Nursing homes need improvement in end-of-life directives: Study

A new study highlights the need for better procedures for end-of-life directives in nursing homes.

Amy Wallace
A new study finds that nursing homes are falling behind in the proper utilization of advance care directives. Photo by Mary Rice/Shutterstock
A new study finds that nursing homes are falling behind in the proper utilization of advance care directives. Photo by Mary Rice/Shutterstock

Jan. 17 (UPI) -- A study from the University of Missouri School of Social Work suggests nursing homes need to give more attention to how advanced directives are used.

"In a 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," Colleen Galambos, professor in the University of Missouri School of Social Work, said in a press release. "Evidence suggests that advance directives improve the dying experience for nursing home residents and decrease the cost of end-of-life care while honoring residents' expressed wishes about health care. However, at the national level only 65-70 percent of nursing home residents have advanced directives; that number is significantly less here in Missouri."


Advance directives, or living wills, are legal documents that allows a person to choose their treatment preferences if faced with a serious injury or illness that renders them unable to make decisions for themselves. These directives can include do not resuscitate, or DNR, orders in cases where a person in a nursing home chooses to not have any medical interventions to save their life in a medical emergency.

The study examined more than 1,800 medical records from nursing homes in the St. Louis, Mo., area. Roughly 50 percent of the records included advance directives but researchers found that many were hard to find in the patients' charts due to poor record keeping.

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Galambos suggests that healthcare providers include a section in medical records specifically for advance directives and reinforce the importance of checking for advance directives.

"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 said. "People can enact an advance directive at age 18, which is a good time to start thinking about what their wishes would be during an emergency."

Galambos also encourages parents and adult children to talk about their healthcare wishes and end-of-life care before an emergency arises.

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The study was published in Health and Social Work.

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