Choice is an increasingly important part of health care policy, especially at the end of life as deteriorating mental and physical functions may lead to a situation where a person no longer can express his or her preferences. The goal of an advance care planning discussion is to ensure that clinical care is consistent with the person's expressed preferences and wishes. This planning process also may reduce the incidence of anxiety, depression and post-traumatic stress in surviving relatives and may improve resident and family satisfaction with care.
By educating people living in nursing facilities, their families or surrogate decision makers about advance care planning, they can make a more informed decision about current or future medical care. This process may prevent unwanted medical interventions, particularly near the end of life.
Advance care planning includes making decisions about the use of life-sustaining measures – such as CPR, artificial ventilation and artificially administered nutrition and hydration – as well as the risks and benefits of these measures. The process also may address additional medical interventions, such as hospitalization, chemotherapy, dialysis or antibiotic therapy that might eventually be considered. Decisions should be recorded in specific documents to ensure that the person's decisions will have the support of the law. In Texas, these documents include
- Directive to Physicians and Family or Surrogates is designed to help people communicate their wishes about medical treatment at some time in the future when they are unable to make their wishes known because of illness or injury.
- Medical Power of Attorney (MPOA) gives someone named as agent the authority to make any and all health care decisions in accordance with someone's specified wishes, including religious and moral beliefs, when that person is no longer capable of making those decisions themselves.
- Out-of-Hospital Do-Not-Resuscitate (DNR) instructs emergency medical personnel and other health care professionals to forgo resuscitation attempts and to permit the patient to have a natural death with peace and dignity. This does NOT affect the provision of other emergency care including comfort care.
Brief, periodic discussions may be more useful than a one-time discussion about advance directives. The directive to physicians, family or surrogates establishes a framework to discuss current quality of life and what level of medical treatment will be provided at the end of life. The MPOA allows a person to designate someone to make health care decisions for him or her. The MPOA takes effect if the person is unable to make his or her own decisions, and that fact has been certified in writing by the person’s physician.
Resources Created by HHSC
Thinking Ahead: My Way. My Choice. My Life at the End. (PDF) can be used to help plan what someone wants to happen at the end of their life.
Form 2189, Palliative Care, is for use by a physician to document palliative care choices and services at the end of life for people living in nursing facilities.
Advance Care Planning Facility Checklist (PDF) consists of items to be included in nursing home policies and procedures for advance care planning.
Advance Care Planning Protocol (PDF) includes information on how to implement advance care planning activities for people living in nursing facilities.
Care Plan for Advance Care Planning (PDF) provides guidance for developing person-centered care plans that address advance care planning.
Advance Care Planning Frequently Asked Questions (PDF) can be used to educate staff, people living in nursing facilities and their families on the advance care planning process. In Spanish (PDF).