Relatives & Residents Association

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Older people’s rights breached by DNRs

Blanket and inappropriate use of Do Not Attempt Cardiopulmonary Resuscitation (DNR) orders breached the rights of care users at the start of the pandemic, a Care Quality Commission report has found. The number of older and disabled people having notices placed on them increased dramatically during the past year. In nursing homes the number of DNRs rose from 74% of residents on 16 March to 92% from 17 March. The CQC says with many care homes facing challenges at the beginning of the pandemic with shortage of PPE, food and staff, some inappropriate DNRs could have gone unnoticed. In one care home every resident over the age of 80 who had dementia had a DNR applied at the start of the pandemic before this was challenged.

 

The CQC’s review highlights the very worst fears of callers to our helpline, about the response to the pandemic devaluing the lives of older people. Throughout the pandemic R&RA has raised concerns about the rights of older people being side-lined, warning in April that “the response to this emergency should not be discriminatory or devalue lives”. Sadly, our helpline heard concerns that older people’s rights were put at risk by inappropriate practice around DNRs but also poor care planning about end of life. We raised these concerns with Parliament and have fed them into the CQC review, many of which have been covered in their report, including:

  • A “worrying picture of poor involvement” of people using services and lack of consultation meaning many people and their relatives didn’t know a DNR order was in place, in breach of human rights
  • Families being pressured into agreeing to a DNR decision
  • Conflating conversations about DNR with conversations about whether people would go to hospital to receive treatment, or people being asked to agree end of life plans that excluded hospitalisation, raising fears that the process of prioritising health services was being based on non-clinical factors such as age or disability
  • Lack of visits from health professionals, including GPs, with appointments and consultations taking place over phone/video where sensitive conversations about end of life care planning are much more difficult
  • Concerns about care staff lacking the training, expertise or equipment to plan and provide appropriate end of life care
  • Visiting restrictions in care homes meaning family members/friends were not able to be there to support older people when these conversations took place, to aid with communication and understanding as well as providing emotional support

 

No-one’s life should be devalued. The systems and services designed to protect older people should look to our human rights and equality laws to help steer them through a time of crisis, to ensure no-one is left behind.

We welcome the recommendation by CQC that health and care workers should receive adequate training to give them the knowledge and skills to engage people in these discussions and ensure their rights are protected. This is not just about care workers understanding the minimum requirements of the law, but also developing their skills and confidence. Care staff must have the confidence to be able to challenge colleagues and other professionals over inappropriate decisions, to play a vital advocacy role for care users, particularly those with no-one to support them. Sadly, there is a long way to go in care settings.

 

More support

If you, or a relative/friend, have been affected by inappropriate use of a DNR order or poor practice around end of life care, please contact our helpline. One of the ways we can support you is by helping you to share your experience with the CQC via the Tell Us About Your Care programme of work.


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