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Editorial Calls For Better End Of Life Care In Nursing Homes

A new editorial published in the Journal of the American Medical Directors Association calls for bold action to improve the care and support provided to seriously ill nursing home patients and their families.

Author Dr. Kathleen Unroe, an Indiana University Center for Aging Research investigator, focuses on applying key recommendations from the Institute of Medicine’s (IOM) widely circulated report, Dying in America, within long-term care facilities.

Courtesy WikiMedia Commons
Courtesy WikiMedia Commons

“Their report on dying in America presents us with an opportunity to have a national conversation about how we can better care for the many individuals who will die in nursing homes,” Unroe wrote in a statement to Life Matters Media. “Unless we use this opportunity to push the conversation forward, the IOM report is a wasted effort, and we, as a nation, can’t afford that.”

The 2014 report cited the present as the best time to normalize conversations about death and dying, as millions of aging baby boomers will soon face difficult end of life care decisions for themselves and on behalf of family members.

The report also emphasized the urgent need for end of life care to reflect the principles of palliative medicine– care that provides pain relief and that centers on enhancing the quality of life among the chronically or seriously ill.

Dr. Kathleen Unroe
Dr. Kathleen Unroe

Nearly all nursing home patients, Unroe writes, will benefit from palliative care. Evidence suggests that, on average, palliative care and hospice patients live longer than similarly ill patients who do not receive such care.

More than one in four older adults die in nursing homes, including 70 percent of Americans with advanced dementia. However, end of life care for nursing home residents has long been associated with poor symptom management and low family satisfaction. In 2014, patients and caregivers ranked nursing homes to be the worst settings for end of life care.

That survey, conducted by the Centers for Medicare & Medicaid Services (CMS), measured experiences in three hospice settings: nursing homes (skilled and regular facilities), home care (home and assisted living facilities) and inpatient care (acute care hospitals and freestanding hospice inpatient units).

Out of a possible high score of 100, hospice inpatient units ranked highest overall (97), followed by acute care hospitals (93) and home care (92). Nursing home care received a 90, receiving lower marks for hospice team communication and emotional support.

Researchers suggest a lack of visits from skilled nursing staff in nursing homes led to lower scores.

National implementation of the survey will begin this year, and hospices will be required to participate on a monthly basis in order to receive the full Annual Payment Update from CMS.

“Those of us who care for vulnerable nursing home patients have an obligation to recognize the reality of caring for people near the end of life and work collectively to improve the quality of this care,” the editorial concludes. “These IOM report recommendations can be incorporated into the strategic plans, policies, and activities of professional societies and health and social service organizations.”