Advance Care Planning in Care Homes for Older People

Care homes remain an important place of care until death for a significant number of very frail older people with 21% of the UK population aged over 65 dying in such institutions.

The practices of how care is planned, for all aspects of care between staff, residents and relatives in care homes, create the foundations upon which planning for care at the end of life or when communication is impaired, is based. Difficulties in engaging with these issues are further increased when older people experience communication and cognitive problems, as is the experience of numerous frail older people living in care homes, many with illnesses such as dementia. An informed understanding of, and support for, Advance Care Planning between care home staff, residents and relatives is of fundamental importance to help ensure quality care at the end of life. However, Advance Care Planning (ACP), while widely used in other countries, is a relatively new intervention in the UK, and little explored within the context of care homes.

Counsel and Care and research partners (Lancaster University, University of the West of England, Bristol) have identified an urgent need to clarify, develop, and promote good practice in Advance Care Planning (ACP) in the context of care homes for older people.

The study will be based in Lancaster and the research will be undertaken with in two study sites across the United Kingdom.

Research questions:

• To what extent is ACP is undertaken in care homes for older people?
• Which ACP ‘tools’ or other decision-making processes are currently in use?
• How are residents consulted and involved in decision making about general care?
• How staff are prepared and trained to undertake consultation and ACP?
• What are managers' attitudes towards residents’ and relatives’ end-of-life issues?
• What models of good practice in advance care planning are currently in use in care homes?

Research design and methods:

Phase 1:
A postal survey of registered managers of 500 care homes (nursing and residential) will be undertaken in i] the North, and ii] the South West of England. The questionnaire will address the following areas: the care home organisation and population (including ethnic, faith and cultural characteristics), manager’s views about consultation, decision-making for care including end-of-life care, the current methods of consultation and ACP, the use of ACP tools and the level of staff preparation.

Phase 2:
Semi-structured interviews will be undertaken with a sub-set of care home managers about good practice in the area of advance care planning. The areas to be addressed in the interview will include: examination of the ‘tools’ or process of ACP adopted, the way in which these processes were introduced into the care work, how the need for staff education and support is met.