Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device

OBJECTIVE: To gain an understanding of how advance care planning (ACP) is understood and approached by managers of residential aged care facilities. METHODS: Qualitative interviews with managers from 41 residential aged care facilities from South Western Sydney, Australia. Content and thematic analysis of interview transcripts. RESULTS: The majority of facilities do not have a systematic approach to ACP, but tend to initiate discussions about end-of-life treatments late in a resident's illness. There are varying degrees to which these discussions are used in ongoing care planning or made explicit if the resident is transferred to hospital. A number of factors are identified that support the implementation of ACP. CONCLUSION: A continuum model of practice is proposed that describes four broad approaches to practice under the domains of initiation, scope, follow-up and documentation of ACP as well as the organisational leadership adopted around ACP.