Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes

Abstract

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent). Financial power of attorney documents were sometimes found within the AD, even though these documents focused on financial decision making rather than health care decision making. Code status was the most prevalent health preference documented in the record at 97 percent of the records reviewed. The intervention used these initial findings and the philosophical framework of respect for autonomy to develop education programs and services on advance care planning. The role of the social worker within an interdisciplinary team is discussed.

Educating Healthcare Employees about Advance Care Planning

“…The values of patient autonomy and individual choice fall under the moral principle of respect for autonomy. [13] Based on this professional perspective, these decisions should be approached at a time when a person is of sound mind and emotional stress is not impacting decision-making status. It has been reported that 70% of patients needing to make end-of-life decisions are incapable of making those decisions.…”

Successful Advance Care Planning in a Rural Nursing Home

“…Other studies have shown a higher percentage of nursing home residents who preferred not to proceed with cardiopulmonary resuscitation and opted for more limited additional interventions. 14,15…”

“…Other studies have shown a higher percentage of nursing home residents who preferred not to proceed with cardiopulmonary resuscitation and opted for more limited additional interventions. 14,15 Nevertheless in this nursing home, the initiation of the RPLST helped to create and sustain a supportive culture toward talking about death and dying starting at the admission process. Having such a collaborative environment that works together to discuss aspects of death with residents and significant others is crucial to the success of ACP.…”

The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

“…Advance care planning requires people to consider their own values and preferences, contemplate, discuss with their family and providers, and complete an advance directive (Johnson et al, 2016). Previous literature has documented extensively that the process of advance care planning should begin when the person is healthy or stable, preferably not when he or she is dealing with a health crisis or going through a transition such as hospitalization or nursing home admission (Galambos, Starr, Rantz, & Petroski, 2016; Heyman & Gutheil, 2003; Houben et al, 2014; Stein et al, 2017). This suggests that social workers have many opportunities to initiate the discussion of advance care planning with the diverse population with which they work, particularly those who work in community-based settings (Heyman & Gutheil, 2003, Stein et al, 2017).…”