Perceived Barriers that Impede Provider Relations and Medication Delivery: Hospice Providers' Experiences in Nursing Homes and Private Homes

Abstract

OBJECTIVES Hospice providers often work with nursing home providers or with family caregivers to deliver medication services aimed at alleviating suffering in patients with life-limiting illnesses. From the perspective of hospice providers, this study explores barriers that may impede provider relations and medication delivery in nursing homes and private homes. METHODS Semi-structured, open-ended interviews were conducted in-person with a purposive sample of 22 hospice providers (14 registered nurses, 4 physicians, and 4 social workers) from 4 hospice programs in the greater Chicago metropolitan area. RESULTS In general, registered nurses, doctors, and social workers discussed similar barriers in nursing homes and in private homes. According to hospice providers, nursing home providers and family caregivers exhibited comparable attitudinal barriers (“owning” their settings; “knowing what’s best for the patient”; distrust toward hospice; and emotional state), and encountered similar site-readiness barriers (ill-defined hierarchy, poor communication, disagreements among care providers, and responsibility overload). Additionally, comparable alignment barriers (differences in care priority and in education/training) existed between hospice providers and care providers in nursing homes and private homes. Together, these barriers impeded care providers’ communication with hospice providers and their readiness to accept hospice guidance. Overall, poor provider relations compromised the efficiency and quality of medication management, as well as potentially undermined the role of hospice providers. CONCLUSION From the perspectives of hospice providers, this study provides preliminary insight into barriers that multilevel interventions may need to address to improve provider relations and medication delivery in nursing homes and private homes.

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

“…Lau and colleagues 19 , went on to identify additional site-readiness barriers which included communication difficulties and disagreements, responsibility overload along with differences in education and training 19 .…”

“…Although there are studies identifying structural and organizational barriers to quality end of life care in nursing homes 2,15,19 , the studies surrounding the actual care processes of assessment, delivery, communication and coordination among providers and communication with residents and families are scarce 20 . One recent study sought to validate an instrument for measuring end-of-life care processes in nursing homes.…”

“…They differed on their responses related to the benefit of hospice for a NH/SNF resident. Since both staff felt they had knowledge and skills to work with a hospice resident, it may be that NH/SNF staff viewed the complexity of adding hospice to their already complex care issues a burden 19 . In addition, many residents become like family members to NH/SNF staff and the initiation of hospice care may cause territorial issues due to their ownership of the resident's care.…”

“…Hospice perceived communication as more positive than NH/SNF reported, indicating differences in perceptions of these two providers. In a number of studies, NH/SNFs perception was that their staff provided adequate end-of-life care and did not need hospice support 7,15,19 . The present study supported this finding as the NH/SNF staff rated higher than hospice in all areas of care.…”

“…In a recent study on the barriers to effective medication delivery, researchers identified attitudinal barriers of "knowing what's best for the patients", along with differences in care priority and in education and training 19 . One study identified that NH/SNF staff were not willing to give "as needed" pain meds if the patient was not able to verbalize needs 24 .…”