Community Care Planning

Question 1

What are end of life care decisions to be made?

Answer 1

Advanced directive
Power of attorney
Life sustaining treatments
DNACPR order

Who 
What
When
Where 
How

Question 2

What is an advanced directive?

Answer 2

Living will
Legally binding document outlining what medical treatment you would not want in the future, if you lack capacity

Must be signed, witnessed, patient not done under duress, no doubt about patient’s state of mind at time of signing

• You cannot specify which treatments you want, only ones you would not want

Question 3

What is lasting power of attorney

Answer 3

Third party appointed in advance to make decisions on the patient’s behalf should they lose capacity - can be on or more than one person.

Forms are available from the GOV.UK website and can be downloaded or completed online

Question 4

What are types of LPA?

Answer 4

Health and welfare:
Daily routing
Medical care
Moving into care home
Refusing life-saving treatment

Property and finance affairs

Cose £130 for each type

Question 5

Limitations of LPA

Answer 5

LPA has a right to refuse offered medical treatments but not choose which treatments to have
Only takes effect when patient lacks capacity

Question 6

What are life-sustaining treatments?

Answer 6

CPR
Defibrillation
Intubation and ventilation
Dialysis
Life sustaining surgery
Blood transfusions
Antibiotics
Tube feeding (parenteral nutrition)

Question 7

Limitations of advanced directive

Answer 7

Cannot:
Ask for specific medical treatment
Refuse basic care
Request something that is illegal (assisted suicide)
Choose someone to make decisions unless LPA
Refuse treatment for a mental health conditino

Question 8

Structure

Answer 8

Open question:
How have you been coping with your illness recently/what do you understand about this diagnosis/what worries you the most about the future

Direct to helpful sources o info and advice
e.g. Alzheimer’s Society website or NHS guide planning for your future care

LPA forms online

Check mutual understanding

Allow for review or follow-up

Consider informing family - encourage to involve and to inform them of any advance planning documents they create

Can have a copy of their advanced care plan or LPA on medical records to refer to in the future if they wish

Document discussion

Question 9

How to assess mental capacity

Answer 9

Two step test:

1. Does the patient have impairment/disturbance of brain function?
   - If NO - patient has capacity
2. If yes, does this mean they are unable to make a decision as a result?
   - Consent test:
3. Understand information relevant to decision (consequences, risks benefits)
4. Retain the information long enough
5. Weigh up/use the information to make a decision (considers pros/cons)
6. Communicate the decision by any means