Advance care planning in residential care

Background: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the p rocess of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data . Aim: To study the process of ACP and the prevalence of ACD in residential c are. Methods: Cross-sectional study using a questionnaire in the Hunter area, NS W, Australia. Results: Very low levels of formal advance directives were fo und (available for only 0.2%). Only 1.1% of residents had 'no-CPR' orders d ocumented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian. Informal processes of advance planning were much more prevalent. Sixty-five per cent had a 'person responsible' recorded to make decisions for them while in 13% of cases, there was 'staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clea r process for medical decision making identified. Conclusions: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore curr ent processes of decision making.