Senior living providers are revisiting and clarifying company policies in the wake of a resident’s death at a Brookdale Senior Living-operated community—an incident that grabbed the nation’s attention and could drive changes to the independent living industry.
In late February, a staffer at Brookdale’s Glenwood Gardens location didn’t follow a 911 dispatcher’s requests to provide CPR to Lorraine Bayless, an 87-year-old resident of the community’s independent living section who had collapsed in the dining hall and ultimately passed away. The staffer can be heard telling the dispatcher in a released recording of the call that providing CPR would be against company policy.
The following week, Brookdale issued a statement saying the incident resulted from a “complete misunderstanding” of its policy on emergency medical care for residents. Now other providers are looking internally at their own practices.
“Everybody ought to look at what their policies are,” says Paul Gordon, a senior living law-focused partner at Hanson Bridgett LLP. “I think everyone’s going back to their policy and trying to clarify it.”
While it’s unlikely that anyone’s policy specifically says not to intervene or provide assistance in medical emergency situations, Gordon says, there may be confusion over the existence of such a policy in general.
“Our heart goes out to this family, and this situation has caused all of us in this industry to re-look at what goes on in our independent living communities,” says Keven Bennema, COO of Chicago-based Senior Lifestyle Corporation. “The distinction is, independent living is exactly that: an independent living environment, no different from a senior living in their own residence in their own home. Even though they live in one of our communities, we can’t dictate how they live their lives.”
That is an important distinction, Gordon agrees, because providers must consider their legal obligations both under contract to residents and under state regulations.
“Independent living isn’t regulated, and the contracts are usually silent on an issue like [whether to provide CPR],” he says. “Usually for independent living, there probably isn’t regulatory or contractual duty. Even for assisted living, there often aren’t regulations that specifically deal with that.”
Still, companies generally do have a policy regarding what course of action to take, and in independent living it’s especially relevant after receiving so much attention on a national scale. “It’s in the court of public opinion, and people are going to try to figure out how to handle this going forward,” Gordon says.
Like many other providers, Senior Lifestyle Corporation has been fielding inquiries stemming from the Brookdale incident, and according to Bennema they’re viewing it as an opportunity to re-educate.
“This has generated some interest, from not only our families, but even some of our residents in our communities,” says Bennema. “In those situations we’re having town hall meetings to remind people of what our policy is if this kind of situation occurs.”
Senior Lifestyle’s policy is for staff to call 911. If the dispatcher gives the caller directions as to how to intervene, Bennema says, staffers can follow that advice until paramedics reach the scene.
“We believe training is a huge part of making sure people are really up-to-date, and we believe our employees know what to do when an emergency occurs—call 911. Ultimately, there shouldn’t be any misinterpretation when it comes to someone who’s in a compromised situation,” he says.
While Gordon doesn’t think there will be any widespread change in the definition of independent living or regulations for the sector, there could be some industry initiatives to address related issues.
“Are independent living residences going to start making sure they have staff on the premises 24/7 who are trained in CPR? A lot of stand-alone IL properties may not have a lot of staff at night, and may only be providing housekeeping or dining services, neither of which are 24/7,” Gordon says, adding that this makes it difficult for properties to offer CPR. “Does that mean every resident manager has to have CPR training? I think you’re going to see, in those kinds of settings, a much clearer statement of what the policy is, if the community doesn’t have staff on hand who are trained in CPR.”
There could also be a larger push for advanced directives (ADs). Senior Lifestyle discusses end-of-life preferences with incoming residents, and for residents who do have an AD or a DNR, it’s usual posted prominently in their rooms.
“Ultimately, this has encouraged some residents and their families to try to get more updated ADs,” says Bennema. “However, you don’t always know if someone has an AD, and you don’t know if they’re going to have a situation when they’re out at an event [rather than in their room where the AD is located]. Maybe this discussion will lead to having some kind of ID on them, like a wristband, to let first responders know if they have an AD.”
Written by Alyssa Gerace