Discharging patients from hospice to nursing home: a retrospective case note review

Abstract

This article presents a retrospective case note review of in-patients at one UK hospice considered for discharge to nursing homes during 1999 and 2000. The idea of a nursing home placement was introduced, on average, around 9 days after admission to the hospice; the most common reason cited being the inability to cope at home. Nearly a third of the patients expressed negative or ambivalent feelings about the idea. Transferring patients from hospice to nursing home is often necessary to avoid pressures on hospice beds. The potential distress of transferring patients, particularly when nearing the end of life, must be balanced against the needs of patients on hospice waiting lists. Of the 41 cases reviewed, 16 were transferred to nursing homes as planned, with a mean length of stay of just over 8 weeks. The current provision of palliative care in nursing homes raises ethical questions about transferring patients to an unfamiliar environment that may not necessarily be able to offer the same quality of palliative care. Clear communication with patients and their families and a consistent process are important to reduce some of the distress associated with this issue.

Factors Influencing Survival after Discharge from an Australian Palliative Care Unit to Residential Aged Care Facilities: A Retrospective Audit

“…The sample in this study was drawn from a single PCU in regional Australia and thus the results may not be generalizable to a wider palliative population. It included only quantitative data on PCU to RACF transfers, and therefore important qualitative information emphasized by previous authors, 2,5,6,8,15 such as patient and family satisfaction, was not able to be evaluated.…”

“…There are numerous reasons for this imbalance including an aging population, 1-3 improved survival for patients with advanced cancers, and the increased involvement of palliative care services in nonmalignant pathologies. 3,4 One consequence of increasing demand has been the requirement for PCUs to offer shorter-duration inpatient care [5][6][7] with attempts made to reduce length of stay. Reith and Lucas 8 proposed that average length of inpatient stay in the United Kingdom should be 10 to 12 days to ensure equitable and efficient palliative care.…”

“…The majority have involved small sample sizes and most have emphasised the potential problems for patients, their families, and staff. [5][6][7][8]15 Reith and Lucas, 15 in an audit of patients considered for relocation from hospice to a nursing home, reported that although transfer was considered in 6.9% of admitted patients, only 6 of a total of 347 were actually transferred. In those who were relocated high levels of distress and dissatisfaction were reported by patients and their families.…”

“…15 A retrospective review of 16 patients discharged from hospice to a nursing home found a mean length of stay after transfer of just over 8 weeks, although 38% of patients died within 3 weeks of relocation. 5 More recently, a large review of outcomes for 2568 patients with advanced cancer admitted to an APCU reported that transfers to a long-term care facility made up only 2% of patients discharged alive, and that this group had a median survival of 29 days (14-44; 95% confidence interval [CI]). 10 Data investigating predictors of survival for anyone admitted into an aged care facility are limited.…”

Inpatient transfer to a care home for end-of-life care: What are the views and experiences of patients and their relatives? A systematic review and narrative synthesis of the UK literature

“…All four papers related to the transfer of patients from hospice to care home: no papers addressed hospital to care home transfer for end of life care. Two studies were retrospective case note reviews from one hospice conducted in 1999/2000 (15) and 2004/5 (17): they examined demography, length of survival and the views of patients or relatives about the transfer recorded in the notes. One study interviewed relatives of all those transferred to care home from a hospice during 1991 and had subsequently died (18).…”