The Difficult Discussion on Goals of Care

Talking about end-of-life care can be tough. It's emotional, it's sensitive, and nobody really wants to think about it. But having these conversations with residents and their families is absolutely essential in Assisted Living and Memory Care. It's about ensuring everyone is prepared for potential emergencies and that resident wishes are honored.

These discussions shouldn't be a one-time thing. They should happen upon admission, reviewed at least annually, and whenever you notice even subtle changes in a resident's health. Having an up-to-date code status and emergency plan is crucial. It's the roadmap everyone follows when a crisis occurs.

Most states have specific forms for documenting these wishes (POLST, MOLST, POST, MOST – the names vary). Sometimes these are already in place, discussed with the resident's primary care provider. But often, nurses play a key role in educating residents and families so they can make informed decisions.

And let's be real, these are emotional conversations. Empathy is key. Acknowledge the difficulty of these decisions, and let them know you're there to support them.

Here's how I approach these conversations:

• Start with compassion:  "I know these decisions are difficult, and I want to assure you I'm here to answer any questions you have."

• Gauge their existing knowledge: Ask leading questions such as, have you already considered your wishes regarding emergency care? Do you have a Health Care Directive we can review?

• Explain the purpose of the form: This form helps us and emergency responders understand your wishes in a crisis.

• Be transparent about your facility's capabilities:  For example, our staff is not formally trained in CPR. While they may attempt CPR with guidance from an EMS operator, but it's important to understand that immediate, effective CPR may be delayed until EMS arrives if this applies to your setting.

• Provide realistic information about CPR:  Share statistics on CPR success rates for older adults (and be prepared to share reputable sources).

• Clarify the meaning of "DNR":  Emphasize that a DNR order only pertains to CPR in the event that their loved one's heart stops due to a natural death. It does not mean that other emergency care will be withheld.

• Give them time:  Don't rush the decision. Allow residents and families time to reflect and discuss their options. Follow up if the form isn't completed within a day or so after the conversation.

• Ensure legal validity:  Ensure the form is signed by the resident's primary care provider once completed. Provide a copy to the resident or family.

• Communicate with your team:  Have a clear system in place so staff can quickly access resident code status information in an emergency. These are stressful situations, and quick access to information is vital.

• Document everything: Keep detailed records of your conversations, including the information you provided, the resident/family's responses, and any future plans.

  
  

We understand these conversations can be challenging. We're here to support you! Don't hesitate to reach out if you have any questions or need help navigating these important discussions.