ISNCC publishes document on palliative care models in care and nursing homes
Palliative care, a form of patient-centered care focused on quality of life for the seriously ill, should be the standard of practice for all elderly patients with complex illness in nursing homes. Advances in medicine and the aging of the generation are contributing to a growing population of elderly people who are living longer with chronic illness. The number of people living in long-term nursing facilities in the US is expected to double to more than 3 million by 2030, while more than 40% of adults will die there. For some older people changes in physical, psychological and/or social circumstances will require a move into a long-term care facility, as they can no longer be supported to live in their own homes. Increasingly, nursing homes are responsible for both the long-term management of patients with multiple complex and chronic illnesses, and the care of these individuals at the end of
Different models will be incorporated in various long-term setting for older people, based on the health policies and the resources available.
Essential principals of palliative care in Nursing Homes:
- Recognizing the benefits and need for Palliative care in older people population (1, 2)
- Integration and assimilation of Palliative care in Nursing Homes
- Early identification of patient with Palliative needs with validated tools (1, 3)
- Advanced care planning: choices and preferences based on shared decision-making between interdisciplinary staff, patient and family.
- Impeccable symptom assessment and management.
- 24/7 clinical support for staff and patients
- Use of validated patient reported outcome measures the health policies and the resources available (4)
There are three models for delivering palliative care in Nursing Homes:
Hospice agency/nursing home partnerships. This is a partnership between a hospice agency and a nursing home, where eligible nursing home residents access their Medicare hospice benefit.
Externally based palliative care. An external palliative care consultation teams, a physician or nurse practitioner, respond to requests from nursing home clinicians. This model can serve a broader population of Nursing Homes residents, including those with chronic illness, as there is no need to for go curative therapies or to meet the hospice requirement of a prognosis of six-months or less to live to receive services
Facility-based palliative care. A facility may develop palliative care expertise within its own facility, allowing the creation of palliative care services that meet the needs of their residents. (5)
Partnerships between palliative care providers and nursing homes can improve care for nursing home residents by reducing readmissions and hospital deaths, improving symptom management, aligning care with patient goals, and leading to improved satisfaction of care for those who are dying
- Bull, G. (2016). Palliative Care in the Nursing Home Setting. National Hospice and Palliative Care Organization.
- Froggatt K. Reitinger E. (2013). Palliative Care in Long-Term Care Settings for Older. EAPC.
- Xavier Gómez-Batiste Marisa Martínez-Muñoz, C. B. (2013). Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ.
- Hall S, K. A. (2011). Interventions for improving palliative care for older people living in nursing care homes (Review). The Cochrane Collaboration and published in The Cochrane Library.
- Janet Bull, (2016) Palliative care in the nursing home setting National Hospice and Palliative Care Organization Palliative Care Resource Series
For more information, have a look on the website: www.isncc.org
Yael Ben–Gal RN, MSN, MHA
Board of Directors ISNCC, Health Policy and Advocacy Portfolio
Clinical pediatric palliative oncology nurse, Coordinator pediatric palliative care Schneider Children Hospital, Israel
Glynis J Katz RN MA
Knowledge & Quality control manager, Sabar Health, Palliative care, home hospice and hospital at home