An evaluation of the implementation of a programme to improve end-of-life care in nursing homes

Abstract

The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre-post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.

Continuity, Coordination, and Transitions of Care for Patients with Serious and Advanced Illness: A Systematic Review of Interventions

“…In three of these studies (50%), 23,31,36 patients in the intervention groups were more likely to die at home. Four studies reported enrollment in hospice, use of hospice services or placing patients on a comfort care plan (two were RCTs).…”

Public hospital bed crisis: too few or too misused?

“…75 More universal use of advance care directives and palliative care programs should be mandated in RCFs as these reduce hospitalisation rates involving RCF patients by up to 40%. [76][77][78] Even in the absence of advance care directives, simply raising family awareness of the futility of 'heroic' interventions in RCF. Patients with advanced or endstage disease could help substantially reduce unnecessary hospitalisations in this group.…”

Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

“…Yet, there exists a culture of silence surrounding dying that creates a barrier to end-of-life communications in LTC [2,10]. Lack of discussion with the resident and the resident's substitute decision-maker, most commonly a family member, about end-of-life wishes can lead to unnecessary and unwanted medical treatments [11,12], unnecessary transfers to the acute hospital [13], and discomfort and anxiety for both the resident and family [14]. Implementing effective advance care planning (ACP) can improve patient and family satisfaction with care and increase the likelihood that people will die in their setting of choice [12,15].…”

“…ACP is viewed as an essential component of a quality palliative care program and provides LTC residents important decision-making opportunities [18][19][20] that can guide their caregivers when they cannot speak for themselves [21][22][23]. Knowing individuals' preferences for care and enabling them to die where they choose are recognized as the gold standard in palliative care [11]. Having comprehensive up to date advance care plans can help staff create a peaceful environment for dying residents and their families within LTC [24] and avoid unnecessary health care expenditures [14].…”