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My 94-year old mom is in AL and has had a DNR order for the past 4 years, obtained when her mental faculties were sharper and she knew what the DNR was and its purpose. She always refused to wear her bracelet, so it was placed in her purse so it would be available if she left the facility for an outing with family or facility sponsored event. Recently I checked the purse for her, it was missing, and I found it in her jewelry tray. I told her it is her ID bracelet and she should wear it all the time, just like she wears her wedding ring. Ever since, she has been wearing it all the time.


Another family member thinks this is wrong because I am not being fully honest with her about the bracelet and its purpose. My opinion is that, given her current situation, she would not comprehend, and calling it an ID bracelet is something simple that she understands and can relate to. Am I wrong here?

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Absolutely not. Your mom lacks the capacity to understand what it is, wearing it will allow her wishes to be followed in the event of a collapse. I think it's great that you've found a way for her to wear it :)
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I say good for you for coming up with a creative solution to get her to wear the bracelet.
Who cares what the other family member thinks? If mom and you are happy with it, that is all that matters.
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NeedHelpWithMom Jun 2023
Yep!
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This is not wrong . You are making sure your mother’s wishes will be followed regarding her care.
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You aren’t wrong. It’s a great idea.
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If you were being "fully honest" with her, you would have to explain that modern medicine is a scene of madness, and the bracelet is there to protect her from doctors who know full well that they shouldn't be trying to resuscitate 94-year olds, that the outcomes at this age are *terrible*, but will do it anyway if she doesn't have the bracelet to protect her. 

You'd probably also have to explain that, in an earlier era, many people were genuinely cared for at the end of life and not treated as a sack of parts to be hooked up to this or that machine. But medicine organized itself into a "profession" (originally based on expertise in the application of leeches), vanquished the healers, hoarded control of palliative medicines, and here we are.

Sorry for the hyperbole. Really, though, there is no "honest" explanation that she'd be able to understand now. And saying something like "this bracelet stops doctors from restarting your heart and saving you" actually *isn't* honest. It's one of those partial truths that is, in effect, an appalling lie.

Your mom is lucky to have you.
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Beatty Jun 2023
Interesting thoughts.
Maybe we should all be wearing bracelets with DNH : Do No Harm.
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Sounds like a great idea to me, assuming she has some form of dementia or Alhz.
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Keep it simple.. If she is okay wearing it thinking it is an ID, and I AM PRETTY SURE IT IS SOMEWHAT OF AN ID... RIGHT? CAN YOU IMAGINE IF IT DID NOT HAVE HER NAME ON IT, AND SOMEONE ELSE DECIDED THEY LIKED THE BRACELET and stole it? And that person had an issue.. well... you get the picture...

SO, I AGREE WITH YOU.. It actually is somewhat of an ID... You are okay.

And hope your mom is too...
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Ignore the family member..
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Let me just add this since I see a lot of of people tiptoeing around the topic of white or therapeutic lies. YMMV. People are different. There is no one set way to handle LO.

I have spoken about this at length with my friend who is a hospice doctor, with my therapist, and with other professionals about lying to people with dementia, ALZ and the like.

They ALL said it’s perfectly fine and morally justifiable. LOs don’t have reasoning skills anymore and have lost cognitive abilities. You tell them whatever you need to tell them that settles their mind and allows them to let that topic go or that changes their fixation or focus to something nicer and where you can redirect her.

TBH, if something did happen and a first responder found her, they’re is still (my guess) like a 50/50 chance they are going to do interventions until they see the paperwork or whatnot. This is in no way condemning your mother to death etc.

It is somewhat of an ID bracelet and it more or less really only serves as a heads up to the hospital when she gets there that she might have a legal DNR. Ok. Gotta run
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Wearing the bracelet prevents the broken ribs and other unavoidable injuries and complications caused by CPR and other “heroic measures” that are no longer appropriate or helpful now. Your mother arranged for a DNR on purpose and now you are simply helping it be abided by.

Best wishes to you and your mom.
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Using traditional techniques with dementia is senseless. We have to adapt to THEIR world of normal rather than insist they adapt to our norms. When your family member takes over your mom's care, that's when she gets a say about the bracelet. In the meantime, you're in charge.
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I really wonder what the bracelet accomplishes, a warning?

I had a DNR paper on my frig so if the emts came, I would hand it to them. I had a file I carried to the hospital with copies of all Moms papers. Mom was never alone so no need for a bracelet. Mom had an Advanced directive that stated not to resusitate. When Mom entered the AL, I was told the State required a new form to be filled out. I was POA so I had authority to sign for Mom and of course her doctor. The form covered much more than the simple DNR Mom had. When Mom went to the Hospital, Rehab, and eventually LTC each facility wanted their own new DNR on file with their doctor signing.

So, a bracelet may make everyone aware that a DNR is in place, but that DNR needs to be on file so these facilities can cover their tails. So if you have a hospital u frequent you need to have a DNR in file. Any doctors Mom goes to, DNR on file.
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AlvaDeer Jun 2023
JoAnn, you are correct. In most states the EMS if they respond to a citizen call WILL do CPR unless the POLST which constitutes a PHYSICIAN'S ORDER is clearly visible and correctly done. If it is posted they will not do CPR, otherwise by law in many states they are required to do CPR even if the patient has a tattoo on their chest saying DNR.

The truth is that a 94 year old is very unlikely to come round from CPR, and in most the chest wall will cave from normal CPR, complicating things further.

Many medical personnel do what is called privately a "slow code" in circumstances where a very fragile and aged senior is found down.

We can argue it till the cows come home, but this is a good message to get our polsts done, carry medical info (I have my Kaiser number listed and DNR in big red letters in case of collapse in street, much good THAT will do). Hoping a call to Kaiser will result in a BRIEF resuscitation, if not a slow one. That's about the best we can do.
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OP:
Is this a bracelet you yourself had made? Does it have room on it for further engraving on any side.

When out I, at 81, carry a DNR card with me and my Kaiser ID and number to call. If I get coded it will be, if not a "slow code" as some EMS personnel call it, at least a BRIEF code.

If there is room on this bracelet add the medical information to access no code status (MD number, or in my case the Kaiser number). Then if Mom asks at all you can HONESTLY and BRIEFLY explain it has her medical information on it.

It might spare your wondering and worrying and being further divided by other peoples' opinions. Sometimes, too many opinions just adds to all the confusion.
l
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Well, it *is* an ID bracelet. A medicalert bracelet that doesn't identify the person it's for would be completely useless.

If your mother is happy to wear it now, and especially if she is able to put it on and take it off by herself, that's more than good enough.

If the family member still has qualms, ask what bad thing or loss of dignity or other outcome opposed to your mother's wellbeing and best interests s/he thinks might happen as a result of not giving your mother more detailed information.
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My dh had a liver transplant and a pacemaker inserted....he wears an ID bracelet stating the same. Which does not "replace" his medical records but adds TO THE info immediately available to EMS crews and medical personnel who may come in contact with him so they are aware. It IS an ID bracelet and I don't see where deception of any sort is involved here.

I would've moved heaven and earth to PREVENT my mother who suffered from advanced dementia from being resuscitated had the occasion arisen. Just saying.
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Tell your family member that is criticizing you to sweep their own porch first before they tell you how to sweep yours!

This family member sounds a bit ridiculous, don’t you think? It’s silly to quibble over something like this.

What difference does it make if your mom considers her bracelet jewelry? Technically, it’s jewelry and it’s also an I. D. bracelet because it is identifying an important medical issue.

You are a responsible daughter. You know this and anyone who has any common sense realizes this too. Some people like to stir the pot. Ignore them.

Or is this person be so terribly naive that they actually think it makes a difference how your mom views the bracelet? The only thing that matters is that she wears it daily for it’s intended purpose.
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So, this story reminds me of when I was younger and raising my first child. She loved going to the playground. I enjoyed taking her but I was becoming frustrated with her not wanting to put on her seat belt.

Never in a million years would I have left my home without her being safely buckled up.

She continued to fuss about buckling up and I had the thought of telling her that the car didn’t move until she was buckled up. Was I lying? Nope, because I wouldn’t have dared to drive to the playground without her being safe.

My dad would sometimes go with us to the playground. One day, he wasn’t buckling up. My daughter shouted from the backseat, “Grandpa, hurry up and buckle up. Mom’s car won’t move until we are all buckled. I want to go to the playground!” My dad looked at me slyly and whispered to me, “Is that what you told her? Wow! That’s smart.”
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My adult son has worn a medical alert bracelet his whole life, even through the ages he didn’t want it. I can’t count the lies I told to keep it on him and don’t care a bit. Recently, the health department came for inspection to the place he works as a cook. Jewelry is a code violation. The manager told the inspector that it was a medical alert bracelet, it wouldn’t be removed, and the restaurant would gladly take the point deduction for it. Some rules and people are simply ridiculous, tune them out, you’ve done what’s best for your mother and she’s blessed to have you
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I have a slightly different take on this.

If Mom is going out alone, unsupervised, still independant, then I would expect the decision to wear a safety alert bracelet is up to her.

Does Mom go out alone?

"if she left the facility for an outing with family or facility sponsored event".

OK, so she is supervised. Either with staff or family. If she was to have a sudden collapse, or a fall, WITH STAFF, what would happen? My guess is.. Staff alert their Manager & the facility Doctor. EMS may be called too. Ambulance transport arranged if necessary for transfer to hospital. DNR status is part of handover at each stage.

What if the event happened on FAMILY watch? What would they do? Stay calm? Panic? Would they stand around watching her lay on the floor doing nothing? No of course not.

Yes, people do have sudden collapse or be found unconcsious on the floor with no signs of life. Someone would have to KNOW about the DNR status & the conditions of it & also be prepared to take authority of it. Eg Attempt resus from a major heart attack? Attempt reus from choking on food swalled the wrong way?

More OFTEN (I would guess) people are found fallen or collapsed but CONSCIOUS. In no need of resus. No-one leaves a person lying on the floor unil the end of their time because they wear a DNR bracelet. The cause & damage is unknown... suspected hip, leg fracture, internal injuries, head strike or just a simple feint? Doctor or EMS are called to assess.

Disease, illness, injuries always present risk to our lives. Can bring a slow decline... how many leave by a sudden heart stop?

I get you don't want a chain of un-stoppable events to start that *may aim* to prolong life, but cause undue burden, pain, cost. I do get this. But consider the odds.
- Of a resus event being needed.
- That staff/family keep the DNR status in mind/check for it/see the braclet
- Staff/family could identify a resus/DNR situation
- Staff/family could act on it

Ask yourself if this is more about your anxiety about the unknown future. I'd let it go.
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Beatty Jun 2023
MD this topic came up with a friend years ago. Ex RN, full of common sense. She said if she choked on a fish bone in a cafe, hopefully a bystander would thump it out of her. If it happened at home, unless the dog or cat had more skills than she imagined, it would be up to fate.

I'm thinking that even if a medically trained person finds someone unresponsive.. what the chance they know the wishes?(unless you are in a hospital)
eg Beach lifeguard finding an responsive person in the water... Attempts are made to save them.
Excuse me elderly Sir! We are trying to revive you! Can you hear me? Have you signed a DNR? Did you consider drowning to be a natural death? Or would intervention be accepted to you? 🤔
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Tell that nosy-parker family member to f*…er, that is, to flake off! Or, better yet, tell them nothing, and strap that DNR bracelet on the ol’ gal. For Heaven’s sake! How long do we want to keep ‘em alive? She signed a DNR, so honor it!
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simple question.. Do you want someone performing CPR on your mom, taking into account the damage done caused by that ?

moving my mom to another state , she needed another DNR , at first she didn’t want it until myself and NP explained to her , that she would never be the same as before the event….
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Yes.She is entitled to know this.
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I must say, this thread really got out of hand. It started by the OP asking if she needed to tell her Mom everytime she requested for her to put on the bracelet if she needed to be honest and tell her Mom it was a DNR bracelet. Simple agree or disagree. But we do need to take into consideration the women has Dementia so...we are going to go thru this everytime she wears it? If the woman is never alone, and should not be with Dementia, she does not need the bracelet. As I said, every facility has to have a copy of the form in their records. It should be handed to the EMTs if still living in their own home or with family. If in an AL, MC or NH, a folder is sent along with the resident, with a list of medications, allergies, any pertinent info needed and...a copy of the DNR.

In my experience DNRs are done when a person is terminal. Hospice requires one. My Mom had one because she had Dementia and was 89. My Aunt 80, had it because of terminal lung cancer. My Dad, he was dying from years of heart desease.

Me, when I get around to doing my POAs, my Medical Directive will say "No extreme measures" My daughter, RN, will determine what those extreme measures are. A DNR is not something I am ready for at 73. That will come later when being resuscitated will not mean I will have a good or better quality of life.
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AlvaDeer Jun 2023
I have had my DNR in place since I was 60. My choice. If I go, that's fine. And have had changing instructions of what I will or won't accept in terms of artificial feedings, dialysis and so on. Kaiser has a nice component in their papers saying what is important to you to have a quality life. All important papers should be done by 50s, 60s, in my own opinion, because nothing is certain in life ever; even young people have accidents and if you have children there should always be arrangement in place if possible. I wouldn't have wanted to be young, my last years in Terry Schiavo's condition. But that's just me as a nurse, and I recommended it as a nurse.

As to planning for every single contingency for our elders, or even our YOUNGERS, we simply can't, short of attaching at their hips cover every possible contingency.
I agree with you, JoAnn. Get things done when and as well as you can and then let go of it.

And other people's opinion about what we should and should not do? Well, that's ALWAYS a given. Just ignore them. Just say "Thanks for the suggestion" and move on. Our OP was well and satisfied with her course of action until she made the mistake of listening to someone with input she didn't need. Hee hee, and now she has so much MORE of it.
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If she made the decision to have a DNR while she had all of her faculties and it was important to her I don’t think calling it her ID bracelet is wrong. In a way it is exactly that an ID bracelet that makes sure first responders know her wishes. At this point she probably isn’t able to understand or at least retain the term DNR but ID is something she has understood most of her life and still does.
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It is identifying " her wishes" right?

So it is an " ID" bracelet just as one would wear if diabetic or other medical conditions existed so that responders would know what to do.

Too often the " paperwork" that people have prepared about their EOL wishes never are available and, the exact opposite of their " expressed wishes" happen.

So.....as long as you are confident that the bracelet expresses her ( your mother's) EOL wishes, then it is actually helping her to wear it.

If you have any doubt about her wishes or feel you may have any " guilt" experience and, she is still cognitively able to express her wishes, then by all means revisit the decision with her....people can and do change their minds about things at times...

Otherwise, as long as you are her POA go forward with her wearing the bracelet.....ignore what " others" say as there will always be " opinions" driven by many different factors....
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At age 94 [and/or depending on the level of dementia], the meaning of honesty translates into doing what is needed for the well being of the loved one.

You tell her whatever works - whatever will get her to want to wear it.

I don't even know what ... Oh ... Do Not Resuscitate.

Keep a copy of that information in her purse or on the back of her door (POLST goes there with this information on that form).

"The Physician Orders for Life Sustaining Treatment (POLST) form is a written medical order from a physician, nurse practitioner or physician assistant that helps give people with serious illnesses more control over their own care by specifying the types of medical treatment they want to receive during serious illness."

Since she is in an AL, staff should be well aware of this information already so what is the necessity of her having the information on her body / wrist?

Gena / Touch Matters
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Maryjann Jun 2023
"The meaning of honesty translates into doing what is needed for the well being of the loved one" -- I love how you said that, especially as we are needing to explain over and over again to my MIL where her dog is (in a new home, which was a minor miracle IMO) and why she cannot go home.
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I wear a DNR bracelet because I might die on the grocery store floor or in some stinky public restroom or on some rain soaked road................the POLST isn't realistic.
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The family member doesn’t seem to have a firm grasp of dementia. You could tell your mom it’s a do not resuscitate order, however you’d have to explain it over and over again, causing stress for you both.

You said your mom got it when her faculties were better…do you have any proof of this, like a receipt for the bracelet showing date it was purchased or a cancelled check from your moms bank? Or records from the place she bought it from. That’s going to extremes, but if it’ll appease the family member, do it.

Let your mom think whatever she wants and don’t give a second thought to the family member. If that family member is so concerned, give them Alz.org hotline number and see if they can explain “therapeutic fibbing” to them. The number is 1-800-272-3900. It’s open 24/7.
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Oh my, when it comes to end of life, be very careful. Eternity is forever. Is she ready to face her God? I refuse to sign any DNR order, nor will I ever let anyone take charge of my life. Think of how you want to be treated when you are dying .
Not how you may think today I assure you . Life is precious , death is forever .
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Emma1817 Jun 2023
But…assuming you believe in some sort of peaceful afterlife, why not just relax, and GO there when the body wears out!? The ridiculous circus of using heroic measures for prolonging a terminally ill, or extremely aged, person is obscene, in my view.
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When asked by Mom just say, "That old thing? You bought that years ago!"
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