Indicators of Quality Medical Care for the Terminally Ill in Nursing Homes

Abstract

Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.

The Experience of Living‐Dying in a Nursing Home: Self‐Reports of Black and White Older Adults

“…It was not unexpected that inadequate pain relief was an issue for terminally ill residents in the study nursing homes: inadequate pain assessment and pain relief are well documented problems for hospital patients 11 and for nursing home residents 1 . Among the nursing home residents interviewed, cognitively intact residents reported using withdrawal and resignation as a coping strategy, so they may have given up expressing their need for pain relief.…”

“…Although more than 20% of deaths in the United States occur in nursing homes, 1 and 30 to 50% of all nursing home residents die within the first year after admission, 2 most nursing home staff are not well trained in care of the dying. Nursing home inservice education programs rarely address death, dying, or cultural issues related to terminal care.…”

Nursing Home Physician Educational Intervention Improves End-of-Life Outcomes

“…19 These quality indicators had been tested in other nursing homes and found to correspond with other measures of quality of care. 20 Indicators included documentation of recognition of impending death, presence of advance directives, pain control, dyspnea control, control of uncomfortable symptoms during the dying process, documented hygiene beyond routine nursing home aide care required during the dying process, documented bereavement support, and total patient comfort.…”

The Challenges and Opportunities in Providing End-of-Life Care in Nursing Homes

“…Recently, however, clinicians and researchers are calling for changes in mandated assessment and treatment protocols to reflect appropriate EOL care. 58,59 …”