Chosen-Family / SDM Planning Conversation Guide

Have this conversation early in the stay, privately, and at the resident’s pace. Many 2SLGBTQI+ residents have chosen family instead of, or alongside, biological family — and fear being displaced from decisions at end of life.

Opening

"I’d like to talk about who matters to you and who you want involved in your care — now and later. There are no wrong answers, and you can change this anytime."

Questions

Who do you want us to call and welcome as your family? Who do you want involved in care decisions? If you could not speak for yourself, who should decide for you? Is there anyone you do not want involved? Are there people you consider family who are not legally family?

Record

Record chosen-family contacts and the substitute decision-maker in the care plan, on the same footing as legal next of kin where the resident wishes. Note any people the resident does not want involved.

End-of-life specifics

Confirm who the resident wants present at end of life, how they want to be addressed and dressed, and who to call at death. Record it clearly so every shift and every visitor honours it.

If family disagrees

The resident’s wishes come first. If a family member disagrees, respond with empathy but do not reverse the resident’s choices. Offer a facilitated conversation so the resident is not left to defend themselves alone.