End-of-Life Care in the Nursing Home

2010 ◽  
Vol 11 (7) ◽  
pp. 462-464 ◽  
Author(s):  
Dulce M. Cruz-Oliver ◽  
Angela M. Sanford ◽  
Miguel A. Paniagua
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care

Nursing Home Resident, Family, and Staff Perspectives on Hospital Transfers for End-of-Life Care

2021 ◽  
pp. 003022282199770
Author(s):  
Janet Sopcheck ◽  
Ruth M. Tappen
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Terminally Ill ◽  
South Florida ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Residents who are terminally ill often experience transfers to the emergency department resulting in hospitalizations, which may be potentially avoidable with treatment in the nursing home. This qualitative study explored the perspectives of 15 residents, 10 family members, and 20 nursing home staff regarding end-of-life care and the circumstances prompting resident transfers. Data analysis of participant interviews conducted January to May 2019 in a South Florida nursing home identified four themes related to transfer to the hospital: time left to live, when aggressive treatments would be unavailing, not knowing what the nursing home can do, and transfer decisions are situation-dependent. Study findings underscore the importance of increasing resident and family awareness of treatments available in the nursing home and person-centered advance care planning discussions. Further research should explore the reasons for residents’ and family members’ choice of aggressive therapies and their goals for care at the end of life.

scholarly journals Aging and Advanced Dementia Matters: End-of-Life Care in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 520-521
Author(s):  
Ruth Lopez ◽  
Ellen McCarthy ◽  
Meghan Hendricksen ◽  
Susan McLennon ◽  
Anita Rogers ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
Racial Differences ◽  
End Of Life Care ◽  
Feeding Tube ◽  
Nursing Home Care ◽  
Life Care ◽  
Advanced Dementia ◽  
Southeastern Us ◽  
Intensity Of Care

Abstract Over 5 million Americans have dementia, and the majority will die in nursing home (NHs). While comfort is the main goal of care for most NH residents with advanced dementia, they commonly receive burdensome and costly interventions such as hospital transfers and feeding tubes that are of little clinical benefit. Despite 20 years of research and numerous experts and associations advocating a palliative approach to care, quantitative studies continue to demonstrate striking and persistent regional, facility, and racial differences, including: greater intensity care among African American versus White residents; greater intensity of care in the Southeastern US; and wide variation in care among NHs in the same region of the country. The reasons for these differences are poorly understood. Assessment of Disparities and Variation for Alzheimer’s disease in Nursing home Care at End of life (ADVANCE) is a 3-year, NIA funded qualitative study of 16 NHs in 4 regions of the country which aims to explain regional and racial factors influencing feeding tube and hospital transfer rates. The purpose of this presentation is to present the methodology established in this study and to highlight factors challenging and enabling implementation of the study protocol. To date, data have been collected in 11 NHs, and include 135 staff interviews, 40 proxy interviews, and nearly 800 hours of observation. These findings demonstrate that although challenging, large qualitative research is possible and holds promise as an effective method to illuminate complex processes influencing end-of-life care for NH residents with advanced dementia.

scholarly journals Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xinyi Xu ◽  
Shu-Wen Tu ◽  
Chia-Chin Lin
Keyword(s):  
Hong Kong ◽  
Nursing Home ◽  
End Of Life ◽  
Advance Directive ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Completion Rate ◽  
Life Care ◽  
Term Care

Abstract Background The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

scholarly journals Continuation of end-of-life care in a special elderly nursing home and the role of doctors

2012 ◽  
Vol 49 (3) ◽  
pp. 336-343
Author(s):  
Akira Kurita ◽  
Naosuke Shinagawa ◽  
Eitarou Kodani ◽  
Shinichirou Iwahara ◽  
Bonpei Takase ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care

End-of-Life Care Conversations in Resident Care Conferences in Nursing Home Settings

2018 ◽  
Vol 21 (2) ◽  
pp. 125-125 ◽  
Author(s):  
Gloria Puurveen ◽  
Heather A. Cooke ◽  
Jennifer Baumbusch
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Resident Care

Guilt as an Influencer in End-of-Life Care Decisions for Nursing Home Residents With Advanced Dementia

2022 ◽  
Vol 48 (1) ◽  
pp. 22-27
Author(s):  
Ashley Roach ◽  
Anita H. Rogers ◽  
Meghan Hendricksen ◽  
Ellen P. McCarthy ◽  
Susan L. Mitchell ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Advanced Dementia

scholarly journals Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study

2018 ◽  
Vol 32 (10) ◽  
pp. 1584-1595 ◽  
Author(s):  
Lara Pivodic ◽  
Tinne Smets ◽  
Nele Van den Noortgate ◽  
Bregje D Onwuteaka-Philipsen ◽  
Yvonne Engels ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
Epidemiological Study ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Quality Of Dying

scholarly journals Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia

BMC Nursing ◽  
2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Genevieve N. Thompson ◽  
Susan E. McClement
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Structured Interviews ◽  
Care Needs ◽  
Two Phase ◽  
Home Setting ◽  
Expert Nurses

Abstract Background With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population. Methods A qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors. Results Analysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying. Conclusions The critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.

scholarly journals Spiritual care provided by nursing home physicians: a nationwide survey

2019 ◽  
Vol 10 (4) ◽  
pp. e42-e42 ◽  
Author(s):  
Marie-José H E Gijsberts ◽  
Jenny T van der Steen ◽  
Cees M P M Hertogh ◽  
Luc Deliens
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
End Of Life ◽  
Spiritual Care ◽  
End Of Life Care ◽  
Qualitative Content Analysis ◽  
Elderly Care ◽  
Life Care ◽  
Additional Training ◽  
Broad Concept

ObjectiveTo examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors associated with spiritual care provision.MethodsA cross-sectional survey was sent to a representative sample of 642 elderly care physicians requesting information about their last patient who died and the spiritual care they provided. We compared their general perception of spiritual care with spiritual and other items abstracted from the literature and variables associated with the physicians’ provision of spiritual care. Self-reported reasons for providing spiritual care were analysed with qualitative content analysis.ResultsThe response rate was 47.2%. Almost half (48.4%) provided spiritual end-of-life care to the last resident they cared for. Half (51.8%) identified all 15 spiritual items, but 95.4% also included psychosocial items in their perception of spirituality and 49.1% included other items. Physicians who included more non-spiritual items reported more often that they provided spiritual care, as did more religious physicians and those with additional training in palliative care. Reasons for providing spiritual care included a request by the resident or the relatives, resident’s religiousness, fear of dying and involvement of a healthcare chaplain.ConclusionMost physicians perceived spirituality as a broad concept and this increased self-reported spiritual caregiving. Religious physicians and those trained in palliative care may experience fewer barriers to providing spiritual care. Additional training in reflecting upon the physician’s own perception of spirituality and training in multidisciplinary spiritual caregiving may contribute to the quality of end-of-life care for nursing home residents.

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