Complexity of decision-making in a nursing home: the impact of advance directives on end-of-life care

Since the Patient Self-Determination Act became law in 1991, nursing homes routinely address advance directives with all residents. This study investigated the implementation of end-of-life care wishes of residents in one nursing home in Florida. Data were collected from the medical records of residents who died in the facility (n = 75) in one year. Two-thirds of the residents had either completed a living will, or designated a health care decision-maker, and 90.7% of the residents had do-not-resuscitate orders. Findings suggest that in 94% of the cases advance directives were followed, and that professional social work activities contributed to the high rate of compliance. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: [C] 2003 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Advance directives, nursing home, autonomous decision-making