Journal of palliative medicine
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Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the disease course. The Palliative Excellence in Alzheimer Care Efforts (PEACE) program responds to these deficiencies, striving to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness. ⋯ Initial feedback suggests patients have adequate pain control, satisfaction with quality of care, appropriate attention to prior stated wishes, and death occurring in the patient's location of choice. Families voiced similar high marks regarding quality of care. This program demonstrates an innovative model of providing quality palliative care for dementia patients and their caregivers.
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To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. ⋯ Overall the clinical conditions of both hospice and nonhospice end-stage residents were similar. A greater percentage of hospice residents were found to have living wills, DNR orders, and cancer, and to be in moderate or severe pain. Hospice and nonhospice residents experienced similar time from admission to death or discharge (20 and 36 days, respectively). Based on the clinical condition of the two groups, it would appear that there are limited clinical reasons for the low utilization of the hospice benefit in nursing homes. The increased prevalence of advance care planning may lead toward use of hospice or may result from hospice enrollment. Hospice services seem to be thought of more frequently for residents with cancer and residents experiencing pain. Nursing homes must recognize their role as caregivers to the dying before palliative care is seen as a need for nursing home residents. Nursing homes need education in determining when a patient is appropriate for palliative care as only 4% are designated as end of life, and only 2% are shown to be receiving hospice care in hospice-contracted facilities.
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Approximately 20% of deaths in the United States occur in nursing homes. That percentage is expected to increase as the population continues to age. As a setting for end-of-life care, nursing homes provide both challenges and opportunities. ⋯ In addition to discussing hindrances to providing end-of-life care, this article explores characteristics of nursing homes and their staff that support the care of terminally ill residents. Also included is an overview of models for delivering end-of-life care in nursing homes, including provision of hospice services, specialized palliative care units, and consultation services. Finally, this article discusses educational programs and current educational initiatives to enhance end-of-life care in nursing homes.