Elderly people often live in a retirement or nursing home when their state of health no longer allows them to remain at home, even with the support of relatives and/or home care services. For this group of people, the «Roadmap for the implementation of advance care planning (ACP) in Switzerland» recommends a detailed or disease-specific ACP.
People in long-term care institutions are an important yet vulnerable group when it comes to ACP. Also in this setting, a person should have the opportunity to decide autonomously how they would like to be treated and cared for in the event of future incapacity. Studies have shown, however, that implementing ACP in retirement and nursing homes is challenging, for example because elderly people are still largely unaware of advance directives. Another challenge is that the need for long-term care in Switzerland will have increased by 50% by 2040. Read more: Obsan report 03/2022 in German or French.
People in retirement and nursing homes are a particularly important group for whom ACP should be strengthened. In particular, people with multimorbidities, increasing frailty and/or early dementia should be given the opportunity and support to reflect deeply on their personal values and therapeutic goals. Their wishes should be put in writing if they so choose, and made available to their caregivers. ACP allows each person to reflect on and document their personal wishes for or against certain medical interventions in the event of future incapacity.
Subproject of the national working group ACP
The national working group ACP has set up an interprofessional sub-working group on the implementation of ACP in retirement and nursing homes, chaired by Dr Gabriela Bieri-Brüning, Zürich. The sub-working group aims to develop practical recommendations for the integration of ACP in long-term care, taking into account the specific circumstances and possibilities of each institution.
National survey on ACP in retirement and nursing homes
To find out how ACP is currently handled and implemented in Swiss retirement and nursing homes, the sub-working group conducted a national survey in spring 2024. This has been completed and the results are being evaluated. They will serve the working group as a basis for practical recommendations.
Composition of the sub-working group
Dr Gabriela Bieri-Brüning, Zürich, Chair, Geriatrics/Inpatient Long-term Care
Marie-Rose Barben, Frutigen, Nursing Care
Jikkelien Bohren, Basel, Counselling and Stakeholder Organization
Dr Annette Ciurea, Zürich, Geriatrics/Palliative Care
Dominique Elmer, St. Gallen, Long-term Care
Renate Gurtner Vontobel, MPH, Bern, Palliative Care
Dr Manya Hendriks, SAMS, Bern (ex officio), Ethics
Isabelle Karzig-Roduner, RN, MAE, MScN, Zürich, Advance Care Planning
RA lic. iur. Petra Kropf Giger, Zürich, Law
Dr Larissa Müller Enrile, Ponte Tresa, Long-term Care
Dr Eve Rubli Truchard, Lausanne, Geriatrics/Palliative Care
Dr Reka Schweighoffer, Bern, Long-term Care
Daniela Trachsler, Zürich, Advance Care Planning
Dr Petra Vayne-Bossert, Genève, Palliative Care
Professor Dr Franziska Zúñiga, Basel, Nursing Sciences