6. Advanced Care Planning

Advanced care planning allows us to plan ahead to make sure that our right to make decisions for ourselves is honoured. In dementia care this is important and should be done in the early stages when the person with dementia can voice their opinion. 

Advanced care planning in dementia is particularity challenging as the person may not be able to consider or imagine the future and families may not be able to predict wishes and decisions.

There are a number of potential different approaches to advanced care planning. These include:

Informal Advance statement: written or verbal expression of wishes and choices about care at end of life. They are not legally binding. Please see Think Ahead' (Irish Hospice Foundation) and 'How Do I Plan for the Future?' (The Alzheimer Society of Ireland). This can be done at home.

Advance Decision to Refuse Treatment / Advance Health Directives: written documents stating in advance what health care interventions an individual does not want in the future. They only come into force if people are unable to talk for themselves, and is applicable to the decision being made at the time. This discussion is done with a solicitor.

Lasting Power of Attorney/ Enduring Power of Attorney: formal appointment of a surrogate decision maker who must be consulted about two types of decisions – Health and Welfare (only comes into force if people are unable to say themselves what they want at the time) and Property and Affairs (comes into force any time that the individual authorizes them). This legal document is completed with the person with dementia’s solicitor.

Do Not Attempt Cardiopulmonary Resuscitation: a medical decision not to attempt resuscitation if the attempt is felt to be medically futile or not in the person's wishes, as in a documented Do Not Resuscitate. This discussion is conducted with the person with dementias GP.