Advance directives on admission. Clinical implications and analysis of the Patient Self-Determination Act of 1990

To encourage patients to complete advance directives, Congress the Patient Self-Determination Act. . . last October. The Act takes on December 1, 1991, and requires hospitals, nursing homes, and to advise patients on admission of their right to accept or refuse care and to execute an advance directive. Managed care organizations home health care agencies must provide the same information to each of members on members' enrollment. Provider organizations will also be to (1) document whether patients have advance directives, (2) advance directive policies, and (3) educate their staffs and about advance directives. Compliance with the Act is a condition Medicare and Medicaid reimbursement and is tied to institutional Medicare. . . . Compliance with the Act raises clinical, legal, financial, and problems. Our purpose herein is to review the empirical data on directives, identify potential benefits of and likely barriers to the's successful implementation, and suggest ways in which patients, , and physicians might best take advantage of the new.