Widespread dismay over news that a nurse in California called 911 but refused to perform CPR for an elderly independent living facility resident who collapsed and later died included that of local independent living facility directors who this week shared their facilities’ policies on emergency resuscitation.

Alena Haynes, director of Johnson City’s Colonial Hill independent living facility, was the last to render such aid at Colonial Hill. She says while it doesn’t happen often, the facility’s practice is to call 911 and follow instructions until help arrives.

“We do (CPR). I’ve done it myself,” Haynes said. “We call 911 and we follow their instructions.”

Haynes said when she first read about the incident in California, she thought “there must be something missing, something more we don’t know about.”

Her hunch that there was more to the death of 87-year-old Lorraine Bayless at the Glenwood Gardens independent living facility in Bakersfield, Calif., was borne out Tuesday with the release of a statement from Bayless’ family members, who told the Associated Press she wanted “to die naturally without life-prolonging intervention.

“We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace,” the family said.

Brookdale Senior Living, the Tennessee-based parent company of Glenwood Gardens, initially said the nurse who for seven minutes refused a 911 operator’s pleas for her to initiate CPR had acted correctly. On Tuesday Brookdale reversed that statement, saying the incident “resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents” and the nurse had “misinterpreted the company’s guidelines.”

The nurse has taken a voluntary leave of absence while the incident is being investigated. Had the incident occurred in Tennessee, she could be facing disciplinary action against her license to practice.

While the Tennessee Department of Health does not regulate independent living facilities, which are essentially residential communities without health care services, the state’s nursing regulations regarding failure to provide care could have been applied.

In an email response to inquiries from the Johnson City Press, Shelley Walker, assistant director of communications and media relations for TDOH, said, “It’s important to note that the Tennessee Department of Health does not license independent living communities/facilities, such as the one in California where the incident occurred.”

For licensed health care facilities in Tennessee, Walker cited specific regulations for “decision making” through which “no health care provider or institution shall require the execution or revocation of an advance directive regarding resuscitation.” Walker also cited regulations that protect facilities from liability for adhering to patient directives and allow them to “decline to comply” with directives that do not appear to be properly authorized.

When asked if Tennessee nurses are required to administer CPR, Walker said there is no known directive for the person in distress. Walker said Elizabeth Lund, director of the state Board of Nursing “indicated there are several provisions within the definition of unprofessional conduct that could be used to discipline the license of a nurse who fails to provide care, such as intentionally causing a patient harm (or) abandonment of a patient.”

Ask if those regulations apply outside health care settings, Walker said, “The issue is failure to provide care, period.”

Like Haynes, Marge Shonnard, vice president of operations for Asbury Inc., which owns independent living and assisted living facilities in Kingsport and Maryville as well as skilled nursing facilities in locations including Johnson City, said unless a person has a directive not to resuscitate, “we do whatever we need to do until (Emergency Medical Services) can get there, at all three levels of care.”

Michael Miller, deputy fire chief for Kern County, Calif., where the incident occurred, said while it is not uncommon to have someone refuse to provide CPR if they physically can’t or are too upset, what made the Glenwood Gardens case unique was “the way the conversation on the phone went. It was just very frustrating to anyone listening to it, like, why wasn’t anyone helping this poor woman?”

Mariko Yamada, who chairs the California Assembly’s Aging and Long-term Care Committee, called the Glenwood Gardens incident a wake-up call. “I’m sorry it took a tragedy like this to bring it to our attention,” she said.