Successful Advance Care Planning in a Rural Nursing Home

Background: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70%...

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Bibliographic Details
Published in:American journal of hospice & palliative medicine 2019-05, Vol.36 (5), p.357-361
Main Authors: Hold, Judith, Payne, Camille, Lesandrini, Jason, Glover, Avery Caz
Format: Article
Language:English
Subjects:
Advance Care Planning - organization & administration
Advance Care Planning - standards
Advance Directives
Aged
Aged, 80 and over
Decision Making
Female
Homes for the Aged - organization & administration
Homes for the Aged - standards
Humans
Male
Middle Aged
Nursing
Nursing Homes - organization & administration
Nursing Homes - standards
Patient Preference
Retrospective Studies
Rural Population
Socioeconomic Factors
United States
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Summary:Background: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility. Objective: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility. Methods: A descriptive approach, using a retrospective chart review, of 167 residents was used to examine resident completion of health-care system documents, legal documents, predisposing factors (resident demographics and psychosocial characteristics), and the actual process of ACP as defined by the rural LTC facility. Results: This nursing home utilizes a document entitled resident preference for life-sustaining treatment (RPLST). For residents who do not have formal prepared advance directive documents, the RPLST serves to define resident and family choices for resuscitation and implementation of fluids, nutrition, medications, and antibiotics. The most striking finding was the completion rate of the RPLST within 100 days of being admitted to the nursing home. Conclusion: Documentation of end-of-life preferences within 10 days of admission was achieved through the incorporation of RPLST during the resident admission process.
ISSN:1049-9091
1938-2715
DOI:10.1177/1049909118812162