What you should know about advance care planning

f you are helping move a parent or friend into palliative care or a nursing home, here are some key considerations about planning ahead.

There’s no doubt helping a loved one navigate the later stages of life is a tumultuous time – particularly when it involves leaving home. So, discussing their final medical treatment and care wishes is often be pushed aside.

It’s called advance care planning. A legal document – or guide – that states how your loved one wants to be cared for when they become unable to communicate or participate in the decision making.

It’s particularly important because there are many factors than can influence a person’s individual wishes – religious beliefs, personal values and medical history to name a few. And, while we believe everyone should document advance care planning, it is especially beneficial for people who:

  • Are older and frail;
  • Have chronic progressive and life-limiting conditions;
  • Are approaching end of life;
  • Have multiple comorbidities and/or at risk of conditions such as stroke or heart failure;
  • Have early cognitive impairment; and
  • Are isolated or vulnerable.

The problem is, it is not compulsory for nursing homes to complete advance care planning with new residents.

And, although this is often a challenging time for residents and their family, it is important to request this step be completed in case your loved one suddenly becomes chronically or critically ill.

Without advance care planning, medical professionals may make decisions – not deliberately, just purely out of ignorance – that do not align with your loved one’s values and wishes.

To help, Melbourne Geriatricians Group work with residents, families and nursing homes to document the preferences of each patient.

Broadly speaking, we discuss and record treatment decisions based on the informed consent of the person, their substitute decision-maker(s) and family. This is supported by medical professionals including geriatricians, doctors, nurses, allied health professionals and care workers.

This advance care directive can then be used to communicate specific instructions about things like:

  • Blood transfusions;
  • Artificial hydration and nutrition;
  • Cardio-pulmonary resuscitation; and
  • Assisted ventilation.

As a result, families, carers and – most importantly – older people can experience less stress and anxiety and feel more satisfied with their overall care plan. It also reduces futile transfers to acute care and unwanted interventions.

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