What is Advance Care Planning?

Advance Care Planning is a process that allows individuals to think about, discuss, and document their preferences for future care and treatment. It ensures that if a time comes when they are unable to make or express decisions, their values and wishes are still known and respected.

In nursing homes, where residents often have complex medical conditions or increased frailty, Advance Care Planning is an essential part of delivering high-quality, person-centred care. It enables the team to tailor support and clinical decisions to what matters most to each individual. 

Why Advance Care Planning is important

• It puts the person at the centre:  Care and treatment reflect the resident’s own values and priorities.

• Improved clinical and non-clinical care: Those providing care are able to understand ‘what matters most’ to the resident and adapt practice accordingly. 

• Prevents avoidable hospital admissions: Advance Care Plans help ensure appropriate decisions are made before urgent and non-urgent incidents take place.

• Reduces distress and conflict for families: Loved ones are able to understand wishes in advance leading to a greater understanding and a reduction in the likelihood of conflict. 

When Should Advance Care Plans Be Created?

Advance Care Planning is a proactive and ongoing process. In nursing homes, it is vital that each resident has an appropriate plan in place. Planning should occur:

• Upon admission to the nursing home: ideally within the first few days

• Following a change in health condition: such as deterioration or new diagnoses

• On scheduled review dates: agreed as part of internal care planning cycles

• Any time a resident expresses a wish to update or revisit their plan

• When the resident or a family member requests that the document is revisited

Advance Care Plans should be regularly reviewed and updated to ensure they remain accurate and relevant. It is easy to do this within MyWishes Care. Updates are logged and professionals are accountable.