What is a peace plan in a care home? Understanding advance care planning for seniors

According to a study published in the journal BMJ Supportive & Palliative Care, the PEACE (Proactive Elderly Advance CarE) plan was shown to reduce inappropriate hospital readmissions for care home residents at the end of their lives. This initiative is a form of advance care planning designed to improve communication and respect the wishes of elderly residents, particularly those with conditions like advanced dementia. So, what is a peace plan in a care home and how does it work?

Quick Summary

A PEACE plan in a care home is a specific, formal document for advance care planning, especially for residents with advanced dementia or other terminal illnesses. It outlines a resident's preferences for future medical care, escalation decisions, and end-of-life wishes, ensuring their care is managed effectively and compassionately outside of a hospital setting, aligned with the Mental Capacity Act.

Key Points

• Focused Advance Planning: A PEACE plan is a specific type of advance care planning for care home residents, particularly those with advanced dementia, ensuring their end-of-life wishes are documented and followed.

• Reduced Hospitalizations: The plan aims to prevent unnecessary and distressing hospital admissions for residents with non-reversible conditions by clearly outlining when to escalate care and when to provide comfort care in place.

• Multidisciplinary Approach: It involves a collaborative process with a team of geriatricians, care home staff, and palliative care specialists, ensuring expert guidance for future care decisions.

• Respects Lack of Capacity: The plan is designed to be used when a resident lacks mental capacity, documenting and honoring their best interests and previously known wishes.

• Improved Communication: It standardizes and improves communication between all involved healthcare providers, including hospitals, GPs, and care homes, to ensure consistent and appropriate care.

• Ensures Dignified End-of-Life: The ultimate goal is to provide a more peaceful, dignified, and patient-centered end-of-life experience, often within the familiar environment of the care home.

• Includes DNACPR Status: A PEACE plan can include important decisions like Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), formalizing these sensitive choices.

Demystifying the PEACE Plan: A Comprehensive Guide

The acronym PEACE stands for Proactive Elderly Advance CarE. It is a structured process to align end-of-life care with a care home resident's wishes, particularly for those with advanced dementia or conditions affecting mental capacity. A multidisciplinary team including specialists, nurses, and palliative care works with family or representatives to develop the plan.

The Purpose and Goals of a PEACE Plan

The main aim of the PEACE plan is to avoid unnecessary hospital admissions for residents nearing the end of life. It provides clear guidance on care escalation and desired medical interventions, allowing residents to remain comfortably in the care home when their condition is not reversible. Key goals include enhancing communication, honoring resident preferences, improving quality of life, and complying with legal requirements like the Mental Capacity Act.

How a PEACE Plan is Developed

Developing a PEACE plan is a collaborative process:

1. Identification: Residents likely to benefit, often those with a 'dwindling' end-of-life trajectory, are identified.
2. Team Involvement: A team of medical professionals initiates the planning.
3. Consultation: Discussions are held with family or carers if the resident lacks capacity.
4. Documentation: Preferences for treatment, care escalation, and resuscitation (like DNACPR status) are documented.
5. Dissemination: The plan is shared with the care home, GP, and relevant health teams.
6. Review: The plan is reviewed regularly to adapt to changes in the resident's condition or circumstances.

Key Components of the PEACE Document

The PEACE document includes essential information to guide future care, such as patient identification, clinical summary, mental capacity assessment, care escalation guidelines, treatment preferences, and DNACPR status. It is signed by medical staff and family/representatives.

PEACE Plan vs. Standard Advance Care Planning

Feature	PEACE Plan in a Care Home	Standard Advance Care Planning (ACP)
Focus	Specifically designed for frail, elderly residents in care homes, often with advanced dementia.	A broader process for anyone to plan for future health care, regardless of location.
Capacity	Explicitly addresses situations where the resident lacks mental capacity, involving best interests decisions.	Typically presumes the individual has capacity at the time of planning.
Team	Involves a specialized multidisciplinary team (geriatricians, palliative care).	Can be initiated with a GP or through legal channels.
Documentation	A specific, standardized document with details on care escalation and DNACPR.	Can include a range of documents, like a living will or lasting power of attorney for health.
Communication	Emphasizes improved communication and coordinated care between different healthcare providers.	Can sometimes suffer from fragmentation across different care settings.
Location of Care	Prioritizes care within the care home setting, avoiding inappropriate hospital admissions.	Does not necessarily specify or prioritize a single location for end-of-life care.

The Importance of a PEACE Plan for Residents and Families

A PEACE plan ensures residents have a dignified and comfortable end of life in a familiar setting, even if they can't express their wishes. It gives families peace of mind, knowing their loved one's preferences are documented and will be followed, easing the burden of difficult decisions.

The Impact on Care Homes and Healthcare Systems

Implementing PEACE plans benefits care homes by improving care coordination and reducing emergency transfers, allowing staff to focus on palliative care. Hospitals see fewer inappropriate admissions, freeing up resources.

Conclusion

A PEACE plan in a care home is a specialized advance care plan for elderly residents, often those lacking capacity, guiding end-of-life care within the care home and preventing unnecessary hospitalizations. It ensures patient-centered care, improves communication, and provides peace of mind to families. This initiative serves as a strong example of how planning can enhance the final stages of life for vulnerable seniors. For more information on advance care planning, visit the National Institute on Aging website.

Frequently Asked Questions

What is the difference between a PEACE plan and a living will?

A living will is a legal document created by a person with capacity to state their wishes regarding future medical treatment. A PEACE plan, however, is a comprehensive document developed by a multidisciplinary team for care home residents, specifically addressing end-of-life care when a person may lack mental capacity.

Is a PEACE plan legally binding?

The decisions documented in a PEACE plan are made in accordance with the Mental Capacity Act, making them legally sound, especially those made in the person's 'best interests'. The plan provides clear guidance to all healthcare professionals involved in the resident's care.

Who can create a PEACE plan?

A PEACE plan is typically initiated and overseen by a multidisciplinary team of healthcare professionals, including geriatricians and palliative care specialists, often in collaboration with care home staff. Family and legally appointed representatives provide input for residents who lack capacity.

How does a PEACE plan help families?

For families, a PEACE plan provides clarity and reassurance that their loved one's wishes for end-of-life care will be respected. It reduces the stress of making difficult decisions during a crisis and prevents disagreements among family members.

Can a PEACE plan be changed?

Yes, a PEACE plan is a dynamic document. It should be reviewed and updated regularly to reflect any changes in the resident's health, preferences, or circumstances. The process ensures that care remains appropriate and aligned with the resident's best interests over time.

Does a PEACE plan mean a resident will never go to the hospital?

No, it does not. A PEACE plan is not a blanket refusal of hospital care. It provides clear guidance on appropriate care escalation. For certain medical events, it may advise hospital admission, while for irreversible end-of-life deterioration, it guides care within the care home.

Is a PEACE plan only for residents with dementia?

While often used for those with advanced dementia, PEACE plans can be beneficial for any care home resident with a deteriorating health trajectory or other conditions where proactive end-of-life care planning is necessary. The name 'PEACE' has been modified in some cases to broaden its application.

How is a PEACE plan different from a DNACPR order?

A DNACPR order is a specific part of a PEACE plan that addresses cardiopulmonary resuscitation. A PEACE plan is a much broader document that covers the full spectrum of end-of-life care, including overall treatment goals, care escalation, and preferences for comfort care.