Documenting end of life decisions in residential aged care facilities in South Australia.
OBJECTIVE
This research examined the provision of palliative care for residents with a non-cancer diagnosis including the use of advance directives and advance care planning as part of palliative care policies in residential aged care facilities in South Australia. There are no guidelines for recording residents' wishes if they are no longer competent.


METHODS
Stage 1 involved a survey of 90 randomly selected aged care facilities. Stage 2 involved case studies of 69 residents, appropriate for palliative care, from 17 facilities and interviews with 15 directors of care.


RESULTS
Most residential aged care facilities used forms to record residents' wishes about end of life care, but there was little consistency. Some had no palliative care policy and few facilities required a formal advance directive. Not all residents had formally appointed a proxy.


CONCLUSIONS
Residential aged care facilities should be required to develop and implement a palliative care policy acknowledging the Accreditation Standards and State legislation and including a simple tool for advance care planning. Case conferencing could assist in discussing and documenting the resident's wishes. Public education is essential to increase community and professional awareness in order to promote empowerment for the increasing number of older people who will die in residential aged care facilities.
Brown
Margaret
M
Hawke Institute, University of South Australia, Magill. Margaret.Brown@unisa.edu.au
Grbich
Carol
C
Maddocks
Ian
I
Parker
Deborah
D
Connellan
Penny Roe
PR
Willis
Eileen
E
D032722:Advance Care Planning; D016223:Advance Directives / Q000639:trends*; D001293:Attitude to Death; D004282:Documentation; D005260:Female; D006302:Health Services Research; D006707:Homes for the Aged; D006801:Humans; D008020:Life Support Care / Q000592:standards* / Q000639:trends; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012680:Sensitivity and Specificity; D012866:Skilled Nursing Facilities; D013021:South Australia