Advance Directive for Nursing Home and Long-Term Care in PEI

Why Care Facilities Ask About Advance Directives

When a parent or spouse is being admitted to a nursing home or long-term care facility in Prince Edward Island, the intake process includes questions about advance care planning that many families aren't prepared for. The facility needs to know: does this person have a Health Care Directive? Have they appointed a proxy? What are their Goals of Care preferences?

These aren't just administrative checkboxes. Care facilities need this information because they make medical decisions on a regular basis — responding to falls, infections, changes in condition, and end-of-life situations. If a resident's heart stops during the night, the staff need to know immediately whether to initiate CPR or provide comfort care. If a resident develops pneumonia, the care team needs to know whether the family wants aggressive treatment or symptom management.

Without a Health Care Directive and a documented Goals of Care Designation, the facility has to track down family members for every significant medical decision. In PEI's statutory hierarchy, that means a guardian (if they have authority to give or refuse consent to treatment), then the spouse, then a child or a parent (they sit in the same class), then siblings, then a trusted friend with close knowledge of the resident's wishes, then any other relative. When people in the same class — two children, or a child and a parent — disagree, the decision stalls.

What PEI Facilities Actually Need

Most long-term care facilities and community care homes in PEI will ask for three things during or shortly after admission:

A copy of the Health Care Directive. This is the legal document created under the Consent to Treatment and Health Care Directives Act. It specifies which treatments the resident accepts or refuses and names a proxy decision-maker. The facility keeps a copy in the resident's medical file so clinical staff can reference it during emergencies.

Proxy contact information. The named proxy is the facility's primary contact for medical decisions when the resident can't communicate. The facility needs current phone numbers, an alternate contact, and confirmation that the proxy actually signed the Health Care Directive — because in PEI, a proxy appointment is legally invalid without the proxy's signature.

A Goals of Care Designation. The resident's family doctor or the facility's attending physician will discuss the resident's treatment preferences and record a Goals of Care Designation (R, M, or C) in the medical record. Designation R means full resuscitation efforts. Designation M means active medical treatment but no CPR or mechanical ventilation. Designation C means comfort measures only. This clinical order is what nursing staff actually follow in an emergency — it translates the legal document into a medical instruction.

Preparing Before Admission

The admission window is stressful. Families are usually managing a parent's declining health, coordinating logistics, and processing the emotional weight of the transition. The advance care planning questions can feel like one more administrative burden piled on top of everything else.

Completing the Health Care Directive before the admission process begins eliminates that pressure and gives the family time to have thoughtful conversations about preferences.

Step 1: Create the Health Care Directive. The resident (if they still have mental capacity) writes a Health Care Directive specifying their treatment preferences. Under PEI law, any person aged 16 or older with capacity can create this document. If the person signs it themselves, no witness is required. If someone else signs on their behalf because they're physically unable to sign, a witness is needed — and the witness cannot be the named proxy or the proxy's spouse.

Step 2: Get the proxy's signature. This is the step families miss most often. In PEI, the proxy must sign the Health Care Directive to accept the appointment. If they don't sign, the facility cannot recognize them as the authorized decision-maker. The admission staff will flag this immediately, and the family will be scrambling to get signatures during an already chaotic time.

Step 3: Coordinate with a Personal Directive. PEI separates medical decisions from non-medical personal care decisions under two different statutes. A Health Care Directive covers treatment consent and refusal. A Personal Directive under the Powers of Attorney and Personal Directives Act covers non-medical decisions: where the person lives, their nutrition, clothing, social activities, and daily routine. In a long-term care context, the Personal Directive governs things like room changes, diet modifications, and social programming — decisions that affect quality of life but aren't strictly medical.

Step 4: Have the Goals of Care conversation. Before or during admission, the resident (or their proxy, if the resident lacks capacity) should discuss Goals of Care preferences with the attending physician. The doctor records the designation in the medical record. If the resident already has a GCD from their family doctor, the facility's physician will review it and confirm it's still appropriate for the care setting.

Hospital Admissions and Transfers

Long-term care isn't the only admission that triggers advance care planning requirements. Hospital admissions — whether for surgery, acute illness, or emergency treatment — are another critical moment.

When a PEI resident is admitted to the Queen Elizabeth Hospital in Charlottetown or the Prince County Hospital in Summerside, the intake team checks for an existing Goals of Care Designation in the Health PEI electronic medical record. If one exists, the care team follows it. If one doesn't exist, a Goals of Care discussion is initiated with the patient or their proxy.

For planned admissions (scheduled surgery, elective procedures), completing a Health Care Directive and recording Goals of Care preferences before the admission date prevents the conversation from happening in a pre-operative holding area under time pressure.

For emergency admissions, the advance work has already paid off. If the patient's Goals of Care Designation is in the electronic medical record, the emergency team can access it immediately without needing to locate family members or paper documents. This is particularly important for rural PEI residents who may be transferred from community clinics to the main hospitals — the electronic record follows them.

When the Resident Lacks Capacity at Admission

Sometimes families reach the point of long-term care placement because a parent's cognitive decline has progressed to the point where they can no longer make decisions for themselves. If the parent never created a Health Care Directive while they had capacity, the family faces a harder path.

Without a directive, the facility relies on the statutory hierarchy for substitute decision-makers. A guardian with treatment authority ranks first, then the spouse (if living and capable). If there's no guardian or capable spouse, children and parents sit in the same class and share authority — and this is where problems arise. PEI law doesn't designate one child as the primary decision-maker. If people in that class disagree about Goals of Care, the medical team may need to involve the Public Guardian and Trustee to break the deadlock.

The PGT charges annual management fees that range from $100 to $10,000 depending on the value of the person's assets. For a parent with a home and modest savings, the fees can accumulate significantly over months or years of long-term care.

This is why completing a Health Care Directive early — while capacity is intact — matters so much for families anticipating a long-term care transition. The directive names a single proxy with clear authority, gives that proxy specific instructions to follow, and keeps the PGT out of the picture entirely.

What to Bring to Admission

A practical checklist for the admission day:

• Original signed Health Care Directive (with proxy signature)
• Copy of Personal Directive (if one exists)
• Copy of Enduring Power of Attorney for financial matters
• Proxy's full name and current contact information
• Alternate proxy's contact information
• A note of the Goals of Care Designation already on file with the family doctor (R, M, or C)
• PEI Health Card number
• List of current medications and known allergies
• Any organ donation documentation (health card sticker, driver's licence notation, or written wishes in the directive)

The PEI Advance Directive & Living Will Kit includes step-by-step instructions for creating both a Health Care Directive and coordinating it with PEI's Goals of Care system — designed to be completed before the admission pressure starts.

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