I started working with Advance Care Planning (ACP) about a year and a half ago. While my position includes promoting ACP, I’m also a nurse consultant with the palliative care team, which means I meet with clients who reside in Long Term Care (LTC) facilities.
When I did my Registered Nurse (RN) training many years ago, I did a portion of my practicum in a LTC facility; at the time it was seen by my classmates as a position that lacked excitement and offered limited experience. Twenty-seven years later, I see this experience differently! LTC is an area where there is more of a focus on comfort and normalcy within the resident’s care, because this is likely the last home they will reside in. In these kinds of situations, we must consider the individual’s needs and wants within the care that they receive, including cultural-based values and beliefs. As such, it’s even more important that there’s a focus on the individual, and whether they have thought about what’s important to them regarding their wishes for end-of-life care.
The last year in this position has led me to further see and understand the importance of ACP in LTC facilities, including: discussions that need to happen amongst family members; awareness regarding what the future looks like for the resident; and situations and circumstances that need to be explained. Not having these conversations may lead to misunderstandings and the failure to follow the dying person’s wishes.
As health care staff, we have to ensure that there are open lines of communication with the family members and loved ones, as well as the residents. As a family member, we need to be proactive, involved, and not afraid to ask questions, in order to be informed. ACP needs to be an ongoing process to keep everyone from questioning care choices. Sometimes the residents are at a stage where they can no longer have these conversations, or they may not have loved ones who are involved, and these topics don’t always get discussed. This makes it even more important to have these conversations with our patients before it’s too late, at a time when they are still able to express their wishes.
The extended length of stay creates relationships and bonds between staff and the residents, often closer ones than exist in regular hospital wards. So, sometimes it can be difficult for the staff to experience the decline in the residents and the care involved, and even harder if there is no ACP in place.
Advance Care Planning day was April 16, but ACP should be encouraged every day whether it’s with a loved one or a patient. Find out what’s important to them and get them thinking about what their beliefs and values are, and what would matter most to them at end-of-life. Let’s all work at promoting ACP and make an effort to have those conversations. For more information on ACP visit www.speakup.ca and www.advancecareplanning.ca.