Nursing home care trajectories for older adults following in-hospital palliative care consultation

Abstract

Objective Palliative care consultation (PCC) during hospitalization is increasingly common for older adults with life-limiting illness discharged to nursing homes. The objective of this analysis was to describe the care trajectories and experiences of older adults admitted to a nursing home following a PCC during hospitalization. Design Qualitative descriptive. Setting/Participants Twelve English-speaking adults, mean age 80 years, who received a hospital PCC and discharge to a nursing home without hospice. Measurements Data were collected from medical records at five time points from hospital discharge to 100 days after nursing home admission and care trajectories were mapped. Interviews (n=15) with participants and surrogates were combined with each participant’s medical record data. Content analysis was employed on the combined dataset. Results All PCC referrals were for goals of care conversations during which the PCC team discussed poor prognosis. All participants were admitted to a nursing home under the Medicare skilled nursing facility benefit. Seven were rehospitalized; six of the 12 died within 6 weeks of initial nursing home admission. The two care trajectories were Focus on Rehabilitative Care and Comfort Care Continuity. There was a heavy emphasis on recovering functional status through rehabilitation and skilled nursing care, despite considerable symptom burden and poor prognosis. Conclusions Regardless of PCC with recommendations for palliative interventions, frail older adults with limited life expectancy and their family caregivers often perceive that rehabilitation will improve physical function. This perception may contribute to inappropriate, ineffective care. More emphasis is needed to coordinate care between PCC recommendations and post-acute care.

Does inpatient palliative care consultation impact outcomes following hospital discharge? A narrative systematic review

“…There were specific barriers and facilitators of transitions identified by patient, families and caregivers in qualitative research. 8,[41][42][43][44] Effective transitions involve good communication about expectations, goals of care, medication use, adverse reactions and supportive collaboration across settings. This evidence informed the development of the model (Figure 3) that includes barriers and facilitators of transfers.…”

Transitioning to Life in a Nursing Home: The Potential Role of Palliative Care

“…2 Nursing home placements are a major life event for more than 1.4 million NH residents in the United States, most admitted following a hospital stay with short-term goals of rehabilitation and discharge home. 1,3,4 Short-term stays often evolve into long-term care as a result of physical and cognitive decline or when needs exceed family capacity to provide care. 1,5 Long-term care costs were reported as US$162.7 billion in 2016.…”

The implicit soul: Factors between the representation of death and dehumanization of patients

“…Therefore, we expected their representations of the afterlife, God, and dying to be consistent with Christian beliefs. Finally, the present research discusses the introduction of specific spiritual curricula and death education courses as a possible solution for professionals working in the end-of-life field (Baldacchino, 2005; Edwards et al, 2010; Testoni et al,2016a, 2017c) and in nursing homes (Carpenter et al, 2010; Ersek and Wilson, 2003).…”