Improving Nursing Home Policies for Unrepresented Residents

Nursing home (NH) staff and other stakeholders should establish policies aimed at identifying unrepresented residents and improving medical decision-making practices on their behalf, according to recommendations published in the Journal of the American Medical Disorders Association.

Researchers conducted a survey of 66 staff members from 3 NHs in Georgia and reviewed medical records, NH policy, and procedure documents to understand decision-making for unrepresented adults.

Of 433 residents, 4 met the criteria to be considered unrepresented, or “individuals who lack decision-making capacity and have neither an available surrogate decision maker nor an applicable advance directive.” Eleven staff members had participated in medical decision-making, and the most common decisions were do-not-resuscitate orders, major medical and surgical treatments, and life-sustaining treatments.

Findings indicated that medical decisions were primarily driven by discussions with the resident’s physician or within the NH’s interdisciplinary team.

“Suggestions included adopting explicit mechanisms or protocols related to decision making for unrepresented residents, education/training, and resources for group-based decision making,” study authors wrote.

Reference:
Kim H, Perkins M, Pope TM, Comer P, Song M. Medical decision-making practices for unrepresented residents in nursing homes [published online ahead of print July 21, 2021]. J Am Med Dir Assoc. 2021 Jul 21;S1525-8610(21)00639-3. doi:10.1016/j.jamda.2021.07.001