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

2. 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

3. 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.

4. 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.

5. 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

6. Family in Crisis – No Advance Directive Planning

7. 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.

8. 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.

9. What Can You Do?
Write a Letter to the Editor of your local paper for National Advance Directives Day (April 16th)
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

10. Julie Bayly (804) 758-2363 julie.bayly@rivhs.com
Questions?
Julie Bayly
(804)