Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life?

Abstract

Findings suggest that analgesic management of daily pain is better for nursing home residents enrolled in hospice than for those not enrolled in hospice.The prescribing practices portrayed by this study reveal that many dying nursing home residents in daily pain are receiving no analgesic treatment or are receiving analgesic treatment inconsistent with AMDA and other pain management guidelines. Improving the analgesic management of pain in nursing homes is essential if high-quality end-of-life care in nursing homes is to be achieved.

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

“…8,9 To identify residents who died with advanced dementia a diagnosis of ''Alzheimer's'' or ''Dementia other than Alzheimer's'' had to be documented on the MDS closest to death or on any Medicare Part-A claim (i.e., home health, hospice, hospital, outpatient, or SNF claim) in the last 12 months of life. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes we used to capture dementia have been used by others 24,25 (290.xx, 291.2, 292.82, 294.1x, 294.8, 331.0-331.2, and 332.83).…”

“…2-7 NH hospice care has been found to provide benefits to dying NH residents, including better pain management, 8 fewer hospitalizations, 9 and greater family satisfaction with end-of-life (EoL) care, [10][11][12] and the benefits of hospice have been shown to extend to residents with dementia. 8,9,13 Although the proportion of dying NH residents with advanced dementia accessing hospice almost tripled between 1999 and 2006 (to approximately 40%), 14 there remain important barriers to greater and timelier hospice access.…”

“…8,9,13 Although the proportion of dying NH residents with advanced dementia accessing hospice almost tripled between 1999 and 2006 (to approximately 40%), 14 there remain important barriers to greater and timelier hospice access. 15,16 A major barrier is the Medicare policy disallowing simultaneous access to Medicare Part A hospice care for NH residents receiving Medicare skilled nursing facility (SNF) care (when SNF care is for the terminal condition).…”

Comfort in the last 2 weeks of life: relationship to accessing palliative care services

“…For patients, involvement of SPCS improve the "quality of dying" [55], pain assessment and management of people dying in nursing homes [43,44] and symptomatic manage-ment in people admitted to hospital [26] and meet needs [54] and satisfaction with care [9,28,30]. For caregivers, SPCS involvement has been found to improve satisfaction [28,54] and reduce anxiety [30].…”

Perceptions of Coordination of Care Between Hospice and Skilled Nursing Facility Care Providers

“…Many studies have shown that NH/SNFs are not meeting the resident or families' end-of-life care needs for comfort, pain relief and emotional and spiritual support 1,[6][7][8][9][10] . Hospice care in nursing homes has been associated with decreased hospitalizations, high quality pain management and a collaborative opportunity to provide palliative care to dying residents 11 .…”