scholarly journals Racial Differences in Infection Management and Palliative Care at End-of-Life in Nursing Homes Nationwide

2021 ◽  
Vol 1 (S1) ◽  
pp. s69-s69
Author(s):  
Leah Estrada ◽  
Andrew Dick ◽  
Patricia Stone ◽  
Jordan Harrison
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Home Residents ◽  
County Level ◽  
Infection Management ◽  
Care Services ◽  
Black Residents ◽  
Palliative Care Services

Background: Infections are common at end-of-life in older nursing-home residents. This often leads to the overuse of antibiotics and burdensome treatments. Improving infection management through palliative care at the end of life has been proposed as a key strategy to reducing inappropriate antibiotic use. Black nursing-home residents tend to reside in poorly performing nursing homes. We examined palliative care services in nursing homes with varying proportions of black residents. Methods: Cross-sectional, nationally representative nursing-home survey data (2017–2018) was combined with the Minimum Data Set 3.0 (nursing-home resident characteristics), the Certification and Survey Provider Enhanced Reporting data (nursing-home facility characteristics), and the Multidimensional Deprivation Index (county-level poverty estimates). The survey included 24 validated items on nursing-home palliative care services, as well as the nursing home’s infection control program and integration of infection management and palliative care (summative score, 0–100). We used nursing-home facility-level multivariate regression to estimate the relationship between proportion of black residents and palliative care scores, before and after controlling for county-level poverty estimates, facility characteristics, and resident characteristics. We categorized proportion of black residents using methods reported in the literature (25%). Results: The mean weighted palliative-care score in our sample of 869 nursing homes (weighted n = 15,020) was 47.7 (SE, 0.70). In unadjusted analyses, nursing homes with higher proportions of black residents provided significantly fewer palliative care services than nursing homes with no black residents, with the greatest differences (P = .027) observed between nursing homes with >25% black residents (mean palliative care score, 43.82; SE, 2.31) versus nursing homes with no black residents (mean palliative care score, 49.47; SE, 1.08). These disparities persisted after adjustment for urbanicity and county-level poverty rates (p < 0.01) but were attenuated after further adjustment for resident and facility level characteristics (p=0.138). Conclusions: Our findings demonstrate that wide variations in nursing-home palliative-care services exist with increased proportions of black residents, even after accounting for community characteristics. Further research is needed to identify and understand the specific community characteristics that play a role in the provision of palliative care services. Palliative care is a method to reduce inappropriate antimicrobial use at the end of life and should be expanded with a focus on nursing homes with higher proportions of black residents.Funding: NoDisclosures: None

Long-Term Care

2019 ◽  
pp. 606-614
Author(s):  
Joan Carpenter ◽  
Mary Ersek
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Developed Countries ◽  
The United States ◽  
Nursing Home Population ◽  
Care Services ◽  
Challenges And Opportunities ◽  
Palliative Care Services

This chapter examines palliative care across residential care settings with a focus on nursing homes. It reviews the environment of nursing homes, describes the residents who live there, and provides details about the interdisciplinary team providers who care for the residents. It also discusses the challenges and opportunities for delivering palliative care services to nursing home residents with life-limiting illness. Quality end-of-life care in nursing homes is important because more than 1.4 million Americans live in nursing homes, and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. Of those nursing home residents over 65 years of age, 80% are 75 years or older. Despite the efforts to keep frail elders in the community, the nursing home population is expected to increase as the numbers of older persons in the United States and other developed countries increase. The chapter concludes with a description of models for delivering palliative care in nursing homes.

scholarly journals Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Anke Strautmann ◽  
Katharina Allers ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Staff ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Hospital Death ◽  
Life Care ◽  
Cross Sectional

Abstract Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

scholarly journals Do Palliative Care Teams in Nursing Homes Improve the Quality of End-of-Life Care for Nursing Home Residents?

2019 ◽  
Author(s):  
Helena Temkin-Greener Helena Temkin-Greener ◽  
Dana Mukamel ◽  
Susan Ladwig ◽  
Thomas , Caprio ◽  
Sally Norton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Palliative Care Teams

scholarly journals Palliative care and infection management at end of life in nursing homes: A descriptive survey

2020 ◽  
Vol 34 (5) ◽  
pp. 580-588 ◽  
Author(s):  
Aluem Tark ◽  
Leah V Estrada ◽  
Mary E Tresgallo ◽  
Denise D Quigley ◽  
Patricia W Stone ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Terminally Ill ◽  
Antibiotic Usage ◽  
Care Plan ◽  
Current Status ◽  
Infection Management ◽  
Nationally Representative

Background: Infections are common occurrences at end of life that are associated with high rates of morbidity and mortality among frail elderly individuals. The problem of infections in nursing homes has led to a subsequent overuse and misuse of antibiotics in this already-frail population. Improving palliative care in nursing homes has been proposed as a key strategy to reduce the use of antibiotics. Aim: The aim of this study was to describe the current status of how nursing homes integrates palliative care and infection management at end of life across the nation. Design: This is a cross-sectional survey of nationally representative US nursing homes. Setting/participants: Between November 2017 and October 2018, a survey was conducted with a nationally representative random sample of nursing homes and 892 surveys were completed (49% response rate). The weighted study sample represented 15,381 nursing homes across the nation. Results: Most nursing homes engaged in care plan documentation on what is important to residents (90.43%) and discussed spiritual needs of terminally ill residents (89.50%). In the event of aspiration pneumonia in terminally ill residents, 59.43% of nursing homes responded that resident would be transferred to the hospital. In suspected urinary tract infection among terminally ill residents, 66.62% of nursing homes responded that the resident will be treated with antibiotics. Conclusion: The study found wide variations in nursing home palliative care practices, particularly for timing of end-of-life care discussions, and suboptimal care reported for antibiotic usage. Further education for nursing home staff on appropriate antibiotic usage and best practices to integrate infection management in palliative care at the end of life is needed.

American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care Into Standard Oncology Care

2012 ◽  
Vol 30 (8) ◽  
pp. 880-887 ◽  
Author(s):  
Thomas J. Smith ◽  
Sarah Temin ◽  
Erin R. Alesi ◽  
Amy P. Abernethy ◽  
Tracy A. Balboni ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Clinical Oncology ◽  
Metastatic Cancer ◽  
Expert Consensus ◽  
Care Services ◽  
Palliative Care Services ◽  
Oncology Care ◽  
American Society

Purpose An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing data from major studies. This PCO addresses the integration of palliative care services into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. Clinical Context Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness. Although the use of hospice and other palliative care services at the end of life has increased, many patients are enrolled in hospice less than 3 weeks before their death, which limits the benefit they may gain from these services. By potentially improving quality of life (QOL), cost of care, and even survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Until recently, data from randomized controlled trials (RCTs) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving standard oncology care have not been available. Recent Data Seven published RCTs form the basis of this PCO. Provisional Clinical Opinion Based on strong evidence from a phase III RCT, patients with metastatic non–small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care—when combined with standard cancer care or as the main focus of care—leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel's expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research. NOTE. ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.

Hospitalization burden and end-of-life (EOL) care in elderly patients with glioblastoma (GBM).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 31-31
Author(s):  
Laura Donovan ◽  
Donna Buono ◽  
Melissa Kate Accordino ◽  
Jason Dennis Wright ◽  
Andrew B. Lassman ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Elderly Patients ◽  
Marital Status ◽  
End Of Life ◽  
Remaining Life ◽  
Care Services ◽  
Palliative Care Services ◽  
Race Ethnicity ◽  
Eol Care

31 Background: GBM is associated with a poor prognosis and early death in elderly patients. Prior studies have demonstrated a high burden of hospitalization in this population. We sought to evaluate and examine trends in hospitalizations and EOL care in GBM survivors. Methods: Using SEER-Medicare linked data, we performed a retrospective observational cohort study of patients aged ≥ 65 years diagnosed with GBM from 2005-2017 who lived at least 6 months from the time of diagnosis. Aggressive EOL care was defined as: chemotherapy or radiotherapy within 14 days of death (DOD), surgery within 30 DOD, > 1 emergency department visit, ≥ 1 hospitalization or intensive care unit admission within 30 DOD; in-hospital death; or hospice enrollment ≤ 3 DOD. We evaluated age, race, ethnicity, marital status, gender, socioeconomic status, comorbidities, prior treatment and percentage of time hospitalized. Multivariable logistic regression was performed to determine factors associated with aggressive end of life care. Results: Of 5827 patients, 2269 (38.9%) survived at least 6 months. Among these, 1106 (48.7%) survived 6-12 months, 558 (24.6%) survived 12-18 months, and 605 (26.7%) survived > 18 months. Patients who survived 6-12 months had the highest burden of hospitalization and spent a median of 10.6% of their remaining life in the hospital compared to those surviving 12-18 months (5.4%) and > 18 months (3%) (P < 0.001). 10.1% of the cohort had claims for palliative care services; 49.8% of initial palliative care consults occurred in the last 30 days of life. Hospice claims existed in 83% with a median length of stay 33 days (IQR 12, 79 days). 30.1% of subjects received aggressive EOL care. Receiving chemo at any time (OR 1.510, 95% CI 1.221-1.867) and spending ≥ 20% of life in the hospital after diagnosis (OR 3.331, 95% CI 2.567-4.324) were associated with aggressive EOL care. Women (OR 0.759, 95% CI 0.624-0.922), patients with higher socioeconomic status (OR 0.533, 95% CI 0.342-0.829), and those diagnosed ≥ age 80 (OR 0.723, 95% CI 0.528-0.991) were less likely to receive aggressive EOL care. Race, ethnicity, marital status, and extent of initial resection were not associated with aggressive EOL care. Conclusions: A minority of elderly patients with GBM in the SEER-Medicare database survived ≥ 6 months; hospitalizations were common and patients spent a significant proportion of their remaining life hospitalized. Although hospice utilization was high in this cohort, 30% of patients received aggressive EOL care. Despite the aggressive nature of GBM, few patients had palliative care consults during their illness. Increased utilization of palliative care services may help reduce hospitalization burden and aggressive EOL care in this population.

Does Integration of Palliative Care and Infection Management Reduce Hospital Transfers among Nursing Home Residents?

2021 ◽  
Author(s):  
Jordan M. Harrison ◽  
Mansi Agarwal ◽  
Patricia W. Stone ◽  
Tadeja Gracner ◽  
Mark Sorbero ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Infection Management
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