Advance directives, or
living wills, are the legal documents individuals use to communicate
their treatment preferences when faced with serious injuries or
illnesses. Popular medical dramas such as Grey's Anatomy and Chicago Med often
depict the tensions that can arise while making end-of-life medical
decisions without "advance directives" on file.
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.
‘More attention to how advance directives are used in nursing homes may reduce unnecessary care and save health care costs, all while respecting residents' wishes.’
Following a new study, Colleen Galambos, professor in the
University of Missouri School of Social Work, says that more attention
to how advance directives are used in nursing homes may reduce
unnecessary care and save health care costs, all while respecting
Galambos said. "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% of nursing home residents have advance
directives; that number is significantly less here in Missouri."
Galambos and her team analyzed more than 1,800 medical records from
St. Louis area nursing homes. Fifty percent of the records contained an
advance directive; however, in many cases the forms were difficult to
find in the charts, due to inconsistent record keeping. Galambos
recommends that providers include a designated section in medical files
for advance directives and that they reinforce with staff the importance
of checking advance directives.
Galambos further suggests that parents and adult children begin
discussions about their wishes for health care, including end-of-life
care, as soon as possible, and that the forms be updated on a regular
basis as health needs and philosophies of life can change. She says that
no family member wants to be in a position to have to guess about what
type of care their loved ones want when they are no longer able to
communicate their wishes.
"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
"Analysis of advance directive documentation to support palliative care activities in nursing homes," recently was published in Health and Social Work
a journal of the National Association of Social Workers. Co-authors for
the study were Marilyn Rantz, Curators' Professor of Nursing; Gregory
Petroski, biostatistician with the Office of Medical Research; and Julie
Starr, nurse practitioner with MU Health.
Galambos recently was selected as a National Association of Social
Workers (NASW) Social Work Pioneer of the Year for her contributions to
the social work profession. Galambos is the director of the graduate
certificate in Gerontological Social Work program. The School of Social
Work is part of the MU College of Human Environmental Sciences.