The challenge of providing palliative care in the nursing home

Abstract

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home's control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home's control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families' expectations regarding residents' care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.

The involvement of volunteers in palliative care and their collaboration with healthcare professionals: A cross‐sectional volunteer survey across the Flemish healthcare system (Belgium)

“…The contrast between nursing home volunteers and volunteers from other care services, shown in the current paper and in previous studies (Vanderstichelen et al, 2019b(Vanderstichelen et al, , 2019cVanderstichelen, Houttekier, et al, 2018) is striking, particularly considering that the Belgian nursing homes have historically been anchored in their local community and considering many people spend the last days of their life in a nursing home. The reasons behind the poor development of palliative care volunteering in nursing homes may be tied to challenges for palliative care provision itself in nursing homes, for example, lack of knowledge about the principles and practices of palliative care (Smets et al, 2018;Wowchuk, Mcclement, & Bond, 2007), negative care provider attitudes towards death and dying and unnecessary hospital transfers for dying residents (Wowchuk et al, 2007). This unfamiliarity with palliative care provision is likely to affect the use of volunteers within nursing homes.…”

“…This unfamiliarity with palliative care provision is likely to affect the use of volunteers within nursing homes. Additionally, nursing homes have chronic problems of understaffing (Hayes et al, 2012;Wowchuk et al, 2007) and time pressure for care staff (Wowchuk et al, 2007), which likely negatively affect the extent and quality of volunteer coordination within the facility. Finally, it is possible that the healthcare system itself does not sufficiently recognise the nursing home as a setting for palliative care provision (Wowchuk, McClement, & Bond Jr, 2006).…”

Volunteer involvement in the organisation of palliative care: A survey study of the healthcare system in Flanders and Dutch-speaking Brussels, Belgium

“…However, the low level of volunteer involvement, training, and task performance in nursing homes remains surprising. These results may be due to a lack of recognition of palliative care needs in nursing homes, a lack of coordination resulting from understaffing (Hayes et al, 2012;Wowchuk, McClement, & Bond, 2007), or a mix between care culture, regulations and staff training that may determine what volunteers are allowed to do. Nursing homes may therefore have room to grow towards stronger volunteer involvement and broader volunteer roles than medical oncology departments.…”

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

“…Furthermore, researchers have pointed out several internal factors that are challenging when delivering palliative care in nursing homes. These include the staffs' knowledge on how to provide palliative care, their attitude toward palliative care, staffing levels, lack of physician support, lack of privacy, family expectations for care, and the hospitalization of residents [9]. …”