Strategies and Innovative Models for Delivering Palliative Care in Nursing Homes

Carlson, Melissa; Lim, Betty; Meier, Diane E.

doi:10.1016/j.jamda.2010.07.016

Cited by 54 publications

(56 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31,32 Our findings provide substantial support for these recommendations. The variations in hospice use between SNF and non-SNF residents raise a compelling concern regarding the quality of EoL care received by NH residents with advanced dementia; and, the low level of nonhospice palliative care and expertise in many U.S. NHs 31,32 heightens this concern. The substantially reduced risk of dying in a hospital for residents who access hospice subsequent to an EoL SNF admission provides support for the notion that dual access to SNF and hospice may reduce the rate of EoL hospitalizations.…”

Section: Discussionsupporting

confidence: 67%

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

Miller

Lima

Looze

et al. 2012

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Because Medicare policy restricts simultaneous Medicare hospice and skilled nursing facility (SNF) care, we compared hospice use and sites of death for SNF/non-SNF residents with advanced dementia; and, for those with SNF, we evaluated how subsequent hospice use was associated with dying in a hospital. Methods: This study includes (non-health maintenance organization [HMO]) residents of U.S. nursing homes (NHs) who died in 2006 with advanced dementia (n = 99,370). Sites of death, Medicare SNF, and hospice use were identified using linked resident assessment and Medicare enrollment and claims data. Advanced dementia was identified by a diagnosis of Alzheimer's disease or dementia on the Minimum Data Set (MDS) or a Medicare claim in the last year of life and severe to very severe cognitive impairment (5 or 6 on the MDS cognitive performance scale). For residents with SNF, we used multivariate logistic regression with generalized estimating equations to estimate the effect of subsequent hospice enrollment on dying in a hospital. Results: Forty percent of U.S. NH residents dying with advanced dementia in 2006 had SNF care in the last 90 days of life. Those with versus without SNF less frequently used hospice (30% versus 46%), more frequently had short ( £ 7 days) hospice stays (40% versus 19%), and more frequently died in hospitals (14% versus 9%). Among residents with SNF, those with subsequent hospice use had a 98% lower likelihood of a hospital death (95% confidence interval [CI]: 0.014, 0.025). Conclusions: Dual hospice/SNF access may result in fewer hospital deaths and higher quality of life for dying NH residents.

show abstract

Section: Discussionsupporting

confidence: 67%

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

Miller

Lima

Looze

et al. 2012

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…We also could not determine if patients received palliative or hospice care upon arrival to their post-acute care facilities. However, the use of palliative care and hospice services in nonhospice post-acute care facilities remains limited (35,36). Longterm care facilities are a natural care setting for the integration of palliative and hospice care, and developing standards for incorporating and evaluating palliative care in these settings warrants further investigation.…”

Section: Original Researchmentioning

confidence: 99%

High Burden of Palliative Needs among Older Intensive Care Unit Survivors Transferred to Post–Acute Care Facilities. A Single-Center Study

et al. 2013

View full text Add to dashboard Cite

Rationale: Adults with chronic critical illness (tracheostomy after > 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities.Objectives: To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs. Methods:We examined electronic records from a 1-year cohort of 228 consecutive adults > 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results:The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%.Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.

show abstract

“…These include PC consultations provided to NH residents and NH-staffed PC programs. Although anecdotal findings are promising, 18 there is little empirical study of NH-staffed palliative programs. An exception is a recent study of one NH's PC consult program that found residents with consults (compared to matched nonconsult residents) were more likely to experience reductions in depression and in ER visits.…”

mentioning

confidence: 99%

End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Miller

Lima

Thompson

2015

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Many older adults in nursing homes (NHs) lack palliative care (PC) access; but little is known about whether access to PC knowledge and practice (beyond hospice) impacts residents' care. Objective: The study objective was to evaluate how differing levels of NH PC knowledge and practice are associated with residents' end-of-life health care use. Results: Controlling for NH hospice use, being in a NH with higher PC care knowledge scores was associated with residents having a higher likelihood of documented six-month prognoses and lower likelihoods of having feeding tubes, injections, restraints, suctioning, and end-of-life hospital and ER use. Being in a NH with higher PC practice scores was associated with a lower likelihood of having feeding tubes and ER visits. Conclusion: Policies and advocacy promoting the development of NH PC knowledge and practices could potentially improve care and reduce hospital and ER use.

show abstract

Strategies and Innovative Models for Delivering Palliative Care in Nursing Homes

Cited by 54 publications

References 46 publications

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

High Burden of Palliative Needs among Older Intensive Care Unit Survivors Transferred to Post–Acute Care Facilities. A Single-Center Study

End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Contact Info

Product

Resources

About