Advance Care Planning by Rogne Leah;McCune Susana;

Author:Rogne, Leah;McCune, Susana;
Language: eng
Format: epub
Publisher: Springer Publishing Company, Incorporated

ASSETS OF THE NURSING HOME SETTING

Most of this chapter has been devoted to challenges. It would be wrong to end without recognizing some of the assets and strengths of the setting. First, most families remain involved, indeed quite involved, with a family member who lives in a nursing home. In most cases, the families constitute strengths on which to build, especially during planning care for residents who are not able to communicate wishes. Second, two assets already in place that serve residents and their surrogates can be strengthened: the PSDA and the federal requirement for quarterly care plan meetings.

During the admission process and before the quarterly care plan meetings mandated by law, residents (when cognitively able) and the families should be encouraged to attend quarterly care plan meetings, either in person or through some electronic accommodation. If the resident and family cannot attend quarterly, a special effort should be extended to include them at least annually. Unless residents and/or surrogates opt out, these invitations should come in writing. Whether residents or the surrogates attend or not, they should receive a written summary of the care plan, signed by the staff person to be contacted for questions, objections, or further discussion. Each care plan should include the resident’s goals of care, and should explicitly address how the care plan supports the resident’s goals of care.

In addition to the strengths listed above, there are two other important assets available to nursing home residents: hospice care and the commitment of the nursing home staff.

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