Advance Care Planning for Personal Care Home Admission in Manitoba

When a family member is being assessed for admission to a personal care home in Manitoba, the clinical paperwork can feel overwhelming. Between medical assessments, financial eligibility, and waitlist management, advance care planning documents often get treated as one more form to fill out. In reality, they're the most consequential paperwork in the entire process — the documents that determine what happens when your family member can no longer make their own medical decisions.

What Personal Care Homes Ask For

Manitoba personal care homes (PCHs) typically request several planning documents during the admission process:

• A current health care directive naming a proxy
• A completed Goals of Care form (or willingness to complete one during admission)
• An Enduring Power of Attorney for financial matters
• Contact information for the designated proxy and alternate decision-makers

Not all of these are legally required for admission, but care homes strongly encourage having them in place. The clinical reality is that PCH residents frequently experience situations — falls, infections, sudden decline — where immediate medical decisions need to be made. Without a directive and a named proxy, the care team defaults to the next-of-kin hierarchy, which can create confusion and conflict when multiple family members disagree.

Goals of Care During Admission

One of the first clinical conversations after admission is the Goals of Care discussion. A physician or nurse practitioner will sit down with the resident (if they have capacity) or their proxy to complete a Goals of Care form. This form translates broad treatment preferences into one of three active clinical levels:

Level R (Resuscitative) — all appropriate interventions including CPR, ICU transfer, and mechanical ventilation.

Level M (Medical) — medical investigations and treatments to manage illness, but no CPR or life-support measures.

Level C (Comfort) — all clinical interventions focus on comfort and symptom management, excluding CPR and other life-prolonging measures.

If you've already completed a health care directive that references these levels, the Goals of Care discussion becomes a confirmation rather than a starting point. If you haven't, the care team will work through the options fresh — which is harder to do well under the stress of admission.

Hospital Transfers from a PCH

One of the most common and least-discussed decisions in personal care home life is when a resident should be transferred to hospital. A resident who develops pneumonia, has a stroke, or falls and breaks a hip will face an immediate question: hospital transfer or treatment in place?

A health care directive can specify your threshold for hospital transfers. Some residents and families prefer treatment in the PCH whenever possible, knowing that hospital transfers are disorienting and that the physical environment of an ER or ICU is difficult for someone with cognitive impairment. Others want hospital transfer for any potentially treatable condition.

This preference should be documented in your directive and discussed during the Goals of Care conversation. The clinical team can then make transfer decisions that align with your documented values rather than defaulting to hospital transfer for everything.

The Enduring Power of Attorney Question

Health care directives handle medical decisions. But PCH admission also involves financial matters — paying for accommodation, managing the resident's assets, dealing with the Manitoba Home Care program's assessment of financial eligibility. This is where the Enduring Power of Attorney comes in.

Under The Powers of Attorney Act, a power of attorney must explicitly include an "enduring" clause to remain valid after the donor loses mental capacity. Without that clause, the attorney's authority terminates exactly when it's needed most — when the donor can no longer manage their own finances. Standard templates without the enduring clause are one of the most common planning failures families discover during PCH admission.

If your family member doesn't have a valid EPA, and they've already lost capacity, the only option is a court-ordered committeeship — a process that costs $3,000 to $5,000 in legal fees and can take months.

Preparing Before the Waitlist Call

Manitoba PCH waitlists vary significantly by facility and region, but the call can come with relatively short notice. Having planning documents ready before that call comes means the admission process focuses on clinical care rather than scrambling for legal paperwork.

Before the admission process begins:

1. Complete or update a health care directive with specific treatment preferences for the most common PCH scenarios — infections, falls, decline, hospital transfer thresholds
2. Name a health care proxy who understands the resident's values and can make decisions under pressure
3. Execute an Enduring Power of Attorney with the required statutory witnessing (a qualified professional witness: lawyer, notary, physician, or police officer)
4. Discuss Goals of Care levels as a family so the admission conversation isn't the first time anyone thinks about these choices

Hospital Advance Care Planning

Even if admission to a PCH isn't imminent, any hospital stay in Manitoba will prompt advance care planning conversations. Clinical teams routinely ask about existing directives during admission, and having one on file reduces the burden on both the patient and the medical team.

If you're being admitted to hospital for surgery, a procedure, or treatment of a serious condition, bring a copy of your health care directive. Ask the clinical team to scan it into the electronic patient database so it's accessible to any provider involved in your care.

The Manitoba Advance Directive & Living Will Kit includes worksheets that cover the specific scenarios most common in institutional care — PCH admission, hospital transfers, and clinical decline — alongside the ERIK kit setup guide for those still living at home. Having all of this in place before the first institutional conversation makes every subsequent one easier.

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