Nursing Home Manager’s Knowledge, Attitudes and Beliefs about Advance Care Planning for people with Dementia in Long-term Care Settings : A Cross-Sectional Survey

Aim: To examine nursing home managers’ knowledge, attitudes, beliefs and current practice regarding advanced care planning for people with dementia in long term care settings informed by the Theory of Planned Behaviour.Background: Internationally advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regards to advance care planning, and the perceived factors which influence this.Design: A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed methods study between January-March 2015.Setting and Participants: Nursing home managers in a region in the UK (n=178).Results: A response rate of 66% (n=116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning; with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently they do not view ACP as part of their role, with lack of ownership impacting upon current practice behaviours.Conclusions: Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care2planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident, therefore long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia.