Navigating Advance Directives and End-of-Life Care in Nursing Facilities

Few topics are as sensitive and crucial as end-of-life care. At the heart of this complex and emotionally charged subject are Advance Directives (ADs) – legal documents that spell out a person’s wishes regarding medical care and treatment when they can no longer communicate these wishes themselves. Understanding and implementing these directives is essential to ensuring that residents’ preferences are honored and that they receive the care they desire in their final days.

Advance Directives are comprised of several documents, primarily:

• • • Living Will: Specifies the types of medical treatment a person does or does not want if they are unable to make decisions.
    • Durable Power of Attorney for Healthcare (DPOA-HC): Designates an individual (often referred to as a healthcare proxy) to make medical decisions on behalf of the resident if they are incapacitated.
    • Do Not Resuscitate (DNR) Order: Indicates that the resident does not want to receive CPR if their heart stops or if they stop breathing.

These directives help healthcare providers and family members make critical decisions in line with the resident’s values and desires, preventing unnecessary or unwanted medical interventions.

Nursing Facilities play a pivotal role in end-of-life care, often being the final residence for many elderly and chronically ill individuals. We are tasked with balancing high-quality medical care and respecting the dignity and wishes of our residents. Navigating this delicate process should include:

• • • Comprehensive Care Planning:
      • Upon admission, periodically, and with significant changes in the resident’s condition, nursing facilities conduct thorough assessments to understand the medical, psychological, and personal needs of each resident. This should include Advance Care Planning – discussing, documenting, and affirming the individual’s Advance Directives while further verifying that they are clearly outlined and easily accessible to all healthcare providers involved in the resident’s care.
    • Communication and education:
      • Regular discussions with the residents and their families about the importance of Advance Directives are crucial. These conversations should be approached with sensitivity, providing clear information and answering any questions to alleviate concerns or misunderstandings.
      • Staff training is essential to ensure that all team members understand the legal and ethical implications of Advance Directives and are prepared to implement them appropriately.
    • Personalized End-of-Life Care:
      • Facilities must tailor care plans to respect each resident’s wishes, whether they want all possible measures taken to prolong life or prefer comfort care focusing on quality rather than quantity of life. Pain management, psychological support, spiritual care, and facilitating meaningful experiences and interactions are core components of personalized end-of-life care.
    • Ethical and Legal Compliance:
      • Ensuring compliance with state and federal regulations regarding Advance Directives and end-of-life care is non-negotiable. This involves keeping up to date with laws, maintaining accurate documentation, and regular audits to ensure policies and practices align with requirements.

Proactive planning and early discussions about Advance Directives and end-of-life care can significantly reduce stress and confusion during critical moments. Encouraging residents and their families to engage in these conversations early on helps to ensure that everyone is on the same page and that the resident’s end-of-life journey aligns with their values and wishes.

Join Proactive on 6/18/2024 for the next Documentation in Depth series session, Supportive Documentation for End-of-Life Care. This session is designed to assist healthcare professionals with the essential skills and knowledge needed to provide comprehensive and compassionate documentation during the final stages of life.