Advance Care Planning Among Nursing Home Residents Prior to the Patient Self-Determination Act

The objective of this study is to describe variation and correlates of advance care planning in nursing homes in the United States just prior to the implementation of the Patient Self-Determination Act. Eighteen hundred thirty-five residents were randomly selected from 270 nursing homes in the United States. Research nurses completed Minimum Data Set (MDS) assessments, including information on living wills, do not resuscitate orders, do not hospitalize orders, and orders that artificial hydration or nutrition should not be utilized. Results indicate that the absence of a national policy prior to 1991 led both to considerable variation between states, and to correlates of advance care planning that may not be explained by either patient preferences or standards of best practice.