Advance care planning in retirement and nursing homes

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Elderly people often live in a retirement or nursing home when their state of health no longer allows them to remain at home, even with the support of relatives and/or home care services. For this group of people, the «Roadmap for the implementation of advance care planning (ACP) in Switzerland» recommends a detailed or disease-specific ACP.

People in long-term care institutions are an important yet vulnerable group when it comes to ACP. Also in this setting, a person should have the opportunity to decide autonomously how they would like to be treated and cared for in the event of future incapacity. Studies have shown, however, that implementing ACP in retirement and nursing homes is challenging, for example because elderly people are still largely unaware of advance directives. Another challenge is that the need for long-term care in Switzerland will have increased by 50% by 2040. Read more: Obsan report 03/2022 in French or German.

 

People in retirement and nursing homes are a particularly important group for whom ACP should be strengthened. In particular, people with multimorbidities, increasing frailty and/or early dementia should be given the opportunity and support to reflect deeply on their personal values and therapeutic goals. Their wishes should be put in writing if they so choose, and made available to their caregivers. ACP allows each person to reflect on and document their personal wishes for or against certain medical interventions in the event of future incapacity.

 

 

Guidance for professionals in retirement and nursing homes

An interprofessional sub-working group commissioned by the national working group ACP has produced a brochure to strengthen ACP in retirement and nursing homes. It serves as a practical guide to help professionals implement ACP in this setting. The brochure is intended for all professionals working in long-term inpatient care institutions, in particular nurses, doctors and ACP consultants. The aim is to ensure that ACP is understood and established in the daily work of nursing homes, for the benefit of residents. The brochure is available in French, German and Italian in PDF format or in paper form.

 

 

Projet de soins anticipé dans les établissements médico-sociaux – Guide de mise en œuvre (2025)

In six steps, the when, what and how of ACP are described. Planning ahead for health in nursing homes is a continuous process between residents, professionals and, where available, relatives. Elderly people should be offered the opportunity to start this process upon admission to the home. If residents wish to do so, they are supported in reflecting on their personal values and wishes regarding medical treatment. Together the matters are discussed and put in writing. This includes setting treatment goals and the desired level of treatment intensity in the event of a deterioration in health or in emergency situations. If a person is not capable of making decisions, the therapeutic representative is involved.

 

Pilot phase: Form treatment intensity

To document treatment goals and the desired level of treatment intensity, the working group recommends using a standardized form, even if the person already has an advance directive or a treatment plan. This is an additional document that summarises the most important information for emergency situations on one page.

 

A preliminary version of the recommended form – in German, French and Italian – is available for a pilot phase. Feedback will be collected in a public consultation (starting in October 2025 at the earliest), in which all interested parties can participate. The consultation will be announced via the SAMS newsletter. The document is available in three languages:

 

This form ensures that the desired level of treatment intensity is immediately apparent. It is intended as a means of communication between the nursing home, the emergency service and the hospital.

 

ACP as a medical quality indicator

On behalf of the «Commission fédérale pour la qualité (CFQ)» (Website available in French or German), the national implementation programme «Qualité des soins de longue durée dans les établissements médico-sociaux (NIP-Q-UPGRADE)» is underway. The programme focuses on data-based quality of care. Numerous quality indicators have already been successfully introduced. In autumn 2025, «advance care planning» will be launched as an additional medical quality indicator and its concrete implementation will be tested. The way in which ACP is implemented in retirement and nursing homes and the documentation play a central role in this. More about NIP-Q-UPGRADE in French or German.

 

The brochure provides important information on this topic. The «Commission fédérale pour la qualité (CFQ)» is expected to decide on the definitive national introduction of a «ACP» quality indicator in 2027.

 

CONTACT

Dr. Manya Hendriks
Project Manager Ethics
Tel. +41 31 306 92 77