Advance Directives in Long Term Care Julie Bayly, LNHA October 22, 2009

Long Term Care Providers Nursing Home Assisted Living Continuing Care Retirement Community Adult Day Care PACE – Program for the all inclusive care for the elderly Hospice Home Health Care

Right To Be Informed Virginia State Law requires Nursing Home residents upon admission to be informed of their right to make decisions about medical care. LTC Providers will discuss Advance Directives and individual preferences when enrolling in a new LTC service.

Best Practice All Long Term Care Providers have an assessment tool completed on a routine schedule. This may be quarterly, monthly, bi- annually- varies depending on the service. The assessment will include the interdisciplinary care team, the individual receiving care and in some cases the resident responsible party. Advance Directives should be discussed during this assessment and the documentation should reflect the discussion. “Your Right to Decide” a publication from the Virginia Department of Health and Department of the Aging. Include the physician in the discussion.

Durable Do Not Resuscitate Order Written by a physician May be verbally revoked Durable Do Not Resuscitate Order – Yellow Form Provided by Virginia Department of Health

Family in Crisis – No Advance Directive Planning

The Crisis Weight loss/Refusal to Eat -Feeding Tubes – Provide education on feeding tubes and the relationship with hydration. Palliative Care over Hospitalization or frequent Hospitalizations – Provide education on the dying process. Consider Hospice staff as a resource.

Difference of Opinion in the Family Follow the Advance Directive If no Advance Directive, follow statute hierarchy (guardian, spouse, adult child, parent, adult sibling, blood relative) Work for consensus that is best for the resident Include the Physician in the discussion.

What Can You Do? Write a Letter to the Editor of your local paper for National Advance Directives Day (April 16 th ) Offer to give a presentation on Advance Directives at a Resident Council Meeting Partner with a long term care provider to do a community education seminar on Advance Directives

Questions? Julie Bayly (804)