Advance Directives in
Long Term Care
Julie Bayly, LNHA
julie.bayly@rivhs.com
October 22, 2009
Long Term Care Providers
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Nursing Home
Assisted Living
Continuing Care Retirement Community
Adult Day Care
PACE – Program for the all inclusive care for
the elderly
Hospice
Home Health Care
Right To Be Informed
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Virginia State Law requires
Nursing Home residents upon
admission to be informed of
their right to make decisions
about medical care.
LTC Providers will discuss
Advance Directives and
individual preferences when
enrolling in a new LTC
service.
Best Practice
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All Long Term Care Providers have an assessment tool completed
on a routine schedule. This may be quarterly, monthly, biannually- varies depending on the service.
The assessment will include the interdisciplinary care team, the
individual receiving care and in some cases the resident
responsible party.
Advance Directives should be discussed during this assessment
and the documentation should reflect the discussion.
“Your Right to Decide” a publication from the Virginia Department
of Health and Department of the Aging.
Include the physician in the discussion.
Durable Do Not Resuscitate Order
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Written by a physician
May be verbally revoked
Durable Do Not Resuscitate Order
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Yellow Form Provided by Virginia Department of
Health
Family in Crisis – No Advance
Directive Planning
The Crisis
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Weight loss/Refusal to Eat -Feeding Tubes
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Provide education on feeding tubes and the
relationship with hydration.
Palliative Care over Hospitalization or frequent
Hospitalizations
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Provide education on the dying process. Consider
Hospice staff as a resource.
Difference of Opinion in the Family
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Follow the Advance Directive
If no Advance Directive, follow
statute hierarchy (guardian,
spouse, adult child, parent,
adult sibling, blood relative)
Work for consensus that is
best for the resident
Include the Physician in the
discussion.
What Can You Do?
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Write a Letter to the Editor of your local paper
for National Advance Directives Day (April 16th)
Offer to give a presentation on Advance
Directives at a Resident Council Meeting
Partner with a long term care provider to do a
community education seminar on Advance
Directives
Questions?
Julie Bayly
(804) 758-2363
julie.bayly@rivhs.com