Saturday, 15 January 2005 - 8:00 AM

This presentation is part of: Health-Related Services for Older Adults

Palliative Care in Nursing Homes: Steps for Success

Purpose: While Hospice programs and their palliative care function (care focused on the relief of suffering and attention to quality of life during the dying process) is well understood relatively little is known about the provision of palliative care in nursing homes. The purpose of the study was to explore what leads a nursing home to develop a palliative care program, what tensions are the result of its introduction, what are key elements needed to build a successful palliative effort and what do the participants see as services needed for a high quality palliative care program.

Method: This paper reports the findings of a qualitative study involving focus groups conducted in nine nursing homes. The sample of nine “model programs” to investigate was based on data obtained from a previous quantitative interview survey study of 113 nursing home facilities representing 69% of all facilities in New York City. The selected facilities reflected different auspices and patient characteristics, provided an array of palliative care services and had a longer history with palliative care. The focus groups at each setting included a range of staff with at least the medical director, the head of nursing, the head of social work services, and the head of the palliative care team being present in each group. Focus groups were transcribed and a ground theory method of analysis was used to identify key concepts and broader issues relevant to understanding the questions being studied.

Results: Findings of the study showed a lack of unity in how palliative care is defined and even who is eligible for palliative care. Similarly the establishment of the programs were the result of very different experiences including among others, concerns faced by the facility’s ethics committee, individual staff commitment, the introduction of new ethnic populations, and the patients rights movement as reflected in advance directives. The introduction of palliative care was clearly a stressful process as a shift from a medical education curative model takes place. Other strains are related to cultural beliefs, the personal feeling of staff, and individualization of services in contrast to protocol driven services. Services identified as being as part of palliative care ranged from the traditional approaches of pain management and comfort care to complementary medicine approaches and non-western medical techniques. Key elements for success in building a program included supportive administration, a “Cheerleader”, commitment to resident choice, a climate change toward service orientation, an interdisciplinary team and an educational program. The paper describes all the above through the voice of focus group participants.

Implications: The paper concludes with policy recommendations regarding the standardization of the definition of palliative care, the involvement of regulatory agencies in stimulating change, education of staff to move beyond a focus of curative care, and a broadening of which patients are offered this life choice.

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