• Age and ageing · May 2011

    Advanced care planning in care homes for older people: a qualitative study of the views of care staff and families.

    • F Stewart, C Goddard, R Schiff, and S Hall.
    • Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK. frances.f.stewart@kcl.ac.uk
    • Age Ageing. 2011 May 1; 40 (3): 330-5.

    Objectiveto explore views on advance care planning in care homes for older people.Designqualitative exploration of views from care home staff and the family of residents in care homes for older people.Settingall care homes for the elderly in two London Boroughs.Participantsstaff (care managers, nurses and care assistants), community nurses and families.Methodsindividual semi-structured interviews.Resultsthemes of the analysis: (i)Benefitsstaff and family revealed positive opinions towards advance care planning. Staff felt it provided choice for residents and encouraged better planning. (ii) Barriers: staff and families perceived residents as reluctant to discuss advance care planning. Some care assistants were reluctant to be involved. Furthermore, families and staff reported prevalence of dementia among residents as another barrier. Nurses and care managers identified both family involvement and unforeseen medical circumstances as problematic. (iii) Facilitators: (a) early initiation of discussions (b) family involvement to establish preferences (c) residents and staff being well-known to each other and (d) staff training, were perceived to facilitate ACP.Conclusionsoverall, staff and families support the concept of ACP. Methods to overcome the identified barriers are required to embed ACP within end of life care in care homes.

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