Advance directives sloppy, providers lagging, study finds

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Many nursing home providers are missing out on opportunities to reduce unnecessary care and cut healthcare costs by not having residents' advance directives on file, according to recent research.

Previous research has indicated that advance directives help improve end-of-life care for nursing home residents while decreasing healthcare costs. On a national level, roughly 65% to 70% of residents have such directives on file, a statistic that investigators with the University of Missouri School of Social Work found to be significantly lower in their home state.

A research team led by Colleen Galambos, Ph.D., MSW, found that among a sample of 1,800 skilled nursing resident records, only 50% contained an advance directive. In many of those cases the advance directives were hard to find, an issue blamed on inconsistent record keeping. Those results signify a need for providers to designate a special section in medical files for advance directives, and teach staff the importance of checking the directives, Galambos said.

“In the nursing home setting, some providers use aggressive end-of-life care, even if it is not in a person's best interest or against a resident's wishes,” Galambos said in a news statement published Tuesday. “There is no reason for adults not to have an advance directive, and most nursing home residents should have an advance directive on file to ensure that they receive the type of end-of-life care they desire.”

Galambos also stressed the importance of residents' families discussing end-of-life wishes  and update forms on a regular basis so no relative has “to guess about what type of care their loved ones want when they are no longer able to communicate their wishes.”

The results of the study were published in Health and Social Work.