advance care planning (acp) - an overview acp learning pack. session one
TRANSCRIPT
Advance Care Planning (ACP)Advance Care Planning (ACP)- an overview- an overview
ACP Learning Pack. Session One
Dignity in Advance Care PlanningDignity in Advance Care Planning
• A sense of being in control• A feeling of confidence, knowing you will try to
avoid undignified situations
ACP Learning Pack. Session One
• You have had these discussions in advance with the resident
• You will know how to care for them as they would want
• All care home staff can know their wishes – they’ve been recorded
…because
…can help promote for residents
Introduction to Advance Care PlanningIntroduction to Advance Care Planning
Key terms • Advance Care Planning • Advance Statements• Advance Decisions • ‘Living Will’• Lasting Power of Attorney
ACP Learning Pack. Session One
Advance Care Planning (ACP)Advance Care Planning (ACP)Definition:-• ACP is a process of discussion between an individual
and their care providers irrespective of discipline. If the individual wishes, their family and friends may be included. With the individual’s agreement, this discussion should be documented, regularly reviewed, and communicated to key persons involved in their care.
Taken from ‘Advance Care Planning: A guide for Health and Social Care Staff’, NHS End of Life Care Programme, February 2007
ACP Learning Pack. Session One
Advance StatementsAdvance Statements
• Statement of wishes and preferences• No legal status, not legally binding, but guidance and
preferences• If person lacks capacity to make a decision about
health and welfare, then an advance statement will be taken into account when decisions are being made.
• Helps to inform ‘best interests’ for a person. • An example of a form of ACP is ‘Preferred Priorities
of Care’ from the End of Life Care programme
ACP Learning Pack. Session One
Advance Decisions to Refuse Treatment -1Advance Decisions to Refuse Treatment -1
• Relates to an advance decision to refuse treatment
• Legally binding, if valid and applicable• Must be in writing if it relates to refusal of
life- sustaining treatment, signed & witnessed
• Must state clearly that if it still applies even if life is at risk
• Person must have mental capacity at the time of writing
ACP Learning Pack. Session One
Advance Decisions to Refuse Treatment -2Advance Decisions to Refuse Treatment -2
Validity and Applicability:-• Must relate to treatment being considered• Must relate to exact circumstancesQuestions to consider:-• Has the person done anything that clearly goes against
their advance decision?• Has the person withdrawn their decision?• Has an LPA been set up after advance decision? • Would the person have changed their decision if they had
known more about current circumstances?Taken from Mental Capacity Act Code of Practice
ACP Learning Pack. Session One
‘‘Living Will’ and Living Will’ and ‘Advance Directive’‘Advance Directive’
• Old fashioned terms• Not clear as to meaning• Usually accepted to be an advance refusal of
treatment, but not necessarily so.
ACP Learning Pack. Session One
Lasting Power of Attorney (LPA)Lasting Power of Attorney (LPA)
• A new legal entity– established by the Mental Capacity Act 2005
• Must be registered with the Office of the Public Guardian (OPG)– and stamped and authenticated on each page– there is a defined process to create an LPA
• Differs from an Enduring Power of Attorney– LPA replaces EPA, though existing EPAs will still be valid
ACP Learning Pack. Session One
Care Home contextCare Home context• ACP usually linked with end of life care• A means of empowering older people in care
homes to have control over their lives• Residents ‘tend to perceive a sense of control
and enjoy good health’ – Shui(2001)• Natural progression from being involved in
care planning - from thinking about care NOW, to care in the FUTURE
ACP Learning Pack. Session One
Mrs MillsonMrs Millson
• Mrs Millson has lived in Leafy Glen Care Home since she had a stroke in 2003. She needed help with physical care, due to a right-sided weakness and she was mentally alert.
• Two months ago she became ill and was admitted to hospital. She had sustained another stroke.
• Two weeks ago you were asked to visit Mrs Millson in hospital to assess her, with a view to her returning to Leafy Glen.
• She now has a feeding tube as she is having difficulties with swallowing.
ACP Learning Pack. Session One
Issues to considerIssues to consider
• Do you think Mrs Millson would have wanted a feeding tube, as she loved her food?
• How do you know this was what she wanted?• Could she have not wanted to be fed like this?• For Mrs Millson could life be intolerable without
food?
ACP Learning Pack. Session One
Other legislation and guidanceOther legislation and guidance
• Care Standards Act 2000- Beware the term ‘representative’!
• Data Protection Act 1998• End of Life Care Programme
ACP Learning Pack. Session One
Summary Summary
• The process of ACP can enable people to think about, discuss and have their wishes recorded
• An ACP is only to be referred to if/when a person lacks the capacity to make a decision about their care and treatment
• This can help them to be supported at all times as they would want.
ACP Learning Pack. Session One