Geriatric Palliative Care in Long-Term Care Settings with a Focus on Nursing Homes

Ersek, Mary; Carpenter, Joan

doi:10.1089/jpm.2013.9474

Cited by 55 publications

(44 citation statements)

References 102 publications

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“…The results, however, are consistent with findings in the literature. 5,6 Interview data are also limited as a secondary analysis of data gathered for another purpose. Specific interview questions and follow-up probes regarding the nursing home were not asked; rather these data were in response to questions regarding their experience in care planning with the hospice team.…”

Section: Discussionmentioning

confidence: 99%

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Hospice Family Members' Perceptions of and Experiences With End-of-Life Care in the Nursing Home

Oliver

Washington

Kruse

et al. 2014

Journal of the American Medical Directors Association

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Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care planning process.

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Section: Discussionmentioning

confidence: 99%

“…2,4 Two systematic reviews of end-of-life care in nursing homes found challenges in identifying those facing end-of-life, pain management, collaboration with hospice providers, inappropriate hospitalization, lack of advance care planning, unmet family expectations, and communication problems between residents, family, and staff. 5,6 …”

mentioning

confidence: 99%

Hospice Family Members' Perceptions of and Experiences With End-of-Life Care in the Nursing Home

Oliver

Washington

Kruse

et al. 2014

Journal of the American Medical Directors Association

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“…19 In consideration of pursuing these investigations within the HRS, two issues are of particular note relative to the observational design of the HRS. First, the last decade has seen tremendous growth in hospice enrollment among nursing home residents, leading some to call for reduced payments to hospice for these patients.…”

Section: Caregivers and Caregivingmentioning

confidence: 99%

Leveraging the Health and Retirement Study To Advance Palliative Care Research

Kelley

Langa

Smith³

et al. 2014

Journal of Palliative Medicine

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“…Palliative care has been touted by experts as an answer to some of these NH quality concerns. 6–8 However, formal NH palliative care programs, including specialized training of staff, are scarce. 9 …”

Section: Introductionmentioning

confidence: 99%

Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers

Unroe

Cagle

Lane

et al. 2015

Journal of Pain and Symptom Management

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Context Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice. Objectives To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores. Methods The PCS was administered to frontline NH staff—certified nursing assistants (CNAs), licensed practical nurses (LPNs), registered nurses (RNs), and social workers (SWs)—in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge. Results The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs, and SWs (P < 0.05). LPNs had significantly lower psychological, end-of-life, and total knowledge scores than RNs (P < 0.05 for all). Although knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P = 0.003; 95% CI: 0.02–0.09; SE = 0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P = 0.003; parameter estimate = 0.006; 95% CI: 0.002–0.010; SE = 0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care. Conclusion Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement.

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Geriatric Palliative Care in Long-Term Care Settings with a Focus on Nursing Homes

Cited by 55 publications

References 102 publications

Hospice Family Members' Perceptions of and Experiences With End-of-Life Care in the Nursing Home

Hospice Family Members' Perceptions of and Experiences With End-of-Life Care in the Nursing Home

Leveraging the Health and Retirement Study To Advance Palliative Care Research

Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers

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