Successful Advance Care Planning in a Rural Nursing Home

Area of Science:

• Gerontology
• Healthcare Management
• Medical Ethics

Background:

• Advance care planning (ACP) is crucial for documenting patient treatment preferences, often through advance care directives (ACD).
• Nursing home ACD completion rates in the U.S. range from 60% to 70%.
• Limited data exists on the timing of ACD completion relative to nursing home admission.

Purpose of the Study:

• To evaluate the success of advance care planning in a large, rural long-term care (LTC) facility.
• To examine the completion rates and timing of advance care directives (ACD).
• To assess the integration of resident preference for life-sustaining treatment (RPLST) into the admission process.

Main Methods:

• A retrospective chart review of 167 residents was conducted.
• The study examined health-care system documents, legal documents, and predisposing factors.
• The process of ACP was analyzed as defined by the rural LTC facility's protocols.

Main Results:

• The facility utilizes a "resident preference for life-sustaining treatment" (RPLST) document for residents without formal ACDs.
• RPLST outlines choices for resuscitation, fluids, nutrition, medications, and antibiotics.
• A significant finding was the high completion rate of RPLST within 100 days of admission.

Conclusions:

• Integrating RPLST into the admission process facilitated documentation of end-of-life preferences within 10 days.
• This approach enhances the timeliness and effectiveness of advance care planning in LTC settings.
• Early documentation of resident preferences improves care aligned with patient wishes.