Nursing home residents could greatly benefit from expanded access to palliative care, but providers need more access to standardized tools, staff education and relationships with clinicians to make informed decisions about care, specialists say.
Palliative care focuses on providing relief from symptoms, especially near the end of life or for patients with complex and consistently uncomfortable conditions. This sort of care has clear applications in nursing homes, but is not utilized nearly enough, according to a study in the Journal of the American Geriatrics Society.
One major reason for this care gap is a lack of consistent, evidence-based tools for determining who needs palliative care, the study’s authors noted.
“Our study highlights the need for the implementation of standardized referral criteria to ensure equitable access to palliative care in nursing homes,” wrote lead author Connie S. Cole, PhD, an assistant professor specializing in geriatrics at the University of Colorado in a report commenting on the study Tuesday.
The study goal was to “create a best practice model and help define what the standard of care should be,” according to coauthor Kathleen Unroe, MD, a Regenstrief Institute research scientist.
Several key “themes” could be the foundation for a more formalized method of identifying palliative care needs for nursing home patients, researchers found.
They included factors such as patients with uncontrolled symptoms and otherwise serious illnesses, as well as patients with indicators of significant decline such as frequent rehospitalizations.
Another place where palliative care could be particularly valuable is for patients who are clearly approaching the end-of-life stage but either do not yet qualify for hospice or are stuck with family members or clinical teams disagreeing whether to place them in hospice.
“Our job as clinicians is to get people access to the care and support that they need,” Unroe told McKnight’s Long-Term Care News Wednesday. “Broader access to palliative care services in the nursing home would open that door for more residents for a number of reasons, including at the end of life.”
Provider investments
Unroe said that providers should strongly emphasize increasing access to palliative care where not yet available — by prioritizing staff education, for example.
“I think that frontline nursing home staff who are providing day-to-day supportive care… do need to have their own palliative care training,” she explained.
She also stressed the importance of building better relationships with clinicians who can provide palliative care.
She acknowledged providers’ frequent staffing and resource shortages, but added that “implementing palliative care programs will help nursing homes do what we are already required to do in terms of achieving person-centered care.”
Unroe further advised that excellent palliative care can help mitigate adverse events, such as frequent rehospitalizations, which often lead to outcomes like inflated expenses, significant distress for residents, and long hospital backlogs.
“We can’t escape from the needs we need to meet for people with serious medical illness,” Unroe said. “It is the reality of our population. And what we do is we ask people to navigate these issues without training tools and the support of specialized resources.”
Being proactive and supplying nurses with specialized resources, she added, “will help address all kinds of other fundamental quality issues in nursing homes.”
