Why we should all have an advance care plan

Featured article - 20 May 2019
By Rachel Shortt. Registered Manager,The Garth Nursing and Residential Home

Advance care planning - scie and nice guidance

I qualified as a nurse in 2005 and my area of interest very quickly became palliative/hospice care; in this field advance care planning is second nature.Having worked in hospices for almost 19 years I changed direction and came into the care home world. I have now been here almost two years and I love it.

The difference advance care planning can make to this group of people, as with all individuals, is remarkable. Not only does it ensure they have a voice and it is heard; but it also supports staff to advocate for our residents – to know what is truly important to them and achieve their wishes, real choice; it also helps staff think about their own advance care plan.

The biggest point I've learnt over the years has been to note how difficult we as professionals find it talk about advance care planning during someone’s dying and death phase of their life. Many of us assume this is uncomfortable for the individual so many of us will avoid it. But we have birth plans and many of us have life plans, so why not an end of life/death plan? It can helps us maintain choice and control.

One thing in life is a certain. We are all going to die – we just don’t know when – it could be an accident, an acute illness or co-morbidities and frailty/age.

Whilst I don’t know when or how; I do know how I don’t want it to be: Whilst I could share many stories of conversations/advance care planning with residents, I have chosen to share part of my death plan instead, as for me this is really important for all of us.

Rachel's death plan

I don’t want to be on a life support machine for weeks/months on end if I am ever in an accident and am brain dead.

If I ever develop dementia (significantly likely as it will effect 1:2 of us) I do not wish to be restrained - all of this includes being administered sedation.

If my quality of life has become unsatisfactory to me i.e. I am immobile/incontinent/unable to verbally communicate/can’t eat myself or at all – I do not wish to have life prolonging treatment i.e. insertion of a PEG and I DO NOT wish to be resuscitated.

If I am at high risk of falls - and then fall and hurt myself even repeatedly, please let me continue to walk and take the risks; the risks are mine to take not yours to take away.

I do want to be kept symptom free at the end of my life even if that means I am sedated/unconscious.

If towards the end of my life I live with chronic obstructive pulmonary disease (because I smoked) and I have recurrent chest infections – and if I do not respond to oral antibiotics, I do not wish to be admitted to hospital for IV antibiotics. Please keep me comfortable and palliate my symptoms are you are able to. Please keep me comfortable.

I wish to be cared for at home - my home - and this is also where I want to die. If this is not possible, for instance if my family can’t cope or are struggling, my second choice – my preferred place of death - is the hospice. I do not want to die in an acute hospital.

So let's start thinking about, and developing, our own advance care plans and that, in turn, can comfortably create conversation that can radiate to our residents/patients/clients.

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