Accréditation Sans Frontières

International Accreditation of Healthcare Facilities

Free resource · Patient-safety tools · Toolkit 16 · Long-term care

End-of-Life Care Plan and Family Conversation Record

What matters to the person, what they want and do not want, who speaks for them, and the comfort plan — written while it can still be a conversation

Free A4 print-ready PDF · 1 page · keep the ASF mark · scan the QR on the print to return here

End-of-Life Care Plan and Family Conversation Record

What it is

An advance care and end-of-life plan: the person's priorities, preferred place of care, treatments wanted and not wanted (hospital transfer, resuscitation, antibiotics, feeding tubes), spiritual and cultural wishes, who decides if they cannot, the comfort-care plan for the last days, and the conversation record.

Where to use it

Offered to every resident on admission and reviewed yearly or on any change; in the record; copy to the family doctor. Evidence for: LTC Standard 8 — end-of-life care; Standard 1 — rights and choice. Evidence for: LTC Standard 8 — end-of-life care; Standard 1 — rights and choice. Evidence for: LTC Standard 8 — end-of-life care; Standard 1 — rights and choice. Evidence for: LTC Standard 8 — end-of-life care; Standard 1 — rights and choice.

Translate and adapt

English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.

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The same code is printed on the tool itself. Scan it in any facility to reach this page.

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Adapted by ASF from openly licensed WHO, IAEA, AHRQ, CDC and NHS material, or ASF original — source and licence stated on every sheet. Free for any facility. Keep the ASF block.
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