Goals of Care Discussions and Advance Directives
The proportion of NH residents with completed ADs increased dramatically over the past 15 years. Jones and colleagues reported that 65% of NH residents had an AD in 2004 (the most recent year for which there are national data).
As in community samples, having an AD in the NH was associated with older age, white race, and receipt of hospice care.
The most common types of ADs were living wills and Do Not Resuscitate orders. The majority of ADs for older NH residents reflect preferences for less-aggressive EOL care.40,53 Although documented preferences about resuscitation are common, decisions about other interventions, such as artificial nutrition and hydration, hospitalization, antibiotics, and comfort measures, are not.54 The use of the Physician’s Orders for Life-Sustaining Treatment (POLST) is one effective way of encouraging discussion about and documentation of residents’ and families’ decisions about specific therapeutic approaches. Moreover,
the POLST paradigm increases concordance between residents’/families’ preferences and care received.