Problems With Advance Care Planning Processes and Practices in Nursing Homes

Serious concerns exist about advance care planning (ACP) and end-of-life (EOL) care in nursing homes (NHs). NH residents often experience a progressive burden of severe symptoms leading up to death. Aggressive medical care exposes them to iatrogenic complications and poor quality of EOL care,1 concerns magnified by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, wherein NH residents have taken the brunt of deaths.2 In a prospective, observational study supported by research grants from the Canadian Frailty Network and Research Manitoba and approved by the Research Ethics Boards of all participating institutions, we assessed ACP processes and practices in 38 NHs in 3 Canadian provinces (10 Alberta, 10 Manitoba, 18 Ontario) recruited for the Better Targeting, Better Outcomes for Frail Elderly Patients (BABEL) study, an ongoing, randomized study of ACP in NHs.