A Proposal: NHP = DNR
Think for a moment what the world would look like if everyone admitted to a nursing home was immediately considered a DNR (or, perhaps more acceptably, "AND" as in "Allow Natural Death.") What if the whole concept of Hospice was applied to the nursing home setting? Comfort care only; living life to its fullest, each day. No invasive medical interventions except to relieve suffering.
It would solve a lot of problems.
No more fishing through mounds of paperwork from the nursing home in the ER trying to determine a patient's code status; hell, if they're all DNR, why send them over in the first place? How much of a dent might be made in ER overcrowding by eliminating the nursing home traffic altogether?
Sure, families may balk at the idea of "nursing home as a death sentence," but it might also provide that extra incentive to keep caring for the elderly at home until it's clear that they are in the last stages of life. Certainly with the rise of assisted living facilities, there shouldn't be any problem applying Hospice principles to the final stage of care in the nursing home portion of the facility.
There's no down side here. All I'm talking about is an injection of honesty and realism into our national discourse about the end of life. People die eventually; nursing homes are frequently their last "home." Why not admit it and let death come with peace and dignity, instead of the medicalized nightmare that all too frequently ensues from our refusal to address the issue.