TY - JOUR
T1 - Strategies and Innovative Models for Delivering Palliative Care in Nursing Homes
AU - Carlson, Melissa D.A.
AU - Lim, Betty
AU - Meier, Diane E.
N1 - Funding Information:
M.D.A.C. is a Brookdale Leadership in Aging Fellow and supported by a National Institute of Nursing Research Career Development Award ( 1K99NR010495–01 ); B.L. is supported by a Career Development Award from the Fan Fox and Leslie R. Samuels Foundation ; D.E.M.is supported by, a 2009–2010 Health and Aging Policy Fellowship , NCI R01CA 116227 , and the Center to Advance Palliative Care .
PY - 2011/2
Y1 - 2011/2
N2 - The goals of palliative care address critical issues for individuals with complex and serious illness residing in nursing homes, including pain and symptom management, communication, preparation for death, decisions about treatment preferences, and caregiver support. Because of the uncertain prognosis associated with chronic nonmalignant diseases such as dementia, many nursing home residents are either not referred to hospice or have very short or very long hospice stays. The integration of palliative care into nursing homes offers a potential solution to the challenges relating to hospice eligibility, staffing, training, and obtaining adequate reimbursement for care that aligns with resident and surrogate's preferences and needs. However, the delivery of palliative care in nursing homes is hindered by both regulatory and staffing barriers and, as a result, is rare. In this article, we draw on interviews with nursing home executives, practitioners, and researchers to describe the barriers to nursing home palliative care. We then describe 3 existing and successful models for providing nonhospice palliative care to nursing home residents and discuss their ongoing strengths and challenges. We conclude with specific policy proposals to expedite the integration of palliative care into the nursing home setting.
AB - The goals of palliative care address critical issues for individuals with complex and serious illness residing in nursing homes, including pain and symptom management, communication, preparation for death, decisions about treatment preferences, and caregiver support. Because of the uncertain prognosis associated with chronic nonmalignant diseases such as dementia, many nursing home residents are either not referred to hospice or have very short or very long hospice stays. The integration of palliative care into nursing homes offers a potential solution to the challenges relating to hospice eligibility, staffing, training, and obtaining adequate reimbursement for care that aligns with resident and surrogate's preferences and needs. However, the delivery of palliative care in nursing homes is hindered by both regulatory and staffing barriers and, as a result, is rare. In this article, we draw on interviews with nursing home executives, practitioners, and researchers to describe the barriers to nursing home palliative care. We then describe 3 existing and successful models for providing nonhospice palliative care to nursing home residents and discuss their ongoing strengths and challenges. We conclude with specific policy proposals to expedite the integration of palliative care into the nursing home setting.
KW - Models of care
KW - Pallative care
UR - http://www.scopus.com/inward/record.url?scp=78751704309&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2010.07.016
DO - 10.1016/j.jamda.2010.07.016
M3 - Article
AN - SCOPUS:78751704309
SN - 1525-8610
VL - 12
SP - 91
EP - 98
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 2
ER -