Extendicare Holyrood

My Wishes: A simple, innovative Resident survey tool for end-of-life wishes

An Extendicare staff member works through "My Wishes" with a Resident.

By April Coulter, National Education Consultant and Rosemarie Lindau, Program Consultant

How can we provide excellent care for our residents at the end of their lives when we are unsure of their wishes?

Developed and led by April Coulter, National Education Consultant at Extendicare and Rosemarie Lindau, Program Consultant at Extendicare, “My Wishes” uses 10 cards with straight-forward language that is familiar to most residents, to encourage non-threatening discussions about what is most important to them as they journey through the long-term care (LTC) experience and the end of life trajectory within it. Residents sort through the 10 cards and prioritize them based on their own values and beliefs.

“Being able to complete the “My Wishes” project was really good for me and has given me some piece of mind. Being able to let others know what I want at this time in my life is very important.” - Extendicare Port Hope Resident

“My Wishes” will be implemented in 120 Extendicare LTC homes across Canada by the end of 2019, and over 800 staff will have participated in the workshops. The program aligns with advance care plan discussions in the broader health care spectrum and is now part of Extendicare’s National policy on Advance Care Planning.

The implementation of My Wishes in our homes has resulted in:

  • Resurrection of palliative programs;
  • Improved communication between families, residents and staff – families and residents appreciate that this usually “taboo” subject is being discussed;
  • Having these difficult discussions earlier in the illness trajectory ensuring resident wishes are honoured and decreasing unwanted hospital transfers;
  • My Wishes is now included in care plans for each resident upon admission, after a significant change, in palliation, and in end of life care.

Resources for families and residents include:

  • Cards and instructions in multiple languages
  • Informational brochure
  • Newsletters and tour package samples
  • A process map
  • FAQ’s
  • Educational presentations

Rosemarie and April have presented their program to:

  • Ontario Long Term Care Association;
  • Hospice Palliative Care Ontario conference;
  • International Palliative Congress (Montreal);
  • Point Click Care Summit (Nashville);
  • Provided a day-long workshop for the 4 Counties Palliative Care group in Ontario.

In addition, the team has worked on a National Palliative Initiative with the “Strengthening a Palliative Approach in LTC” group.

The value of the project for Extendicare residents, families, and staff has been unbelievable. By working with residents to determine how they perceive end of life empowers them to be decision-makers in their own care.