How to complete an Advance Care Plan during a COVID-19 outbreak
By the end of unit 3, you will:
- have reflected on how Advance Care Plans were completed prior to COVID-19
- understand how to host a Family Care Conference during COVID-19
- understand how to communicate at a social distance during COVID-19
- be aware of some of the challenges and solutions to completing Advance Care Plans during COVID-19
Advance Care Plans before and during COVID-19
- Reflective activity: if you see a pencil throughout this section, take a few minutes to think about each question and if helpful, write down your answers.
You may have some experience of completing an Advance Care Plan prior to the COVID-19 pandemic. Take a few minutes to reflect on how you would complete an Advance Care Plan in the past. You might want to think about the following:
- When to invite residents and family members to have these conversations?
- At what stage of a resident’s care should these conversations take place?
- What advance care planning forms or processes are used in your organisation?
- How do you envisage COVID-19 might impact on completing an Advance Care Plan?
Due to the pressures caused by COVID-19, it is likely that you might face some additional challenges when trying to complete an Advance Care Plan during this time.
- What challenges might need addressing when completing Advance Care Plans during COVID-19? For example, how might staff shortages or rapid deteriorations in a resident’s health need approaching differently?
- How could these challenges be overcome? What resources might help with solving the problem? Who could you talk to and ask for advice?
Hosting a Family Care Conference during COVID-19
Advance care planning discussions can be ongoing and sometimes happen informally. For example, residents or family members may start conversations about future care with staff that they trust. It is important to recognise these informal discussions as they provide insight on a resident’s wishes, and can be the trigger for a more formal advance care planning discussion.
One approach for hosting a formal conversation about advance care planning is the Family Care Conference. You might know these meetings by a different name. This meeting gives an opportunity for care home staff to host a conversation with the resident and one or more family members about caring for their loved one during COVID-19. The resident should be included in the Family Care Conference where possible, as outlined in Unit 2.
The Family Care Conference should be arranged in advance, and family members should be invited to attend at a time that is convenient for them. These meetings will probably take place remotely or socially distanced during a COVID-19 outbreak, by phone or video call, and the implications of this are addressed later in this training unit.
The following steps explain how a Family Care Conference can be completed.
You should check before the meeting whether the resident already has an Advance Care Plan in place. If so, this should form the basis of your discussion. In order to get the most out of the Family Care Conference, you might want to prepare residents and family members to consider some of the topics covered in Unit 2. It is also important to facilitate an opportunity for the resident and family members to talk in private before the conference takes place.
- Thank the resident and family member(s) for attending.
- Introduce yourself, your role, and your relationship to their relative.
- Reinforce that the Family Care Conference aims to support families as well as their relative.
- Establish ground rules for the meeting, request no interruptions and indicate the length of the meeting – up to 60 minutes should be sufficient.
- Give an opportunity for residents and family members to ask any questions about the process.
Purpose of the meeting
- Outline and confirm the purpose of the meeting, which is to discuss wishes and preferences for care to enable an Advance Care Plan to be completed. The Advance Care Plan should be written-up following the advance care planning conversation, so you can focus on facilitating the discussion.
- Identify any particular concerns or questions that the resident or family member(s) may have – prioritise these and confirm which will be dealt with at the meeting.
- Clarify if any specific decisions need to be made.
Determine what is already known
- Determine what the resident and family member already know about advance care planning and their relative’s current care.
- If necessary, provide further information on the relative’s current circumstances.
- If necessary, invite each family member to ask questions about their relative’s current circumstances.
Advance Care Plan
- Discuss with the resident and family member(s) whether they know what an Advance Care Plan is, and why it is important during the COVID-19 pandemic. Some people may be confused by this term, so it is important to clarify what advance care planning is using words that people are likely to understand. This will be covered in Unit 5.
- Talk through each component outlined in Unit 2 of this training as necessary, and support the resident and family member(s) to make a decision about each area: participants involved in advance care planning; mental capacity; best interest decision making; statement of wishes and preferences; emergency care planning.
- Check in with the resident and family member(s) throughout, to see if the discussion is valuable and meets their needs. Consider taking a short break during the meeting, to give participants time to digest information, and then allow some time to re-focus.
- If an Advance Care Plan is already in place, ensure this forms the basis of the conversation.
Concluding the discussion
- Summarise areas of agreement, disagreement, decisions, outstanding decisions and the ongoing plan for future care.
- Seek endorsement from the participants and emphasise the positive outcomes.
- Offer a final opportunity for questions, comments and concerns – signpost residents and family members to other resources they can look at for further information. Some resources are provided at the end of this training.
- Identify one family spokesperson to be the main point of contact in the future, where possible.
- Thank everyone for attending.
- Record and share the Advance Care Plan – the process for this is outlined in Unit 4.
Watch the video below to hear Violet Graham talk about hosting a family care conference remotely.
Additional video about dementia and advance care planning
A supplementary video about dementia and advance care planning is included to highlight additional considerations that may be relevant to certain residents during a COVID-19 outbreak.
Watch the video below to hear Dr Karen Harrison Dening talk about advance care planning and dementia.
Guidance for communicating at a social distance
It is likely that the Family Care Conference will happen remotely during COVID-19, via phone or video call. Therefore, it is important to consider how to communicate effectively at a social distance, especially when discussing emotional or potentially upsetting topics.
You might wish to consider the following when conducting the Family Care Conference in a virtual environment, so you can truly inVEST in the conversation:
Consider using video technology wherever possible. This will allow the family member(s) to observe your body language, and for you to make attempts at eye contact and give supportive expressions.
Give emotional responses and reassurances to the family member(s), using nods or verbal agreements to demonstrate empathy.
Make sure the conversation is specific to make it feel more personal despite the distance. You should reference their relative by their preferred name and refer to details that are particular to them.
Make sure you use technology which is accessible to the family member(s) and resident, and discuss which online meeting platforms they might be most familiar with or comfortable using. Consider using a combination approach, such as a phone and a tablet, so you should always have a clear audible line of communication, even if the bandwidth cannot support a stable video connection.
It might also be helpful to consider different support protocols you could use in case the resident or family members become distressed during advance care planning conversations. You may have a distress protocol within your care home already. We have provided an example of a distress protocol you could use below:
- Download: Example Distress Protocol