The role of advance care planning in end-of-life care for residents of aged care facilities

Objective: This report will present the case of an elderly woman with rapidly declining health admitted to hospital from a nursing home. It will discuss benefits of advance care planning for residents of aged care facilities who have expressed opinions/wishes regarding their end-of-life care, and identify barriers, varying legal status, the need for documentation of discussion outcomes specifying residents’ wishes, and the importance of education and expert support for nursing staff.

Setting: Nursing home and acute tertiary referral hospital.

Subject: Female resident of a nursing home, aged 97 years, with acute onset of abdominal pain and multiple co-morbidities.

Primary Argument: The majority of nursing home residents do not have advance care planning initiated, nor is this routinely raised by nursing staff. While wishes may be discussed with family, they may not be fully respected if undocumented. Acutely ill residents are frequently hospitalised, especially when death is imminent, and often die alone in unfamiliar surroundings, tended by strangers. Many of these admissions could be avoided with Advance Care Planning, as could the resultant medical interventions which may cause the resident acute pain and discomfort.

Conclusion: Advance Care Planning can lead to avoidance of non-essential hospital transfers and their inherent risks and is likely to facilitate a dignified, peaceful death in familiar surroundings for nursing home residents, averting medical interventions which may cause needless pain and prolonged suffering.