POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-term Care

Caring About Residents’ Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116641606 ◽

2016 ◽

Vol 34 (5) ◽

pp. 466-469 ◽

Cited By ~ 3

Author(s):

Deborah A. Morris ◽

Marissa Galicia-Castillo

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Long Term Care ◽

Descriptive Analysis ◽

Nursing Home Residents ◽

Term Care ◽

Code Status ◽

Care Plans ◽

Palliative Care Consultation

Objectives: To describe the CARES program, a model of palliative care for nursing home residents. Design: Descriptive analysis of the Caring About Residents’ Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. Program evaluation: The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. Results: 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. Conclusion: The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.

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The Case

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180116000244 ◽

2016 ◽

Vol 25 (3) ◽

pp. 553-553

Author(s):

RUCHIKA MISHRA

Keyword(s):

Nursing Home ◽

Long Term Care ◽

Care Facility ◽

Ethics Consultation ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility ◽

Code Status ◽

The Family

Mr. Hope is a 40-year-old man who has resided at a long-term care facility for the past 10 years. The resident was originally admitted to the nursing home for his inability to care for himself secondary to advanced AIDS and complications from progressive multifocal leukoencephalopathy (PML). When he initially arrived at the nursing home, Mr. Hope was able to smile and appeared to respond to some of the staff’s requests. Now, he responds by wincing when told that procedures are being performed and especially when he is told that he has to go back to the hospital. He is extremely contracted, with his arms wedded to his chest in a crossed fashion, as though he is protecting himself from blows. Mr. Hope’s family consists of a partner, his parents, and one sibling. Numerous conversations have been had with the family, and according to the facility staff, “they persist in continuing aggressive measures with the hope that the patient will wake up and walk out of the facility.” What had been frequent visits to the local hospital ER have increased substantially in the last few months, for what appear to be new infections and pneumonia. During most visits he ultimately spends a few days in the hospital to resolve his acute issues. On his most recent return to the long-term care facility, the medical staff approached the family about Mr. Hope’s code status. The family continues to insist on a full code status and that he be provided every opportunity to “live.” The staff is very concerned about Mr. Hope and his welfare. Many of the nursing staff have grown attached to him over the years, and watching him deteriorate has been distressing. They see part of their role as being his advocate and supporting him in ways that his own family has not. They express very strong reservations about performing CPR on Mr. Hope because they think it will be ineffective and they will have to break his upper extremities in order to gain access to his chest for resuscitation. The staff has contacted the ethics consultation service with the request that Mr. Hope needs protection and that his own family is not making the best decisions for him.

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Working With Resistance and Encouraging Buy-In to New Programs

Perspectives on Gerontology ◽

10.1044/gero16.1.18 ◽

2011 ◽

Vol 16 (1) ◽

pp. 18-21

Author(s):

Sara Joffe

Keyword(s):

Long Term Care ◽

Term Care ◽

Optimal Outcomes ◽

Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

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Feeding Dependency Issues in the Long-Term Care Environment

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd10.1.19 ◽

2001 ◽

Vol 10 (1) ◽

pp. 19-24

Author(s):

Carol Winchester ◽

Cathy Pelletier ◽

Pete Johnson

Keyword(s):

Long Term Care ◽

Term Care ◽

Care Environment

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Communication Disordered: Program Implementation in Long-Term Care

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig15.64 ◽

2016 ◽

Vol 1 (15) ◽

pp. 64-67

Author(s):

George Barnes ◽

Joseph Salemi

Keyword(s):

Program Implementation ◽

Long Term Care ◽

Family Satisfaction ◽

Regulatory Compliance ◽

Care Staff ◽

Term Care ◽

Staff Members ◽

Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

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