Hospice in the Nursing Home: Perspectives of Front Line Nursing Home Staff

Abstract

Objective Use of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff towards hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers towards hospice care in nursing homes. Design, Setting and Participants We conducted a survey of 1,859 staff from 52 Indiana nursing homes. Measurements Study data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: 1) makes their job easier; 2) is responsive when a patient has symptoms or is actively dying; 3) makes care coordination smooth; 4) is needed; 5) taught them something; 6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never. Results 1229 surveys met criteria for inclusion. Of respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was ‘patient/family appreciate added care’ (84%); the lowest was ‘hospice makes my job easier’ (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (p=.03 and p=.05 respectively). Conclusion A majority of staff responded favorably regarding hospice care in nursing homes. About 1/3 of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement.

Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

“…Frontline staff consistently have lower levels of knowledge about EOL issues when compared to knowledge about physical and psychological domains of care—and the majority of staff would welcome additional education on palliative and EOL care. 16 A synthesis of our qualitative findings provides potential targets for staff education on best practices for EOL care, including 1) knowledge about the dying process, 2) assessment and management of symptoms, 3) an overview of family dynamics and common affective responses, 4) strategies to facilitate communication between staff, other providers, residents, and families, 5) accurate knowledge about hospice and palliative care, 6) a review of ethical and practical dilemmas, and guidance for what to do in such situations, 7) means to preserve patient dignity, and 8) education on self-care. NH staff cope with a myriad of challenges, including compound losses, being the target of family anger and unwarranted criticism, high levels of stress and burnout, and personal discomfort with providing care to dying patients.…”

“…Unroe et al (2014) quantitatively analyzed NH staff perceptions about hospice and found that the majority viewed hospice as generally positive, but more beneficial for patients and families than for the NH staff themselves. The study also found that staff frequently reported poor communication between NH and hospice staff, which could contribute to poorly coordinated care, 16 and ultimately lower the quality of care for dying patients.…”

“…This study addresses this knowledge gap. As part of a larger study examining perceptions of staff toward palliative care and hospice, 16 we conducted a qualitative content analysis to identify recurring themes related to positive and negative descriptions of experiences caring for dying patients.…”

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

“…This was part of a larger survey that included questions about interactions with hospice, as well as open-ended prompts 14 designed to measure knowledge, practice and attitudes towards both palliative care and hospice by NH staff at multiple levels. In addition to comparing palliative care knowledge and practices across staff roles, we also examined relationships between facility characteristics and PCS scores.…”

End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale

“…Unroe et al (2014) conducted a survey of staff from several nursing homes in EEUU about attitudes of nursing home staff towards hospice, and found that more social workers responded favourably to hospice involvement in nursing homes compared to nursing assistants.…”