End-of-Life Care in Skilled Nursing Facilities

2014 ◽  
pp. 121-136
Author(s):  
Corrine Y. Jurgens ◽  
Diane K. Pastor
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Life Care ◽  
Skilled Nursing

scholarly journals Preliminary Report of a Pilot Tele-Health Palliative Care and Bioethics Program for Residents in Skilled Nursing Facilities

2009 ◽  
Vol 3 ◽  
pp. PCRT.S3296
Author(s):  
Sean O'Mahony ◽  
Patricia Marthone ◽  
Gabriella Santoro ◽  
Clare Horn ◽  
Sandy Selikson ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Skilled Nursing Facilities ◽  
Rank Test ◽  
Nursing Facilities ◽  
Life Care ◽  
Skilled Nursing ◽  
Face To Face

Currently about 25% of Americans die in nursing homes, many with poorly controlled pain and other symptoms, with minimal provisions for psychosocial support. New models are necessary to lessen structural and process barriers to give effective end-of-life care in nursing homes. Objectives 1) To extend hospital-based Bioethics Consultation Services (BCS) and Palliative Care Services (PCS) at Montefiore Medical Center (MMC) in the Bronx to two local Skilled Nursing Facilities (SNFs), Morningside House Aging in America (MSH) using direct face-to-face consultations and Beth Abraham Health Systems (BAHS) via video consultations (VC); 2) Achieve improvements in quality of life and comfort for elderly residents and their families; 2a) Improve the level of practice and increase staff satisfaction with palliative care content-related knowledge and bioethical analysis. Methods We report preliminary findings of this two group quasi experimental project with results of pre- and post-tests rating content-related knowledge in aspects of end-of-life care for staff. Select pre-test and post-test questions were given to physicians and other staff, but were re-configured for, registered and licensed practice nurses, social workers, and certified nursing assistants from the End-of-Life Physician Education Resource Center (EPERC). Patient, family, and staff ratings of the quality of palliative care were measured with a Palliative Outcomes Scale (POS) one week prior to and post consultation. Results 72 staff attended in-services; 53 completed pre-tests and 49 post-tests. Overall knowledge scores increased for 9 of the 16 items that were analyzed. There were improvements in knowledge scores in 12 of 16 items tested for staff content related knowledge which were statistically significant in regard to management of cancer pain from 63.8% to 81.5% (p = 0.03) and a trend to significance for assessment and management of delirium from 31.6% to 61.9% (p = 0.073). Seventy five POS surveys were completed from 13 video-conferenced Palliative Care consultations and 14 direct face-to-face consultations from March 2008 to January 2009. There were improvements in ratings for some aspects of quality of care on the POS. Patient and staff aggregate response scores for the POS were significantly improved between baseline and follow-up (Wilcoxon signed-rank test p = 0.0143 and p = 0.005) at the videoconsultation site and for family and staff at the face-to-face consultation site (Wilcoxon signed-rank test p = 0.0016 and p = 0.0012). Conclusion Preliminary evidence suggests that use of real time videoconferencing to connect hospital-based Bioethics and Palliative Care clinicians with patients, families, and staff in Skilled Nursing Facilities may enhance some aspects of end-of-life care for their residents, as well as content related knowledge in core aspects of end-of-life care for interdisciplinary groups of staff or caregivers.

Developing a national quality register in end-of-life care: The Swedish experience

2011 ◽  
Vol 26 (4) ◽  
pp. 313-321 ◽  
Author(s):  
Staffan Lundström ◽  
Bertil Axelsson ◽  
Per-Anders Heedman ◽  
Greger Fransson ◽  
Carl Johan Fürst
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care ◽  
Quality Register ◽  
Dying Patients ◽  
National Quality ◽  
Hospital Wards ◽  
National Quality Register

Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

Improving End-of-Life Care in Nursing Facilities: The Community State Partnership to Improve End-of-Life Care—California

2005 ◽  
Vol 8 (2) ◽  
pp. 300-312 ◽  
Author(s):  
Terry E. Hill ◽  
Marjorie Ginsburg ◽  
Judy Citko ◽  
Mary Cadogan
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care

Discussing End of Life Care: An Opportunity

2015 ◽  
Vol 20 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Amanda Stead ◽  
Caitlin McDonnell
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
End Of Life Care ◽  
Close Contact ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Skilled Nursing

Most deaths now occur in medical or skilled nursing settings. This brings speech-language pathologists, and other professionals, in close contact with clients who face death. While it can feel uncomfortable, speech-language pathologists are in a position to influence this phase of their client's quality-of-life life by addressing death and end of life wishes. This can be a goal of therapy.

The Importance of End-Of-Life Care in Nursing Home Settings is Not Diminished by a Disaster

2012 ◽  
Vol 64 (2) ◽  
pp. 143-155 ◽  
Author(s):  
Kathryn A. Frahm ◽  
Lisa M. Brown ◽  
Maggie Gibson
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Disaster Response ◽  
Nursing Home Residents ◽  
Life Care ◽  
Care Needs ◽  
Nursing Home Population ◽  
Skilled Nursing ◽  
Emergency Responders

The emphasis in disaster situations is on preserving life, and this goal is both appropriate and laudable. There is a risk, however, that the needs of people who are dying can become lost when there is a sudden surge of people needing acute intervention. There are significant ethical considerations inherent in society's prioritization of care needs across the acute, rehabilitative, and palliative spectrum in general, let alone in a disaster situation. These ethical conundrums are not the focus of this article. Rather, we anchor our discussion on the assumption that care needs are equally valid, and our purpose is to explore the issues that impact the provision of quality end-of-life care in nursing home settings for those who require this care when a disaster occurs. Nursing home residents, in particular, are at heightened risk for experiencing negative disaster-related outcomes due to compromised physical or mental health that requires skilled nursing care. Moreover, within the already vulnerable nursing home population are many people who are receiving palliative end-of-life services when a disaster strikes. Education and training in end-of-life services for nursing home staff, disaster emergency responders, and other lay people is vital to build capacity for adapting the delivery of these services in disaster situations in the interest of equity and human rights. Given the present lack of guidance in the literature as to what end-of-life care looks like when adapted to the context of disaster response, there is also a pressing need for research to inform this discussion. The purpose of this article is to draw attention to this topic and highlight some of the critical issues, gaps, and opportunities.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Initiative Improved End-of-Life Care in Homes

2011 ◽  
Vol 12 (6) ◽  
pp. 2
Author(s):  
DAMIAN McNAMARA
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care
Sign in / Sign up

Export Citation Format

Share Document