Palliative care is grossly underutilized in nursing home settings, but providers can develop new tools that could bring those services to more residents, a recent study has found.
A range of barriers contribute to the under-utilization of palliative care in nursing home settings, including poorly defined referral criteria and a general lack of awareness and understanding of what palliative care is and does, the study published in the Journal of the American Geriatrics Society indicated.
Greater access to palliative care is essential in the nursing home environment, according to study co-author Dr. Kathleen Unroe with the Indiana University Center for Aging Research and the Regenstrief Institute.
“It’s inherent in the nature of the people we serve in the nursing home setting. You’re not in a nursing home unless you have serious medical illnesses, functional impairment, cognitive impairment — some combination of those needs,” Unroe told Palliative Care News. “Palliative care is important to address uncontrolled symptoms, polypharmacy and identify goals of care. It feels so aligned with the goal we have in nursing homes of providing tailored, person-centered care.”
To address the gaps, researchers examined existing referral practices, explored recommendations for ideal criteria and integrated both to create a framework for palliative care referrals in nursing homes.
Participants included three nursing home staff members, 10 nursing home companies and four palliative providers from six states. Researchers recruited them nationally through web-based platforms and “snowball sampling,” which occurs when study participants bring other potential study subjects on board. These individuals were interviewed about their experiences with identifying and addressing palliative care needs among nursing home residents.
The study authors then analyzed their findings to identify common themes in the participants’ comments, which included five domains in residents’ palliative care needs — goals of care support, uncontrolled symptoms, the prevalence of serious illness, management of patients in decline and timely transitions to hospice care.
Given the diverse range in nursing home palliative care referral criteria, decision-making is incredibly complex, the study authors indicated, accentuating a need for improved clarity and standardized guidelines. The development of a palliative care screening tool would help mitigate some of these challenges, the research concluded.
Nursing home staff need to be aware of the significance of palliative care and be equipped with tools to identify when those services are needed, study authors wrote. Whether a nursing home develops an in-house program or partners with an outside provider, their staff need to be educated about the nature and benefits of palliative care, according to Unroe.
“The more nursing home patients I take care of in my career as a geriatrician, and the more I learned about palliative care, the more I feel that the toolkits that specialty palliative care has to offer are an asset to supporting this population,” Unroe said. “There’s an obvious match between needs and the tools and services that can be delivered through palliative care.”
