Checklist of Items for Discussion When in a Nursing Home

(For Physicians & Staff ) The following topics, which have a significant impact on the quality of life a resident and their family experience, should be discussed between the family and the staff and the doctor at the admission meeting or within 2wks of admission ideally, and then as needed during subsequent/annual meetings.

Confirm that the resident/family received/read those handout materials available for each topic – give them “Important Decisions for Residents/Sponsors/Families” (their own checklist – on page 2 below) if they haven’t received it already. 

1. Summarize and clarify each health problem and its status.

2. Discuss prognosis related to the problems – what’s the family’s perception v reality.

3. Living Will / Advance Directive – in place?  

4. HealthCare Proxy or DPOA (Durable Power of Attorney) – who is it?  [if not done, can we facilitate them getting one]

5. Goals of care – what would resident want, given above prognosis

6. Order for AND/DNR

7. Medications – based on goals, can we stop unnecessary drugs; encourage the Drug Holiday option; 

8. What situations, if any, might require transfer to hospital [injury/infection/organ failure? – should be based on goals – e.g. Alzheimer’s Stage 7 will be made worse if transferred]

9. Feeding Tubes

10. Surgery – especially if falls and has fracture when resident has dementia [ ORIF (as in a hip pinning) not needed to control pain

11. In presence of dementia, should we treat pneumonia with antibiotics – many families opting to not use antibiotics

12. Potential risks all elderly face [nurse manager to lead off and tag team reinforce with the doctor]:  falls [most common cause is medication], delirium & agitation [70% residents have dementia], aspiration [most common cause of pneumonia in LTC] – and how can we best manage these with the help of the family.  [have they read the handout on “Expectations”]