to stop interfering with Mum’s care. I
refused to budge because I did not have
confidence that staff could provide the
care Mum required.
Recently, a woman contacted me
because a 94-year-old woman was
resuscitated in an aged care home
despite having an advance care directive
stipulating ‘do not resuscitate’. Rather than
die peacefully after breakfast, this woman
had a slow and painful death in a hospital
palliative care unit.
Although residents and their families
are encouraged to make advance care
directives to state their wishes for end-
of-life medical care, these advance
care directives are meaningless unless
healthcare professionals respect an older
person’s wishes.
Aged care homes require policies to
ensure residents are not resuscitated
against their wishes. Managers must ensure
direct care staff on each shift know which
residents are, and are not, for resuscitation.
Each handover sheet should identify
residents who have documented ‘do not
resuscitate’ in their advance care plan. This
is particularly important for agency staff.
A few years ago, I arrived at an aged
care home to find a fire truck, two
mobile intensive care unit ambulances, a
paramedic motorcycle and an ordinary
ambulance. All these flashing lights
heralded the death of a resident. This
resident had expressed a wish not to be
resuscitated.
When Ambulance Victoria receives a
000 call from an aged care home, their
first question should be: “Does the resident
have ‘do not resuscitate’ in their advance
care plan?”
A doctor once told his colleagues that,
when he reached a certain age, he would
have ‘NOT FOR RESUSCITATION’ tattooed
on his chest. This would undoubtedly
guarantee his wishes were respected.
Currently, residents in aged care homes
must ‘opt out’ of resuscitation. They do
this by indicating ‘do not resuscitate’ in
their advance care plan and advance care
directive. It may be more appropriate to
make cardiopulmonary resuscitation an
‘opt in’ for residents in all aged care homes.
Only those residents who choose to be
resuscitated will be. Others will be allowed
a dignified death.
Dr Sarah Russell is a public health
researcher and director of Aged Care
Matters. Her previous research includes
Living Well in an Aged Care Home
and Older People Living Well with
In‑Home Support.