Improving Access of Advance Directives in a Skilled Nursing Facility

Skilled nursing facility (SNF) patients should have good quality Advance Care Planning (ACP) to ensure that their wishes are respected. However, SNF patients often lack advance directives (AD) due to barriers including multiple care transitions and poor document accessibility. Baseline review of patient charts in our facility revealed that 24% (8/33) patients did not have ADs upon their discharge from their short stay. This is concerning as lack of ADs can decrease compliance with patient preferences and utilization of palliative care, decrease quality of life, and increase hospitalizations and healthcare expenditure.