What to know about wills & wishes in a care home

Before you enter a nursing home, it’s a good idea to plan ahead and write down your wishes related to your health, well-being, and future care. Doing so can make things easier for you and your loved ones — especially if you become seriously ill and can longer make or communicate your own decisions. 

Typically, you have two options when recording your wishes: you can make an advance statement, or you can write an advance decision (also known as a “living will”). 

In this short post, we explain the difference between the two and why you should consider writing both before you enter a nursing home.  

What is an advance statement, and what does it cover?

An advance statement lists your likes, dislikes, and anything else that’s important to you to help you feel comfortable later in life. It should be reviewed and considered by everyone involved in your care. However, it’s not a legally binding document.

When you write an advance statement of wishes, you might want to include the following:

  • Where you’d like to be cared for (e.g., your home, a nursing home, or a hospice)
  • Your dietary requirements and restrictions
  • Your favourite (and least favourite) foods
  • What kind of clothes you like to wear
  • Your favourite music, books, TV shows, and movies
  • Whether you prefer showers or baths
  • When you like to go to bed (and when you like to get up in the morning)
  • Whether you like to sleep with the light on
  • Your religious beliefs and/or personal values
  • Who you’d like to visit you (and perhaps who you’d like to stay away)

You can write your advance statement in a way that suits you, whether that’s a handwritten note, an email, a text message, or a print out from a computer. Copies should be sent to everyone involved in your care, such as your GP, nursing home staff, carers, and family members.

What is an advance decision (living will)?

An advance decision (often referred to as a “living will”) is a legally binding document that lets you decide whether you want to refuse specific types of medical treatment in the future, should you be unable to make or communicate that decision later in life.

If you have an advance decision in place, you can refuse any life-sustaining treatment except the most basic of care (such as being offered food and water by mouth). 

The types of treatment you may wish to refuse as you approach the end of your life can include those designed to support or replace body functions to keep you alive, such as: 

  • Cardiopulmonary resuscitation (CPR) if you stop breathing
  • Ventilation to help support breathing
  • Clinically assisted hydration and nutrition
  • Antibiotics to fight infection
  • Chemotherapy 
  • Organ transplant

What’s the difference between an advance statement and an advance decision?

In short, an advance statement focuses on the care you’d like to receive, whereas an advance decision focuses on the treatments you wish to refuse

It’s important to note that deciding to refuse treatment is not the same as asking someone to end your life or help you end your life. Euthanasia and assisted suicide are illegal in the UK.

Also, an advance decision cannot be used to give someone else the power to make decisions on your behalf. You’ll need a lasting power of attorney for that.

What makes an advance decision legally binding?

An advance decision is legally binding if:

  • It complies with the Mental Capacity Act
  • You’re aged 18 or over and had the capacity to make, understand, and communicate your decision when you made it
  • You specify clearly which treatments you wish to refuse (and why you wish to refuse them)
  • You’ve made the decision yourself, without any influence or harassment by anyone else
  • It’s signed by you and a witness

Why should you write both before entering a nursing home?

Writing an advance statement and an advance decision can give you and your loved ones complete peace of mind that your care and treatment wishes will be considered both now and in the future. Preparing them in advance simply means it’s one less thing to worry about as you adjust to your new surroundings. 

What if you don’t get a chance to write them in advance? 

Don’t worry! If things happen quickly and you move to a nursing home before you get to record your wishes, you’ll still have an opportunity to express them once you’re there. A plan of care “care plan” is written in partnership with you, the resident, and the staff during the initial assessment. It’s also reviewed at least monthly, so you can always update or change your wishes. As long as you remain able to make your own decisions, you’re in control of your care. 
Ultimately, whether you write your wishes before or after entering a nursing home, everyone involved in your care will know that the actions they’re taking (be it eggs for breakfast or specific end-of-life care) are based on decisions you made.

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