1. Advance Care Planning (ACP) - an overview ACP Learning Pack. Session One

2. Dignity 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

3. Introduction to Advance Care Planning Key terms Advance Care Planning Advance Statements Advance Decisions ‘Living Will’ Lasting Power of Attorney ACP Learning Pack. Session One

4. 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

5. Advance 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

6. Advance 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

7. Advance Decisions to Refuse Treatment -2 Validity and Applicability:- Must relate to treatment being considered Must relate to exact circumstances Questions 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 Has the person withdrawn their decision?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

8. ‘Living Will’ and ‘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

9. 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

10. Care 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

11. Mrs 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

12. Issues 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

13. Other 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

14. 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