Background ACP was introduced into our 40-bed dementia unit in 2011. As residents are typically unable to make choices regarding future care, we developed a specific process based on, and maintaining the essence of, the New Zealand ACP process for competent people.

Aim To describe the process of incorporating ACP into the care of people with significant cognitive impairment, and to identify the challenges, risks and benefits.

Methods

• The ACP process is described.

• Questionnaires provided to staff and families.

• Vignettes describe a variety of examples of the ACP process in practice.

• Retrospective and current file audits.

Results Challenges include staff finding time, and lack of confidence and ability, for ACP conversations.

Risks include inappropriately excluding the resident from the conversations.

Benefits include improved end of life experience for residents and their families, and reduced requirement for crisis intervention.

Discussion Concern has been expressed that ACP for people with significant cognitive impairment is not appropriate, or is risky. Our experience tells us that not only is a safe and effective process possible, it is essential if the preferences of people with significant cognitive impairment are to consistently be taken into account. Maybe the process needs to have a different title?

Conclusion The process we use improves efficiency and effectiveness of the healthcare we provide, by promoting a proactive approach to the care of residents, positively impacting residents, staff, GPs and the wider healthcare team.