Decision making and the use of advance directives among nursing home residents at admission and one year after admission

This research utilized the national Minimum Data Set (MDS) to compare decision making authority and the use of advance directives between nursing home residents at admission and residents at the time of their first annual MDS assessment. Over 444,000 admission assessments recorded during 2000 and over 70,000 annual assessments recorded during 2001 for residents with a date of nursing home entry during 2000 were analyzed. More than 50 percent of residents at admission had no advance directives in place, less than one quarter had executed a durable power of attorney for health care decisions, and fewer than 16 percent had executed living wills. In contrast, at their first annual MDS assessment, more than 60 percent of residents had documentation of advance directives, about one third had executed a durable power of attorney for health care decisions, and less than one quarter had executed living wills. Almost four residents in 10 had no advance directives in place at the time of their first annual MDS assessment. Social workers can promote the execution of these advance directives among nursing home residents before, during, or after admission.