Nursing home resident use of care directives

Background. The Patient Self-Determination Act of 1991 requires that nursin g homes reimbursed by Medicare or Medicaid inform all residents upon admiss ion of their rights to enact care directives in the event of terminal illne ss. This study investigated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the fi rst half of 1993 and followed them in the nursing home through the end of 1 994. We created logistic models to examine independent correlates associate d with having an advance directive or a do-not-resuscitate (DNR) order on a dmission. We then created similar logistic models to examine independent co rrelates associated with writing an advance directive or DNR order subseque nt to admission. Results. Of the 2,780 residents, 11% (292) had advance directives and 17% ( 466) had DNR orders upon admission. Of those without care directives upon a dmission, 6% (143) subsequently had an advance directive and 15% (339) subs equently had a DNR order. Cross-sectionally, older individuals and whites w ere more likely to have a care directive. Having poor cognitive and physica l function was associated with having a DNR order upon admission. Longitudi nally, longer stayers and whites were more likely to have an advance direct ive. residents who lost physical function were more likely to have an advan ce directive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemograph ic and functional characteristics.