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When residents in Long Term Care Facilities (LTC) enter the final phase of life, healthcare interventions have to be carefully considered as it would be incorrect to assume that any and all treatments would necessarily be desired by or could benefit the resident.
While admission to an acute care hospital does not require consent, transfer from LTC to an acute care hospital does insofar as the transfer represents a change in the ‘treatment plan’ for that resident. Most residents are asked to complete a form called a Level of Care Form so staff can appropriately respond to medical emergencies. Unfortunately, these forms often do not reflect the wishes of the resident. In other instances, these forms are filled out or changed by a substitute decision-maker, and so they cannot be used as ‘advance care plans’. Wishes from the resident need to be continuously updated and documented in the chart. In particular, if there are wishes known from a resident that she/he does not wish to be transferred to the hospital then those wishes should be respected. Transfers should be supported if the resident desires a transfer and can benefit from a transfer.
The message for LTC staff is the following, if a resident is capable, even in a medical emergency they should be asked about whether or not they want to go to hospital. This is part of the consent process given that those residents will necessarily receive emergency treatment upon arrival at hospital. Where residents are incapable in the event of a medical emergency, substitute decision makers should consider prior expressed of the resident before consenting to transfer to hospital.
For physicians and hospital staff, the patient’s prior expressed capable wishes should be canvassed as soon as they no longer require emergent care.