In this month's issue, the Legal Issues section features an article entitled, "Test of an Educational Brochure on Advance Directives Designed for Well-Elderly People," by Gladys L. Husted, RN, PhD, M. Carroll Miller, RN, MSN, MA, and Barbara A. Brown, RN, MN, CCRN. This article is particularly timely in light of recent evidence (Castle & Mor, 1998) suggesting increased numbers and more diverse groups of nursing home residents are using advance care plans as a result of the Patient SeIfDetermination Act (PSDA) of 1991. As reported in the July 1998 Agency for Health Care Policy and Research's AHCPR Research Activities Newsletter, investigators merged and compared Health Care Financing Administration data from 1990/1993 with that from 1991/1994 for more than 4,000 residents of 268 nursing homes. The purpose of the study was to identify resident and organizational characteristics associated with use of advance care plans before and after implementation of the PSDA. As summarized in the AHCPR article, results showed increased use of do-not-resuscitate (DNR) and do-not-hospitalize (DNH) status, as well as use of living wills following the PSDA. Interestingly, the Castle and Mor research (1998) also documented that use of advance care plans, DNH orders, and living wills was affected by facility characteristics in addition to resident health status and preferences. Pertinent factors included staff size, type of ownership (for-profit), and number of Medicaid residents in the nursing home. The investigators speculated these findings may reflect the financial concerns of facilities.
Given this concern, it is even more imperative that gerontological nurses continue to play a key advocacy role in ensuring nursing home residents are informed of their rights regarding the PSDA to participate in medical decisions and use advance directives to plan future medical care in the event their status changes.
Kathleen C. Buckwalter
- Agency for Health Care Policy and Research. (1998, July). Use of advance care plans increases among nursing home residents. AHCPR Research Activities Newsletter, 217, 5.
- Castle, N.G., & Mor, V. (1998). Advance care planning in nursing homes: Pre and post Patient Self-Determination Act. Health Services Research, 33(1), 101-124.