Advanced care planning in care homes for older people: a qualitative study of the views of care staff and families

Design: qualitative exploration of views from care home staff and the family of residents in care homes for older people. Setting: all care homes for the elderly in two London Boroughs. Participants: staff (care managers, nurses and care assistants), community nurses and families. Methods: individual semi-structured interviews. Results: themes of the analysis: (i) Benefits: staff and family revealed positive opinions towards advance care planning. Staff felt it provided choice for residents and encouraged better planning. (ii) Barriers: staff and families perceived residents as reluctant to discuss advance care planning. Some care assistants were reluctant to be involved. Furthermore, families and staff reported prevalence of dementia among residents as another barrier. Nurses and care managers identified both family involvement and unforeseen medical circumstances as problematic. (iii) Facilitators: (a) early initiation of discussions (b) family involvement to establish preferences (c) residents and staff being well-known to each other and (d) staff training, were perceived to facilitate ACP. Conclusions: overall, staff and families support the concept of ACP. Methods to overcome the identified barriers are required to embed ACP within end of life care in care homes.