Institutional Efforts to Promote Advance Care Planning in Nursing Homes: Challenges and Opportunities

Bradley, Elizabeth H.; Blechner, Barbara; Walker, Leslie; Wetle, Terrie

doi:10.1111/j.1748-720x.1997.tb01890.x

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…Second, the current scope of routine advance care planning discussions is fairly narrow. This study and previous data 11 demonstrated that advance care planning discussions often focus on CPR and other life‐support rather than preferences regarding broader and more common future medical circumstances. The third reality is that advance care planning conversations rarely involve physicians and are sometimes conducted by an administrative or clerical staff person.…”

supporting

confidence: 55%

Assessment of Capacity to Discuss Advance Care Planning in Nursing Homes

Walker¹,

Blechner²,

Bradley

1998

J American Geriatrics Society

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supporting

confidence: 55%

Assessment of Capacity to Discuss Advance Care Planning in Nursing Homes

Walker¹,

Blechner²,

Bradley

1998

J American Geriatrics Society

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“…During care preference discussions, surrogate decision makers' perspectives often overshadowed residents' perspectives. 15 Research has primarily relied on family and staff reports and resident perspectives are generally unrepresented.…”

Section: Introductionmentioning

confidence: 99%

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Towsley

Hirschman

Madden

2015

Journal of Palliative Medicine

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Background: Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. Objective: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. Methods: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n = 16), family (n = 12), and interdisciplinary staff (n = 10) from four NHs. Results: The overarching theme-missed conversations-describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry (''No one asked''); assumptions (presence of an advance directive [AD], ''They know me''); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. Conclusions: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.

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“…11 Pressure ulcers (11% of residents), 1 physical restraints (39% of residents), 1 and feeding tubes (53.9 per 1000 persons in a 12-month period) 12,13 are common. Inattention to advance care planning, 14–18 inadequate use of hospice, 19 and recurrent hospitalizations or “churn” 20,21 are widespread, with an estimated 39% of NH residents hospitalized in the last 30 days of life. 20 Hospitalization routinely results in medication errors, 22 functional decline, 23 and poor communication of new care plans.…”

mentioning

confidence: 99%

Strategies and Innovative Models for Delivering Palliative Care in Nursing Homes

Carlson

Lim

Meier

2011

Journal of the American Medical Directors Association

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The goals of palliative care address critical issues for individuals with complex and serious illness residing in nursing homes, including pain and symptom management, communication, preparation for death, decisions about treatment preferences, and caregiver support. Because of the uncertain prognosis associated with chronic nonmalignant diseases such as dementia, many nursing home residents are either not referred to hospice or have very short or very long hospice stays. The integration of palliative care into nursing homes offers a potential solution to the challenges relating to hospice eligibility, staffing, training, and obtaining adequate reimbursement for care that aligns with resident and surrogate’s preferences and needs. However, the delivery of palliative care in nursing homes is hindered by both regulatory and staffing barriers and, as a result, is rare. In this article, we draw on interviews with nursing home executives, practitioners, and researchers to describe the barriers to nursing home palliative care. We then describe 3 existing and successful models for providing nonhospice palliative care to nursing home residents and discuss their ongoing strengths and challenges. We conclude with specific policy proposals to expedite the integration of palliative care into the nursing home setting.

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Institutional Efforts to Promote Advance Care Planning in Nursing Homes: Challenges and Opportunities

Abstract: In an empirical study of Connecticut-area for-profit and nonprofit nursing homes, authors examine use of institution-specific advance care planning forms among nursing home residents.

Cited by 8 publications

References 14 publications

Assessment of Capacity to Discuss Advance Care Planning in Nursing Homes

Assessment of Capacity to Discuss Advance Care Planning in Nursing Homes

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Strategies and Innovative Models for Delivering Palliative Care in Nursing Homes

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